A new technique for transumbilical insertion of central venous silicone catheters in newborn infants

AIM: A new technique allowing placement of umbilical silicone venous catheters (USVC) is described and compared with percutaneous silicone venous catheters (PSVC). METHODS: Data were retrospectively recorded for 198 infants with USVC and 141 infants with PSVC. RESULTS: Overall rate of complications was low and comparable in both groups: thrombosis 1.2%, catheter-related sepsis 3.5% and mechanical obstruction 5%. CONCLUSION: A new device allows safe introduction of silicone catheters into the umbilical vein.     

Performance of percutaneous Silastic central venous feeding catheters in surgical neonates

In surgical neonates receiving total parenteral nutrition a prospective study was undertaken to assess the performance of fine-bore central venous Silastic catheters inserted percutaneously via a peripheral vein. During a 1-year period a total of 33 catheters was inserted into 28 neonates. The mean duration of catheter survival was 14.98.0 (range 4–34) days. No complications occurred with 22/33 (66%) catheters which were removed when redundant. Although there were no long-term sequelae, 11 (33%) catheters was removed because of complications, the commonest being sepsis, which occurred in 5 (15%) patients. No septic complications were detected in the 13 patients having a catheter for 10 days or less. Catheters positioned in the great veins peripheral to the superior vena cava and right atrium proved to be safe and reliable in the short term. Offprint requests to: M. D. Stringer     

Radiographic inguinal curl may indicate paraspinal misplacement of percutaneously inserted central venous catheters: report of three cases

Background: Misplacement of percutaneously inserted central venous catheters (PCVCs) into the paraspinal venous plexus can result in devastating outcomes. Several cases have been reported in the literature together with an explanation of the mechanism. Objective: To describe three premature babies with their PCVCs inserted through the left saphenous vein that ended up in the lumbar spinal dural venous plexus. Results: Plain radiographs obtained to check positions showed an unusual 360° curl of the PCVC in the left inguinal area. Conclusion: We believe that misplacement of the catheter into the paraspinal venous plexus could be diagnosed with great accuracy if such a curl is seen.     

Unusual complications of central venous catheters in two infants with congenital venous anomalies associated with congenital heart disease

We report two infants with congenital heart disease who had unusual complications of indwelling central venous catheters related to anomalies of systemic and pulmonary venous drainage. Correspondence to: B. J. Pettitt     

脐静脉联合外周中心静脉置管在极低出生体重儿中的应用

目的：研究脐静脉联合外周中心静脉置管在极低出生体重儿中的应用。方法：回顾性分析新生儿重症监护病房极低出生体重儿脐静脉联合外周中心静脉置管的应用,比较导管组（63例）与非导管组（38例）在院内感染、体重增长情况及住院天数方面的差异。结果：导管组院内感染率（17%）与非导管组感染率（24%）差异无统计学意义;导管组体重增长（11.7±2.0 g/kg?d）明显高于非导管组（10.6±2.3 g/kg?d）;导管组的住院天数（40±11 d）明显短于非导管组（45±14 d）;导管组早产儿相关并发症的发生率与非导管组的差异没有统计学意义。结论：脐静脉联合外周中心静脉置管在极低出生体重儿的应用中,早产儿体重的增长显著优于非导管组,住院天数明显缩短,而且院内感染有下降的趋势。     

Calcified catheter “cast”: a rare complication of indwelling central venous catheters in infants

Peri-catheter calcification is an unusual and previously unreported complication of central venous (CV) catheterization in infants. A 1.9 Fr Silastic CV catheter was placed in a term infant for administration of total parenteral nutrition and antibiotics following intra-abdominal sepsis. The catheter was removed, without complication, at a later date after another septic episode. Imaging studies performed in the investigation of a possible intra-abdominal abscess revealed a cylindrical density within a clot in the inferior vena cava (IVC). The density was presumed to be a retained catheter fragment. Further investigation indicated total occlusion of the IVC. Surgical exploration of the IVC revealed only a calcified thrombus. This case represents a rare and previously unreported complication of CV catheterization in infants. Diagnosing this condition on radiographic evidence alone can be difficult. It is hoped that awareness of the potential for this complication will avoid unnecessary invasive procedures in the future. We also suggest a high level of clinical suspicion and routine Doppler ultrasound investigations to detect IVC thrombosis when indwelling CV catheters are used in infants. Accepted: 15 July 1997     

