Safety of Peripheral Intravenous Catheters in Children

1999 ◽  
Vol 20 (11) ◽  
pp. 736-740 ◽  
Author(s):  
Ruth B. Shimandle ◽  
Daniel Johnson ◽  
Mark Baker ◽  
Naomi Stotland ◽  
Theodore Karrison ◽  
...  
Keyword(s):  
Pediatric Patients ◽  
Insertion Site ◽  
Intravenous Therapy ◽  
Catheter Colonization ◽  
Colony Forming Units ◽  
Catheter Sepsis ◽  
Catheter Complications ◽  
Current Guidelines ◽  
Intravenous Catheters ◽  
Catheter Replacement

AbstractObjectives:To determine the overall and per-day risk of complications of short peripheral intravenous (PIV) catheters placed for indefinite periods.Design:During 5 months, general pediatric patients receiving intravenous therapy through short PIV catheters were monitored. Patient and catheter characteristics were recorded, complications were noted, and rolled semiquantitative cultures of removed catheters were performed. Major endpoints were infection and phlebitis. Per-day risk of complications and catheter colonization (>15 colony-forming units) were calculated.Setting:University children's hospital.Patients:General pediatric ward inpatients with PIV.Results:We studied 642 Teflon catheters in place >24 hours (mean, 3.7 days) in 525 patients. There were no cases of catheter sepsis (0%; 95% confidence interval [CI95], 0%-0.6%), one possible insertion-site infection (0.2%; CI95, 0.004%-0.9%), and seven cases of phlebitis (1.1%; CI95, 0.4%-2.3%). Catheter colonization occurred in 92 (26%) of 348 catheters cultured. Neither the per-day risk of phlebitis nor of catheter colonization increased significantly with placement >3 days.Conclusion:Current guidelines recommend replacement of PIV catheters in adults within 2 to 3 days; no recommendations are made for children. Our findings and those of others indicate that the overall risk of PIV catheter complications in children is extremely low and would not be reduced substantially by routine catheter replacement.

Intravascular Catheter Colonization and Related Bloodstream Infection in Critically III Neonates

1990 ◽  
Vol 11 (6) ◽  
pp. 301-308 ◽  
Author(s):  
Wendy A. Cronin ◽  
Teresa P. Germanson ◽  
Leigh G. Donowitz
Keyword(s):  
Bloodstream Infection ◽  
Insertion Site ◽  
Bloodstream Infections ◽  
Coagulase Negative Staphylococcus ◽  
Intravascular Catheter ◽  
Catheter Colonization ◽  
Catheter Tip ◽  
Critically Ill Neonates ◽  
Peripheral Arterial ◽  
Intravenous Catheters

AbstractIntravascular catheter tip colonization was prospectively evaluated in critically ill neonates to determine its relationship to the type of device used, duration of catheterization, insertion site and nosocomial bloodstream infection. Sixty-one percent (376 of 621) of all intravascular catheter tips were retrieved from 91 infants. Thirteen percent (41 of 310) of peripheral intravenous, 14% (6 of 42) of umbilical, 21% (3 of 11) of central venous, 36% (4 of 11) of peripheral arterial and 100% (2 of 2) of femoral catheters were colonized. Duration of catheterization was significantly longer for colonized lines (p < .001). Eight of 26 (30.8%) peripheral intravenous catheters remaining in place for more than three days were colonized, compared with 33 of 284 (11.6%) at three days or less (p= 0.012). Coagulase-negative staphylococcus was the organism most frequently isolated from catheter tips and bloodstream infections. Catheter colonization rates in this population were higher than those found in adults. Heavily manipulated devices and those in place for longer periods of time were the most frequently colonized.

