scholarly journals Stewardship Intervention to Optimize Central Venous Catheter Utilization in Critically Ill Children

2021 ◽  
Vol 6 (2) ◽  
pp. e389
Author(s):  
Jennifer A. Blumenthal ◽  
Jennifer A. Ormsby ◽  
Dimple Mirchandani ◽  
Chonel A. Petti ◽  
Jane Carpenter ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous

Central Venous Catheter-Associated Deep Venous Thrombosis in Critically Ill Children

2017 ◽  
Vol 44 (01) ◽  
pp. 052-056 ◽  
Author(s):  
Edward Faustino
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Postthrombotic Syndrome ◽  
Central Venous ◽  
Pharmacologic Prophylaxis ◽  
Catheter Related Thrombosis

AbstractThe presence of a central venous catheter and admission to the intensive care unit are the most important risk factors for deep venous thrombosis (DVT) in children. At least 18% of critically ill children with a catheter develop radiologically confirmed catheter-associated thrombosis. Clinically apparent thrombosis occurs in 3% of critically ill children with a catheter and is associated with 8 additional days of mechanical ventilation. Even when the thrombus is initially asymptomatic, 8 to 18% of critically ill children with catheter-associated thrombosis develop postthrombotic syndrome. Thrombosis is uncommon within 24 hours after insertion of a nontunneled catheter in critically ill children, but nearly all thrombi have developed by 4 days after insertion. Hypercoagulability during or immediately after insertion of the catheter plays an essential role in the development of thrombosis. Pharmacologic prophylaxis, including local anticoagulation with heparin-bonded catheter, has not been shown to reduce the risk of catheter-related thrombosis in children. Systemic anticoagulation in critically ill children started soon after the insertion of the catheter, however, may be beneficial. A multicenter clinical trial that is testing this hypothesis is currently underway.

scholarly journals The natural history of asymptomatic central venous catheter–related thrombosis in critically ill children

Blood ◽  
2019 ◽  
Vol 133 (8) ◽  
pp. 857-866 ◽  
Author(s):  
Sophie Jones ◽  
Warwick Butt ◽  
Paul Monagle ◽  
Timothy Cain ◽  
Fiona Newall
Keyword(s):  
Natural History ◽  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Postthrombotic Syndrome ◽  
Central Venous ◽  
History Of ◽  
Clinically Significant

Abstract Asymptomatic central venous catheter (CVC)–related thrombosis in children varies in incidence from 5% to 69%. The rate of acute and long-term complications, such as postthrombotic syndrome (PTS), from asymptomatic CVC-related thrombosis is unknown. This article reports the outcomes of a prospective study of 189 children in pediatric intensive care that aimed to determine the frequency of asymptomatic CVC-related thrombosis during hospital admission, and the incidence of residual CVC-related thrombosis and clinically significant PTS 2 years later. Risk factors associated with CVC-related thrombosis were also identified. This study is distinct from previous work as children identified to have asymptomatic CVC-related thrombosis were not treated (clinical team kept blinded) and the entire cohort was followed for 2 years to determine the natural history of asymptomatic thrombosis. Ultrasounds of 146 children determined a 21.9% incidence of acute CVC-related thrombosis. Two children were symptomatic. No radiological thrombosis extension or clinical embolization occurred in the 126 children assessed at follow-up. Using 2 recognized PTS scales, clinically significant PTS was reported in 2 children (1 symptomatic, 1 asymptomatic CVC-related thrombosis), however, neither had functional impairment. Cardiac arrest was a risk factor for CVC-related thrombosis during admission and femoral CVC placement was predictive of residual thrombosis 2 years later. This study challenges the notion that critically ill children with asymptomatic CVC-related thrombosis require anticoagulant treatment, as the results demonstrate that the incidence of acute or long-term complications is low. A larger confirmatory study of nontreatment of CVC-related thrombosis in critically ill children is justified.

scholarly journals Factors Associated With Continuous Low-Dose Heparin Infusion for Central Venous Catheter Patency in Critically Ill Children Worldwide

2016 ◽  
Vol 17 (8) ◽  
pp. e352-e361
Author(s):  
Sara-Jane N. Onyeama ◽  
Sheila J. Hanson ◽  
Mahua Dasgupta ◽  
Raymond G. Hoffmann ◽  
Edward Vincent S. Faustino
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Low Dose ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous ◽  
Heparin Infusion ◽  
Factors Associated ◽  
Dose Heparin ◽  
Low Dose Heparin

1002: PREVALENCE OF CENTRAL VENOUS CATHETER MALPOSITIONING IN CRITICALLY ILL CHILDREN

2020 ◽  
Vol 48 (1) ◽  
pp. 480-480
Author(s):  
Mark Weber ◽  
Thomas Conlon ◽  
Charlotte Woods-Hill ◽  
Rachael Crowe ◽  
Stephanie Watts ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous

scholarly journals Feasibility of Tissue Plasminogen Activator Dwell Therapy to Reduce Central Venous Catheter Associated Thrombosis: A Randomized Controlled Pilot Trial

2021 ◽  
Author(s):  
Sheila J Hanson ◽  
Sadaf Shad ◽  
E. Vincent S. Faustino
Keyword(s):  
Central Venous Catheter ◽  
Plasminogen Activator ◽  
Tissue Plasminogen Activator ◽  
Critically Ill ◽  
Study Drug ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous ◽  
Randomized Controlled ◽  
Tissue Plasminogen