Trimming long‐term tunneled central venous catheters in pediatric patients

Long‐term tunneled central venous catheters (CVC) are employed in critically ill patients. Manufacturers do not provide patient‐customized devices; therefore, trimming is required for pediatric use. Scanning Electron Microscopy (SEM) coupled with energy‐dispersive X‐ray spectroscopy and attenuated total reflection‐Fourier transform infrared spectroscopy (ATR‐FTIR) was used to assess changes induced by different trimming methods on single and double lumen Hickman–Broviac catheters. Increased roughness, exposure of inorganic macroaggreagates and increase in surface inorganic charges were generated by the trimming procedure, with the scalpel producing a smoother surface compared to scissors. Trimming produces changes on the CVC surface that may influence the rate of long‐term complications. Pediatr Blood Cancer 2013; 60: 152–155. © 2012 Wiley Periodicals, Inc.     

Central venous catheters in pediatric patients – subclavian venous approach as the first choice

BACKGROUND: It is critical to establish a safe and functional i.v. access in severely sick patients. We evaluated the frequency of application and complications of central venous catheters in a pediatric intensive care unit. METHODS: Pediatric patients in whom central venous catheters were inserted between March 1997 and May 1999 in the Pediatric Emergency Room and Intensive Care Unit were enrolled in this study. Patients were evaluated with respect to age, sex, weight, central venous catheter indication, site, duration of catheter stay and complications. RESULTS: During the study period a total of 156 central venous catheters were successfully inserted into 146 patients. Of the 156 central venous catheter attempts, 148 (94.9%) were placed into the subclavian vein, six were inserted into the femoral vein, and two into the jugular vein. In 156 attempts, arterial injuries occurred in 20 cases (12.8%). Pneumothorax developed in two patients on mechanical ventilation. Three catheters had to be removed due to catheter related infections. The mortality rate was 0%. CONCLUSIONS: We concluded that subclavian central venous catheterization is a safe procedure with minimal complications in pediatric patients. Arterial injury was the most frequent complication. In experienced hands, the success rate was 100%. Subclavian central venous catheter insertion may be considered as the first approach in critically ill patients.     

Cardiac tamponade from a fine silastic central venous catheter in a premature infant

A 790 g infant developed cardiac tamponade 17 h after starting parenteral nutrition through a fine silastic catheter, the tip of which was accidentally positioned against the wall of the right atrium. Cold light examination suggested the diagnosis and pericardial aspiration of clear fluid with a high glucose content restored the circulation.     

经外周置入中心静脉导管在高危新生儿应用的临床评估

目的：观察新生儿应用经外周置入中心静脉导管（peripherally inserted central catheters, PICC）的优缺点,为需要长期使用静脉治疗的患儿寻找稳定有效的手段。方法：采用回顾性队列研究方法,以2006年4月至2008年2月间在该科住院,使用PICC的65例新生儿和使用外周静脉留置针(peripheral intravenous catheters, PIV)的80例新生儿为研究对象,分别对两组患儿导管留置时间、导管机械性并发症、败血症以及死亡情况进行比较。结果：PICC的置留时间为18.75±7.62 d（7~62 d）;PIV为1.49±0.57 d（0.5 h至4 d）,PICC明显长于PIV（P<0.01）;PICC组机械性并发症发生率为27.7%,PIV组为63.8%,PICC组明显低于PIV组（P<0.01）;PICC与 PIV组的败血症发生率以及死亡率比较差异无显著性意义。结论：PICC对新生儿是一项安全有效的治疗措施,能够明显减少静脉穿刺次数。［中国当代儿科杂志,2009,11（2）：100-103］     

Removal of percutaneously inserted central venous catheters in neonates is associated with the occurrence of sepsis