Use of 8-cm 22G-long peripheral cannulas in pediatric patients

2018 ◽  
Vol 19 (5) ◽  
pp. 496-500 ◽  
Author(s):  
Maurizio Pacilli ◽  
Catherine J Bradshaw ◽  
Simon A Clarke
Keyword(s):  
Pediatric Patients ◽  
Insertion Site ◽  
Perforated Appendicitis ◽  
Seldinger Technique ◽  
General Anaesthetic ◽  
Intravenous Therapy ◽  
Medium Term ◽  
Intravenous Access ◽  
Ethical Approval ◽  
Central Catheters

Introduction: Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery. Methods: Following ethical approval, we prospectively collected data in children requiring medium-term intravenous access. The 22G-8-cm-long peripheral cannulas were inserted with a Seldinger technique in a peripheral vein. Position was checked by flushing and aspirating the catheter. Results are reported as mean ± standard deviation. Results: A total of 18 children were included. Indications for medium-term intravenous therapy included perforated appendicitis (n = 14), infected central venous port (n = 2), fungal infection (n = 1) and septic arthritis (n = 1). In all, 15 (83%) patients underwent the procedure under general anaesthetic. The procedure failed in an 8-year-old patient. Insertion time was 8 ± 3.7 min. Age at insertion was 6.3 ± 4.9 years. Duration of intravenous therapy was 6.4 ± 5.1 days. About 13 (76%) patients completed the treatment with no complications. Three (17%) lines occluded by day 3 needed removal; one (7%) line needed removal on day 3 because of redness/pain noted around the insertion site. Conclusion: Long peripheral cannulas represent a valid option for medium-term intravenous access in children undergoing surgery. Majority of patients will be successfully treated with one long peripheral cannula for the duration of their treatment without the need for further cannulation.

scholarly journals Phlebitis associated with peripheral intravenous catheters in adults admitted to hospital in the Western Brazilian Amazon

2016 ◽  
Vol 50 (2) ◽  
pp. 263-271 ◽  
Author(s):  
Sandra Maria Sampaio Enes ◽  
Simone Perufo Opitz ◽  
André Ricardo Maia da Costa de Faro ◽  
Mavilde de Luz Gonçalves Pedreira
Keyword(s):  
Intermittent Infusion ◽  
Brazilian Amazon ◽  
Fisher Exact Test ◽  
Intravenous Therapy ◽  
Chi Square ◽  
Significance Level ◽  
Exact Test ◽  
Dorsal Hand Vein ◽  
Mean Time ◽  
Intravenous Catheters

Abstract OBJECTIVE To identify the presence of phlebitis and the factors that influence the development of this complication in adult patients admitted to hospital in the western Brazilian Amazon. METHOD Exploratory study with a sample of 122 peripheral intravenous catheters inserted in 122 patients in a medical unit. Variables related to the patient and intravenous therapy were analyzed. For the analysis, we used chi-square tests of Pearson and Fisher exact test, with 5% significance level. RESULTS Complication was the main reason for catheter removal (67.2%), phlebitis was the most frequent complication (31.1%). The mean duration of intravenous therapy use was 8.81 days in continuous and intermittent infusion (61.5%), in 20G catheter (39.3%), inserted in the dorsal hand vein arc (36.9 %), with mean time of usage of 68.4 hours. The type of infusion (p=0.044) and the presence of chronic disease (p=0.005) and infection (p=0.007) affected the development of phlebitis. CONCLUSION There was a high frequency of phlebitis in the sample, being influenced by concomitant use of continuous and intermittent infusion of drugs and solutions, and more frequent in patients with chronic diseases and infection.

scholarly journals ASSESSMENT OF DRUG UTILIZATION AMONG PEDIATRIC PATIENTS IN PRIVATE CLINIC AND PUBLIC HOSPITAL OF BANGLADESH

2020 ◽  
pp. 54-58
Author(s):  
AHSAN UDDIN ◽  
TRIPTI RANI PAUL ◽  
MONALISA MONWAR ◽  
SHAHIN SARKER ◽  
CHAND SULTANA ◽  
...  
Keyword(s):  
Drug Utilization ◽  
Private Practice ◽  
Public Hospital ◽  
Pediatric Patients ◽  
Medical Practitioners ◽  
Number Of Patients ◽  
Sensitivity Tests ◽  
Questionnaire Form ◽  
Current Guidelines ◽  
Group 1

