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Haas, Nikolaus A.

doi:10.1186/cc2880

Cited by 82 publications

(14 citation statements)

References 107 publications

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“…PICC lines may be decreasing the numbers of CVL being placed in the PICU ( 16 , 17 ). Intraosseous lines may substitute for CVL for emergent fluid resuscitation ( 18 ). Vasoactive agents can be safely administered for short periods of time through a peripheral intravenous line ( 19 ) and recent guidelines endorse early vasoactive agents through a peripheral intravenous or intraosseous line in pediatric and neonatal shock ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

et al. 2018

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Background: Pediatric Critical Care Medicine Fellowship trainees need to acquire skills to perform procedures. Over the last several years there have been advances that allowed for less invasive forms of interventions.Objective: Our hypothesis was that over the past decade the rate of procedures performed by Pediatric Critical Care Medicine Fellowship trainees decreased.Methods: Retrospective review at a single institution, tertiary, academic, children's hospital of patients admitted from July 1, 2007–June 30, 2017 to the Pediatric Intensive Care Unit and Cardiothoracic Intensive Care Unit. A Poisson regression model with a scale adjustment for over-dispersion estimated by the square root of Pearson's Chi-Square/DOF was applied.Results: There has been a statistically significant decrease in the average rate of central venous lines (p = 0.004; −5.72; 95% CI: −9.45, −1.82) and arterial lines (p = 0.02; −7.8; 95% CI: −13.90, −1.25) per Fellow per years in Fellowship over the last 10 years. There was no difference in the rate of intubations per Fellow per years in Fellowship (p = 0.27; 1.86; 95% CI:−1.38, 5.24).Conclusions: There has been a statistically significant decrease in the rate of central venous lines and arterial lines performed by Pediatric Critical Care Medicine Fellowship trainees per number of years in Fellowship over the last 10 years. Educators need to be constantly reassessing the clinical landscape in an effort to make sure that trainees are receiving adequate educational experiences as this has the potential for an impact on the education of trainees and the safety of the patients that they care for.

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Section: Discussionmentioning

confidence: 99%

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

et al. 2018

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“…Using 2-dimensional ultrasound techniques is helpful to increase the success rates of catheter insertion. 9 Considerable efforts have been directed toward increasing the CSA of the IJV as well as decreasing the complication rate during the procedure. Maneuvers that raise the intravascular pressure probably increase the CSA of the IJV.…”

Section: Discussionmentioning

confidence: 99%

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Kim

Choi

Lee³

et al. 2016

Medicine

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Catheterization of the internal jugular vein (IJV) remains difficult in pediatric populations. Increasing the cross-sectional area (CSA) of the IJV facilitates cannulation and decreases complications. We aimed to evaluate the Trendelenburg position and the levels of positive end-expiratory pressure (PEEP) at which the maximum increase of CSA of the IJV occurred in children undergoing cardiac surgery.In this prospective study, the CSA of the right IJV was assessed using ultrasound in 47 anesthetized pediatric patients with simple congenital heart defects. The baseline CSA was obtained in response to a supine position with no PEEP and compared with 5 different randomly ordered maneuvers, that is, a PEEP of 5 and 10 cm H2O in a supine position and of 0, 5, and 10 cm H2O in a 10° Trendelenburg position. Hemodynamic variables, including blood pressure and heart rate, maximum and minimum diameters, and CSA, were measured.All maneuvers increased the CSA of the right IJV with respect to the control condition. In the supine position, the CSA was increased by 9.4% with a PEEP of 5 and by 19.5% with a PEEP of 10 cm H2O. The Trendelenburg tilt alone increased the CSA by 19.0%, and combining the 10° Trendelenburg with a 10 cm H2O PEEP resulted in the largest IJV CSA increase (33.3%) compared with the supine position with no PEEP. Meanwhile, vital signs remained relatively steady during the experiment.The application of the Trendelenburg position and a 10 cm H2O PEEP thus significantly increases the CSA of the right IJV, perhaps improving the chances of successful cannulation in pediatric patients with simple congenital heart defects.

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“…The use of venous cut-down to obtain access to the circulation could be the last resort in patients who are critically ill and in whom percutaneous venepuncture may be difficult [4]. Examples include patients in shock, paediatric age group, sclerosed veins of intravenous drug abusers.…”

Section: Discussionmentioning

confidence: 99%

Billateral Femoral Osteomyelitis Following Venous Cutdown

Akinsorotan¹,

Eyesan²,

Obalum³

et al. 2013

OJO

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Obtaining rapid access in emergency situations for infusion of IV fluids, blood and blood products or medications is vital in using various methods. These include venopuncture, intraosseous infusion, percutanous central venous access and peripheral venous cut-down. We report a case of a 30-year-old woman who developed severe obstetric hemorrhage and had peripheral venous cut-down that was complicated by bilateral femoral osteomyelitis. This is a rare occurrence and this case report shows the need for strict adherence to safety precautions to prevent complications such as that from the procedure.

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Untitled

Cited by 82 publications

References 107 publications

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

Declining Procedures by Pediatric Critical Care Medicine Fellowship Trainees

Effects of the Trendelenburg Position and Positive End-Expiratory Pressure on the Internal Jugular Vein Cross-Sectional Area in Children With Simple Congenital Heart Defects

Billateral Femoral Osteomyelitis Following Venous Cutdown

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