BACKGROUND: Clinical signs of sepsis are frequently observed after removal of a percutaneously inserted central venous catheter (PCVC) in neonates admitted at our Neonatal Intensive Care Unit (NICU). To substantiate this finding and to evaluate the effect of antibiotics administered at the time of removal of a PCVC, we conducted a retrospective study among all infants with a PCVC, admitted at our NICU during 2002 and 2005. METHODS: Clinical data, infectious complications and use of antibiotics were studied retrospectively. RESULTS: A PCVC was inserted in 345 infants. Sepsis occurred in 90/345 (26%) infants, in 50/90 (56%) during indwelling PCVC and in 40/90 (44%) after removal of the PCVC. Of the latter 40 sepsis episodes, 24 (60%) occurred within 5 days after removal of a PCVC with a clustering of 21 cases of sepsis within 72 h after the removal. The remaining 16 episodes occurred after 7 days. Administration of antibiotics during removal of the PCVC significantly reduced the incidence of sepsis: 22/213 (10.3%) cases of sepsis occurred when no antibiotics were administered versus 2/132 (1.5%) cases of sepsis when antibiotics were administered (p = 0.002). CONCLUSION: Our study suggests that peripherally inserted central venous catheters are associated with sepsis not only during the indwelling period of the catheter, but also after removal. Administration of antibiotics targeted at the time of removal of the catheter significantly reduced the incidence of sepsis. Future prospective studies are warranted to confirm this observation.     

A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters

This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.     

Postoperative sepsis in infants below 6 months of age

Background  Sepsis is a threatening postoperative complication especially in small infants. Regarding the advances in perinatal medicine, its incidence is unknown to date. We aimed to investigate the incidence, risk factors, laboratory findings and outcome of postoperative sepsis in infants younger than 6 months old. Methods  We examined postoperative sepsis in babies below 6 months of age during a 4-year period at a tertiary pediatric institution. Results  The rate of postoperative sepsis was 6.9%. Laparotomy with enterotomy, thoracotomy and diaphragmatic hernia repair (P<0.05, respectively) as well as low postnatal age and long operation time (P<0.001, respectively) were correlated with the incidence of sepsis. Significant independent predictors for the development of sepsis were the presence of a central venous catheter and perioperative antibiotic treatment (P<0.001, respectively). Coagulase negative Staphylococci were the major infecting organism associated with postoperative sepsis, accounting for 53% of monomicrobial infections. Complete blood counts with differential were not different between infants with sepsis and controls, who had undergone the same surgical procedures. Outcome was favorable in all cases; however, the length of hospital stay was significantly longer in sepsis patients (P<0.05). Conclusions  Postoperative sepsis syndrome is a frequent complication in infants below 6 months of age and causes significant prolongation of hospital stay. Adequate prevention and therapeutic strategies warrant further prospective investigations.     

Central venous catheters and catheter locks in children with cancer: A prospective randomized trial of taurolidine versus heparin

Background

To determine if the catheter lock taurolidine can reduce the number of catheter‐related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).

Procedure

During a study period of 34 months, 129 newly placed tunneled CVCs in 112 patients were randomly assigned to standard lock with heparin solution or experimental lock with a taurolidine solution ( ClinicalTrials.gov Identifier NCT00735813).

Results

Sixty‐five CVCs were included in the standard group and 64 CVCs in the experimental group. The groups were comparable regarding patients' characteristics. A total number of 72 bloodstream infections of which 33 were CRBSIs were observed during 39,127 CVC‐days. A lower rate of CRBSI (0.4 per 1,000 CVC‐days) was observed in the experimental arm compared with the standard arm (1.4 per 1,000 CVC‐days, incidence rate ratio (IRR) = 0.26; 95% confidence interval (CI) 0.09–0.61; P = 0.001). A lower rate of total bloodstream infections (1.2 per 1,000 CVC‐days) was also observed in the experimental arm compared with the standard arm (2.5 per 1,000 CVC‐days, IRR = 0.49; 95% CI 0.29–0.82; P = 0.004). Median interval from catheter insertion until first CRBSI was significantly lower in the standard group (156 days, range 12–602) compared with the experimental group (300 days, range 12–1,176; P = 0.02). Premature removal of the CVC due to infection and overall CVC survival were similar in the two study groups.