Objective: Aim of the study was to assess drug utilization among pediatric patients in both private practice and hospital settings in Rajshahi city, Bangladesh. Methods: This observational study was conducted during a period of two months (March to April) in 2017. Prescriptions were randomly collected from patients and recorded in a predesigned questionnaire form. The data analysis was carried out by using a statistical software package GraphPad Prism. Results: The study involved a total of 185 patients, of which 62.70% were male and 37.30% were female. The patient’s age ranges from 1 mo-12 y and highest number of patients visited physicians belong to group 1 mo-1 y (47.57%). Most commonly occurring disease conditions were pneumonia (24%), the leading cause of hospitalizations among the children's age group of 1 mo-1 y. The results indicated that physician’s handwriting was not clear and legible in 50 (27.03%) prescriptions. A total of 468 drugs were prescribed with an average of 2.53 per prescription. However, none of the drugs were prescribed by generic name. The most commonly prescribed drugs were antibiotics 173 (93.5%). About 78% patients were exposed to antibiotics, of which single antibiotic was prescribed in 116 (62.70%) and two antibiotics in 23 (12.43%) prescriptions. Among the drugs, NSAIDS 65 (35.14%), anti-histamine 57 (30.81%), anti-asthmatic 49 (26.49%) drugs were assigned in prescriptions followed by vitamin and minerals 51 (27.57%). Steroids 57 (30.81%) and hypnotics 26 (14.05%) were also accounted in many prescriptions. Interestingly, antibiotics were indiscriminately prescribed in private practices without any bacteriological examinations, whereas in hospital settings, most of the treatment was initiated after culture and sensitivity tests. Conclusion: Children were highly exposed to antibiotics, steroids and hypnotics in both private practice and hospital settings.  So Medical practitioners should be aware of current guidelines for prescriptions of antibiotics and drugs in child.

scholarly journals Staphylococcus aureus prophylaxis in hemodialysis patients using central venous catheter: effect of mupirocin ointment.

1998 ◽  
Vol 9 (6) ◽  
pp. 1085-1092
Author(s):  
R Sesso ◽  
D Barbosa ◽  
I L Leme ◽  
H Sader ◽  
M E Canziani ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Insertion Site ◽  
Venous Catheter ◽  
Hemodialysis Patients ◽  
Control Group ◽  
Catheter Colonization ◽  
Central Venous ◽  
Exit Site Infection ◽  
Staphylococcus Aureus Bacteremia ◽  
Mupirocin Ointment

Central venous catheterization is a common technique to establish rapid and temporary access for hemodialysis. However, it is a known risk factor for Staphylococcus aureus infection and bacteremia. Mupirocin is a topical antibiotic with high in vitro anti-staphylococcal activity. A randomized prospective trial was conducted to assess the effectiveness of mupirocin ointment in the prevention of Staphylococcus aureus skin and catheter colonization, and episodes of bacteremia in 136 end-stage renal disease patients. Of these, 67 received skin disinfection at the venous catheter insertion site with povidone iodine (control group), and 69 received the same treatment followed by application of 2% mupirocin ointment at the cannula site after catheter placement and at the end of each dialysis session. Patients were followed until catheter removal and were monitored for the development of Staphylococcus aureus skin/catheter colonization and episodes of bacteremia. Median duration of catheter use was greater in the mupirocin than in the control group (37 versus 20 d, P < 0.01). Patients in the mupirocin group had a significantly lower rate of Staphylococcus aureus isolation from the pericatheter skin (1.76 per 1000 versus 14.27 per 1000 patient-days, P < 0.001) and from the catheter surface (3.17 per 1000 versus 14.27 per 1000 patient-days, P < 0.001). The proportion of patients with Staphylococcus aureus skin infection at the insertion site was lower in the mupirocin group (4.3% versus 23.9%, P = 0.001). Staphylococcus aureus-associated bacteremia was observed in 17 patients (two in the mupirocin group [0.71 episodes per 1000 patient-days] and 15 in the control group [8.92 per 1000 patient-days], P < 0.001). The hazard ratio of developing Staphylococcus aureus bacteremia was 7.2 (95% confidence interval, 1.6 to 31.6) times greater in patients not receiving mupirocin. Mupirocin applied to the insertion site significantly reduces the risk of Staphylococcus aureus skin and catheter colonization, exit-site infection, and Staphylococcus aureus bacteremia in hemodialysis patients.