Abstract Backround: To evaluate the feasibility of a randomized controlled trial (RCT) of the fibrinolytic tissue plasminogen activator (t-PA) vs unfractionated heparin (UFH) central venous catheter (CVC) dwell therapy to reduce risk of CVC-associated deep venous thrombosis (CADVT) in critically ill children. Methods: This single center quadruple blinded pilot RCT enrolled children ≤18 years of age with CVC placed within 72 hours of admission to the pediatric intensive care unit (ICU)Weight-adjusted dose of study drug dwell (t-PA vs UFH) was installed to alternating lumen of CVC every 3 days for 10 doses, CVC removal or ICU discharge. Ultrasound with doppler was performed at study completion.Main Results: Of 426 children screened from April-Dec 2019, 86 (20%) were eligible with 20 enrolled and randomized. Primary outcome measure of enrollment rate was 23%. One child was withdrawn immediately after randomization due to development of exclusion criterion. Secondary feasibility outcome measures were proportion of children who received study drug within 24 hours of consent (100%), proportion with ultrasound (100%), and proportion completing the study (95%). Eighteen of 19 children received the first dose within 48 hours of CVC placement. All children missed some dose days because of lumen specified to be in continuous use. Median dwell time for doses received was >2 hours. There were no protocol violations. Six of 19 patients (31.6%) developed CADVT, 1 of which was occlusive. There were no catheter-associated blood stream infection or significant bleeding.Conclusion: Critically ill children requiring CVC are at high risk for CADVT. A future multicenter, blinded, RCT to determine the effectiveness of t-PA vs UFH dwell in reducing CADVT is feasible.Registered August 10, 2018 on ClinicalTrials.gov NCT03672006

scholarly journals Incidence and Acute Complications of Asymptomatic Central Venous Catheter–Related Deep Venous Thrombosis in Critically Ill Children

2013 ◽  
Vol 162 (2) ◽  
pp. 387-391 ◽  
Author(s):  
Edward Vincent S. Faustino ◽  
Philip C. Spinella ◽  
Simon Li ◽  
Matthew G. Pinto ◽  
Petronella Stoltz ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Venous Thrombosis ◽  
Deep Venous Thrombosis ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous ◽  
Acute Complications

Ultrasound-guided or landmark techniques for central venous catheter placement in critically ill children

2017 ◽  
Vol 44 (1) ◽  
pp. 61-72 ◽  
Author(s):  
Ignacio Oulego-Erroz ◽  
◽  
Rafael González-Cortes ◽  
Patricia García-Soler ◽  
Mónica Balaguer-Gargallo ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Catheter Placement ◽  
Critically Ill Children ◽  
Ultrasound Guided ◽  
Central Venous ◽  
Central Venous Catheter Placement

Chronic Complications After Femoral Central Venous Catheter-related Thrombosis in Critically Ill Children

2015 ◽  
Vol 37 (6) ◽  
pp. 462-467 ◽  
Author(s):  
Jeanine J. Sol ◽  
Hennie Knoester ◽  
Marjorie de Neef ◽  
Anne M. J. B. Smets ◽  
Aukje Betlem ◽  
...  
Keyword(s):  
Central Venous Catheter ◽  
Critically Ill ◽  
Venous Catheter ◽  
Critically Ill Children ◽  
Central Venous ◽  
Chronic Complications ◽  
Catheter Related Thrombosis

scholarly journals Effect of Central Venous Catheter Care Bundle Implementation on Outcomes of Critically Ill Patients

2020 ◽  
Vol 2 (1) ◽  
pp. 12
Author(s):  
Gehan A. F. Atia
Keyword(s):  
Central Venous Catheter ◽  
Bloodstream Infection ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Venous Catheter ◽  
Care Bundle ◽  
Central Venous ◽  
Significant Difference ◽  
Post Test ◽  
Catheter Care

Context: Central venous access device (CVAD) bundles for insertion and maintenance demonstrate a reduction in the frequency of complications and bloodstream infection when implemented with compliance monitoring, with the reported success of CVAD bundles. Aim: This study aimed to examine the effect of central venous catheter care bundle implementation on outcomes of critically ill patients. Methods: Quasi-experimental research (pre/post-test design) used to achieve the aim of this study. The study conducted at general and surgical intensive care units affiliated to Menoufia University and teaching hospital. Two study samples recruited in this study. All nurses working at the ICUs, as mentioned above, were recruited in this study. They were 6o critical care nurses. A convenient sample of all available critically ill patients at the time of the study was subjected to treatment via a central venous catheter. Four study tools used to collect the data of this study. These are a structured interview questionnaire, CVC nurses’ knowledge assessment questionnaire, nurses’ compliance assessment checklists, and patient complications assessment records. Results: The study result showed a highly statistically significant difference between pre and post-test knowledge scores of studied nurses regarding assisting line insertion, removal, maintenance, care, and infection control practices. Besides, a highly statistically significant difference between pre and post-test scores of nurses’ compliance to central venous catheter care practices of assisting in CVC insertion, blood sample withdrawal, medication and fluid administration, CVP measurements, CVC removal, and the management of central venous line complications. The study also revealed a highly statistically significant difference between the study and control group patients regarding the central venous catheter complications. However, signs of infection were the most frequent complications in both groups. Conclusion. The study concluded that a statistically significant difference between pre and post nurses’ knowledge and compliance with the CVC care bundle. The patients’ outcomes were also improved significantly after the implementation of the CVC care bundle compared to the controls. The study recommended the adoption of the current care bundle that should be disseminated and updated following the international organizations’ recommendation for implementing evidence-based practices for successful central line-associated bloodstream infection (CLABSI) prevention.

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