Conclusion

Locking of long‐term tunneled CVC with taurolidine significantly reduces catheter‐related bloodstream infections in children with cancer. Pediatr Blood Cancer 2013;60:1292–1298. © 2013 Wiley Periodicals, Inc.     

Difficulty in removing a percutaneous central venous catheter inserted from a peripheral vein

Two girls with acute lymphocytic leukemia (ALL) are reported. There were difficulties in removing their central venous catheters inserted from a peripheral vein. One girl required surgery under general anesthesia for the removal. The other patient received continuous infusion of low dose urokinase from a distal peripheral vein. The residual catheter was then removed successfully.     

中美两家医院早产儿营养策略的对照研究

目的 对比中美两家医院的早产儿营养支持数据,以期找到差距及改善方法。方法 对2011年1 月至2012 年5 月北京协和医院儿科NICU（PUMCH 组）及2011 年1 月至2012 年1 月美国辛辛那提儿童医学中心辛辛那提大学医院NICU（CCHMC 组）收治的胎龄结果 PUMCH 组74 例、CCHMC 组82 例纳入研究。PUMCH 组胎龄和出生体重均显著大于CCHMC 组（PPPPPPP=0.018）。PUMCH 组败血症发生率显著高于CCHMC 组（32% vs 12%,P结论 PUMCH 组较CCHMC 组肠外营养时间延长、院内感染发生增加。需要推进强化母乳喂养、采取更积极的喂养方案以加快喂养进程。     

Effectiveness of fixed 50% nitrous oxide oxygen mixture and EMLA cream for insertion of central venous catheters in children

BACKGROUND: Although the equimolecular mixture of oxygen and nitrous oxide (EMONO) seems a good choice to relieve procedure-related pain in children, it has not been evaluated for insertion of central venous catheters in children. To assess the safety and the effectiveness of this gas mixture for insertion of central venous catheters, we conducted a prospective observational study. PROCEDURE: This study was performed by the "Centre National de Greffe de Moelle Osseuse." Procedure and inhalation characteristics, as well as pain evaluations and side effects, were reported. RESULTS: Fifty central venous catheters were inserted in 50 consecutive children. Median age was 7 (range, 4-13) years. An anesthesiologist was responsible for delivering EMONO, and provided constant surveillance throughout the procedure. EMLA cream was applied 2 hr before EMONO inhalation. No associated drugs were used. All catheters were inserted by the same experienced physician in the operating theater. Median inhalation length was 5 min (range, 3-6) before starting catheter's insertion and 12 min (range, 9-25) for the total inhalation. Median procedural pain evaluations were 10 (range, 0-30) for children on a 0-100 visual analog scale (VAS). Minor side effects were observed during eight (16%) inhalations. These side effects were euphoria (14%), deep sedation (4%), nausea and vomiting (2%), hallucinations (2%). All side effects were transient and resolved within 5 min after removing the inhalation device. CONCLUSIONS: This study which shows that EMONO is effective for insertion of central venous catheters in children and represents a simple and safe alternative to general anesthesia.     

Complications of percutaneously inserted central venous catheters in Japanese neonates

Background: To determine institutional policies concerning percutaneously inserted central venous catheter (PICC) utilization and also frequencies of complications such as pericardial effusion (PCE), cardiac tamponade (CT), pleural effusion, ascites, venous thrombosis, and catheter removal difficulties. Methods: Nationwide postal questionnaire survey was carried out that included institutional policies on PICC and numbers of complications recorded from January 1999 to December 2003. Results: A total of 98 replies were received from 193 neonatal intensive care units (NICU) in Japan. As a catheter tip location, positions outside of the heart were highly preferred, while only 9% accepted a right atrial position. Twenty‐eight cases of PCE or CT were reported, representing an estimated frequency of 0.07–0.11% of PICC insertions. Pleural effusion/ascites and removal difficulties (36 and 35 cases, respectively) were encountered in approximately 0.09–0.14% of insertions. Conclusions: Frequency of PCE/CT appeared comparable to previously reported occurrences. Also, pleural effusion/ascites and removal difficulty appeared to be rare complications.