scholarly journals 477. Characterization of Extended-Spectrum Β-Lactamase (ESBL) Producing Gram-negative (GN) Urinary Tract Infections (UTI) in Pediatric Patients

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S233-S233
Author(s):  
Leslie Stach ◽  
Regina Orbach ◽  
Kanokporn Mongkolrattanothai
Keyword(s):  
Urinary Tract ◽  
Pediatric Patients ◽  
Selective Pressure ◽  
Once Daily ◽  
E Coli ◽  
Colony Forming Units ◽  
Amoxicillin Clavulanate ◽  
Tract Infections ◽  
Abnormal Urinary Tract

Abstract Background There has been an increase in antimicrobial resistance among GN pathogens, not only in adults, but also pediatrics. UTIs are common in pediatrics; however, reports of pediatric UTI with ESBL producing GN are limited. Methods All urine cultures positive for ESBL producing GN from 5/1/18 to December 31/18 were retrospectively reviewed. Proven infection (PI) defined as ≥50,000 colony-forming units (CFU)/mL of bacteria plus pyuria or positive leukocyte esterase for catheterized or clean catch specimens. Relapsed infection defined as same pathogen cultured within 30 days of infection. Abnormal urinary tract systems or functions (AUTS) include neurogenic bladder, structural anomalies, or intermittent catheterization. Results A total of 107 urine cultures for ESBL producing GN, from 85 patients, were included. Majority of specimens [78/107 (73%)] were obtained from the ED or outpatient clinics. 43% of specimens were from patients with AUTS. E. coli was the majority (95%) of ESBL isolates. 57% of ESBL producing GNs were susceptible to amoxicillin/clavulanate (AC) or trimethoprim/sulfamethoxazole (TMP/SMX). 88% were nitrofurantoin susceptible. Only 1 isolate was meropenem resistant. Antibiotics (ABX) were prescribed for UTI in 67/107 episodes. However, only 52 episodes were PI. Of these, 38 were empirically treated with oral ABX and 29 with intravenous ABX. The most commonly prescribed empiric ABX was oral cephalexin (25/67, 37%.) Ineffective empiric ABX for UTI was very common, 83% (43/52). Of these, 5/43 never received effective therapy and none had relapse. Most common duration of ABX was 10 days (range 5–17 days.) 43% (23/52) of PI were treated with oral AC or TMP/SMX. 15% (8/52) of PI were treated with nitrofurantoin. 12% of PI were treated with a once-daily aminoglycoside. Only 6% of PI were treated with a carbapenem. Conclusion Many ESBL UTI isolates remain susceptible to oral ABX. Although small numbers, patients treated with ineffective ABX did not return with relapsed infection. Non-carbapenem ABX are a reasonable option to minimize selective pressure or unnecessary use. Empiric narrow-spectrum antibiotic therapy may still be appropriate. Disclosures All authors: No reported disclosures.

scholarly journals Apnea Threshold in Pediatric Brain Death: A Case with Variable Results Across Serial Examinations

