No abstract

We were able to confirm intravascular location of peripheral intravenous catheters using the color-flow injection test in pediatric patients. The test can lead to early recognition of malfunctioning peripheral intravenous catheters and decrease rate of infiltration-extravasation injuries associated with their use.

In pediatric patients undergoing cardiac surgery, FLEV derived from Functional Fibrinogen correlated linearly with plasma fibrinogen levels (Clauss) both before and after CPB. FLEV estimation of plasma fibrinogen was improved after CPB in neonates, infants, and small children. After CPB, FFTEG can be used to predict laboratory diagnosis of critical hypofibrinogenemia (≤200 mg·dl ) during pediatric cardiac surgery. Further studies are required to assess the impact of predictability of FFTEG on component transfusion during pediatric cardiac surgery.

A 29-month-old girl was admitted with a 2-week history of cough followed by complaints of abdominal pain, vomiting, anorexia and easy fatigability. On examination, she was noted to be tachypneic and have hepatomegaly. Chest X-ray revealed cardiomegaly and echocardiogram showed dilated left ventricle with severely reduced function and significant mitral valve regurgitation. She was transferred to our institution with an initial diagnosis of acute myocarditis, which was confirmed subsequently on cardiac biopsy and was attributed to be because of parvovirus infection. Initial medical management, which included diuresis and afterload reduction failed to improve her symptoms, and 38 days postadmission a decision to place a Berlin EXCOR LVAD (25 ml pump, 9 mm apical cannula, and 5 mm aortic cannula) was made. Postoperative transesophogeal echocardiogram demonstrated decompression of the left ventricle and no evidence of intracardiac thrombus.Post-LVAD placement, the patient did well and was successfully extubated, advanced to full enteral diet and an aggressive rehabilitation program was initiated. Anticoagulation management of the LVAD was accomplished with twice daily enoxaparin (anti-factor Xa level was 1 on the day of stroke with levels maintained 0.6-1.1 during the previous 2 weeks), two-times-per-day aspirin and four-times-per-day dipyridamole (100% inhibition of

Objectives: To determine if a saline-filled cuff seen at the suprasternal notch on ultrasound corresponds to correct endotracheal tube depth on a chest radiograph (tip at/below clavicle AND ≥ 1 cm above carina). Design: Prospective observational study. Setting: Tertiary Care Pediatric hospital. Patients: Patients between the ages of 0–18 years requiring nonemergent cardiac catheterizations and endotracheal intubation with a cuffed endotracheal tube were included in the study. Children with anticipated or known difficult airways were excluded. Interventions: Ultrasound evaluation of the neck following saline inflation of the endotracheal tube cuff. Measurements and Main Results: Ultrasonography of the patient’s neck was performed following intubation by a pediatric anesthesiologist. A linear probe was used in transverse axis to identify the saline-filled cuff starting at the suprasternal notch and moving cephalad. A cine-fluoroscopic image, similar to a chest radiograph, was obtained to ascertain the endotracheal tube depth after the cuff was identified sonographically. Endotracheal tube cuffs seen on ultrasound at the suprasternal notch were compared with the endotracheal tube depth on the cine-fluoroscopic image. A total of 75 children were enrolled in the study. The endotracheal tube was seen sonographically at the suprasternal notch in 70 patients of which 60 had complete data (an adequate chest radiograph available for review). Patient ages ranged from 2 months to 18 years with a median age of 4 years. The median endotracheal tube tip to carina distance was 2.4 cm (interquartile range, 1.75–3.3 cm.) The endotracheal tube tip to carina distance was greater than or equal to 1 cm in 57 out of the 60 patients. Endotracheal tube cuff at the suprasternal notch on ultrasound corresponded with correct endotracheal tube depth on chest radiograph with an accuracy of 95% (CI, 86–98%). Conclusions: Visualization of the cuff at the suprasternal notch by ultrasound demonstrates potential as a means of confirming correct depth of the endotracheal tube following endotracheal intubation.