2018 ◽  
Vol 08 (02) ◽  
pp. 108-112
Author(s):  
Tina Sosa ◽  
Zachary Berrens ◽  
Susan Conway ◽  
Erika Stalets
Keyword(s):  
Brain Death ◽  
Pediatric Patients ◽  
The Family ◽  
Apnea Threshold ◽  
Unexpected Findings ◽  
Pediatric Brain ◽  
Current Guidelines ◽  
Apnea Testing ◽  
Observation Period

AbstractConsensus guidelines currently exist for the evaluation of pediatric patients with suspected brain death. The guidelines include the requirement for two consistent examinations separated by an observation period and a threshold of 60 mm Hg for PaCO2 during apnea testing. We present a patient who met all prerequisites to perform brain death examination but had variability in examinations during apnea testing. We discuss our strategy in managing these unexpected findings, including the importance of open and ongoing communication with the family, and the implications for current guidelines for the determination of brain death in pediatric patients.

INTRAVENOUS CANNULATION-PLASTIC CATHETERS OR SCALP VEIN NEEDLES

PEDIATRICS ◽  
1978 ◽  
Vol 61 (2) ◽  
pp. 223-223
Author(s):  
Donald A. Goldmann ◽  
R. J. H.
Keyword(s):  
High Rate ◽  
Intravenous Therapy ◽  
Catheter Colonization ◽  
Relative Safety ◽  
Serious Infections ◽  
Present Information ◽  
Immunosuppressed Patients ◽  
Periodic Administration ◽  
Heparin Lock ◽  
Growth Of Bacteria

Although there are no adequate studies comparing the incidence of complications with plastic catheters versus scalp vein needles, a review of the available literature does permit certain general observations. The use of plastic catheters is accompanied by a high rate of phlebitis, catheter colonization and sepsis. In most studies the rate of these complications increased with the length of time catheters were left in place; when catheters were left in longer than 48 hours, the associated septicemia rate ranged between 2% and 5%. In contrast, only one case of cannula-related septicemia was noted among 535 patients receiving intravenous therapy via scalp vein needles in 4 studies. Moreover, rates of phlebitis and cannula colonization are lower with scalp vein needles than with plastic catheters. Suppurative thrombophlebitis has recently been reported in association with IV therapy via scalp vein needles. In other words, serious infections may be rare, but they do occur, particularly in immunosuppressed patients. The factors responsible for the relative safety of scalp vein needles are unknown; it has been suggested that needles are safer because they tend to infiltrate quickly, forcing changes at frequent intervals. The small teflon catheters now available may be less irritating than previously marketed plastic catheters. Present information strongly suggests that scalp vein needles should be used for intravenous therapy whenever possible. If the cannula is to be used only for the periodic administration of medications such as antibiotics, a heparin lock is preferred to a "keep open" infusion since intravenous fluid supports the growth of bacteria and thus increases the risk of intravenous-related sepsis. Plastic catheters should be used when a child's life may depend on the reliability of the intravenous cannula as a route for the rapid administration of medications. Both scalp vein needles and plastic catheters should be changed every 48-72 hours.

scholarly journals Simultaneous Catheter Replacement for Infectious and Mechanical Complications without Interruption of Peritoneal Dialysis

2016 ◽  
Vol 36 (2) ◽  
pp. 182-187 ◽  
Author(s):  
John H. Crabtree ◽  
Rukhsana A. Siddiqi
Keyword(s):  
Peritoneal Dialysis ◽  
Central Venous Catheter ◽  
Venous Catheter ◽  
Central Venous ◽  
Technique Survival ◽  
Mechanical Complications ◽  
Tunnel Infection ◽  
Catheter Complications ◽  
Systemic Antibiotics ◽  
Catheter Replacement

BackgroundConventional management for peritoneal dialysis (PD)-related infectious and mechanical complications that fails treatment includes catheter removal and hemodialysis (HD) via a central venous catheter with the end result that the majority of patients will not return to PD. Simultaneous catheter replacement (SCR) can retain patients on PD by avoiding the scenario of staged removal and reinsertion of catheters. The aim of this study was to evaluate a protocol for SCR without interruption of PD.MethodsClinical outcomes were analyzed for 55 consecutive SCRs performed from 2002 through 2012 and followed through 2013.ResultsSimultaneous catheter replacements were performed for 28 cases of relapsing peritonitis, 12 cases of tunnel infection, and 15 cases of mechanical catheter complications. All cases for peritonitis and tunnel infection and 80% for mechanical complications continued PD on the day of surgery using a low-volume, intermittent automated PD protocol. Systemic antibiotics were continued for 2 weeks postoperatively (up to 4 weeks for Pseudomonas). Simultaneous catheter replacement was performed as an outpatient procedure in 89.1% of cases. Only 1 of 55 procedures was complicated by peritonitis within 8 weeks. No catheter losses occurred during this postoperative timeframe. Long-term, SCR enabled a median technique survival of 5.1 years.ConclusionsIn most instances, SCR can be safely performed without interruption of PD for selected cases of peritonitis and tunnel infection and for mechanical catheter complications. The procedure spares the patient from a central venous catheter, a shift to HD, the psychological ordeal of a change in dialysis modality, and a second surgery to insert a new catheter.

Effects of Age and Weight-Based Dosing of Enoxaparin on Anti-Factor Xa Levels In Pediatric Patients

2010 ◽  
Vol 15 (2) ◽  
pp. 119-125
Author(s):  
Lela S. Fung ◽  
Christopher Klockau
Keyword(s):  
Pediatric Patients ◽  
Dose Range ◽  
Age Groups ◽  
Factor Xa ◽  
Retrospective Chart Review ◽  
Average Dose ◽  
Success Rates ◽  
The Relationship ◽  
Current Guidelines ◽  
Range Study

ABSTRACT OBJECTIVE The objective of this dose range study is to expand on the relationship between age and weight-based doses of enoxaparin and resulting levels of anti-factor Xa (anti-Xa) in pediatric patients. The primary outcome of this study is to determine the average dose of enoxaparin required to produce a therapeutic effect. Secondary outcomes include the number of enoxaparin dose changes required to achieve a therapeutic level of anti-Xa in each age group, the success rates of achieving and maintaining therapeutic anti-Xa levels, and the effect of serum antithrombin concentrations on anti-Xa levels. The study will also determine whether different dispensed concentrations of enoxaparin play a role in achieving therapeutic levels of anti-Xa. METHODS Single center, retrospective chart review. Patients were excluded from the study if they were older than 18 years of age, were receiving enoxaparin for prophylactic purposes, had a creatinine clearance &lt; 30 ml/min/1.73m2, and if no anti-factor Xa levels were drawn. RESULTS Average enoxaparin doses required for therapeutic levels of anti-factor Xa were 1.8 mg/kg for patients &lt;1 month, 1.64 mg/kg (1 month to 1 year), 1.45 mg/kg (1 to 6 years), and 1.05 mg/kg (&gt;6 years of age). An average of 3.24 dose changes was required for neonates to achieve therapeutic levels anti-factor Xa. The success rates for achieving and maintaining therapeutic levels were both 41%. Patients with low serum antithrombin levels were more likely to have low anti-Xa levels than those with normal or high values, 52% vs 40% vs 18%, respectively. Patients receiving diluted concentrations, 10 or 20 mg/mL, experienced lower anti-Xa levels than patients who received the standard manufactured concentration of 100 mg/mL, 61% vs 33%. CONCLUSION Based on this dose-range study, enoxaparin should be initiated at larger doses than recommended by the current guidelines to promptly achieve therapeutic anti-Xa levels. Doses should be divided into three age groups instead of two as currently suggested in the guidelines. To increase the likelihood of achieving therapeutic levels, the commercially available enoxaparin product should not be diluted if possible.

Sign in / Sign up

Export Citation Format

Share Document