Percutaneous Central Venous Catheterization

Chathas, Mary Kay; Paton, John B; Fisher, David E.

doi:10.1001/archpedi.1990.02150350078030

Cited by 89 publications

(6 citation statements)

References 20 publications

(2 reference statements)

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“…The majority of these previous studies were conducted in neonatal and pediatric intensive care units and suggested an increased rate of CLABSI with prolonged catheter duration. 33,34 In contrast, we found that pediatric oncology patients are at increased risk for CLABSI during the first month following CVC placement. This finding may differ from those in other settings for several reasons.…”

Section: Discussionmentioning

confidence: 57%

Moving CLABSI Prevention beyond the Intensive Care Unit: Risk Factors in Pediatric Oncology Patients

Kelly

Conway

Wirth

et al. 2011

Infect. Control Hosp. Epidemiol.

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Background and Objective Central line-associated bloodstream infections (CLABSIs) frequently complicate the use of central venous catheters (CVCs) among pediatric patients with cancer. Our objectives were to describe the microbiology and identify risk factors for hospital-onset CLABSI in this patient population. Design Retrospective case-control study. Setting Oncology and stem cell transplant units of a freestanding, 396-bed quaternary care pediatric hospital. Participants Case subjects (N=54) were patients with a diagnosis of malignancy and/or stem cell transplant recipients with CLABSI occurring during admission. Controls (N=108) were identified using risk set sampling of hospitalizations among patients with a CVC, matched on date of admission. Methods Multivariate conditional logistic regression was used to identify independent predictors of CLABSI. Results The majority of CLABSI isolates were Gram-positive bacteria (58%). The most frequently isolated organism was Enterococcus faecium, and 6 of 9 isolates were resistant to vancomycin. In multivariate analyses, independent risk factors for CLABSI included platelet transfusion within the prior week (odds ratio [OR], 10.90 [95% confidence interval {CI}, 3.02–39.38], P<0.001) and CVC placement within the previous month (<1 week vs. ≥1 month: OR, 11.71 [95% CI, 1.98–69.20], P=0.02; ≥1 week and <1 month vs. ≥1 month: OR, 7.37 [95% CI, 1.85–29.36], P=0.004). Conclusions Adjunctive measures to prevent CLABSI among pediatric oncology patients may be most beneficial in the month following CVC insertion and in patients requiring frequent platelet transfusions. Vancomycin-resistant enterococci may be an emerging cause of CLABSI in hospitalized pediatric oncology patients and are unlikely to be treated by typical empiric antimicrobial regimens.

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Section: Discussionmentioning

confidence: 57%

Moving CLABSI Prevention beyond the Intensive Care Unit: Risk Factors in Pediatric Oncology Patients

Kelly

Conway

Wirth

et al. 2011

Infect. Control Hosp. Epidemiol.

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“…This proved to be the case in our study, with a significant (62%) reduction in the total complication rate. Reductions occurred for thrombi, NEC and sepsis, even though the infants in the study group were ventilated longer than those in the control group, and longer ventilation is associated with a higher risk of sepsis (20).…”

Section: Discussionmentioning

confidence: 85%

“…Preterm and term neonates that require intensive care are immuno-compromised and susceptible to opportunistic infections. For any intravascular line infection, the potential sources of bacteraemia are related to the cannula, to contamination of the infusate (2), to duration of intravenous fluid administration (19) and to prolonged catheter placement (20). A study in term newborn infants showed a significant increase in catheter-site life by using a 96-h in-line filter (3).…”

Section: Discussionmentioning

confidence: 99%

“…An air embolism is a rare, but potentially devastating, complication of intravenous therapy. Several neonatal case studies illustrate the problem-the results of an air embolism during the insertion of a peripheral intravenous line may vary from resolution of symptoms within a few minutes (20) to paraplegia due to a "rundry" during peripheral venous administration of fluid and antibiotics (24). These authors suggest that the use of a filter should be standard practice.…”

Section: Discussionmentioning

confidence: 99%

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The use of in-line intravenous filters in sick newborn infants

Lingen¹,

Baerts²,

ACM³

et al. 2004

Acta Paediatrica

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“…Reducing exposure by this amount could reduce the number of infections by between 5 and 15 cases per 250 infants, which is an absolute risk reduction of 4%. This is possibly an underestimate of the reduction as infection risk increases with the length of time a catheter is in place [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

The Speed of Increasing milk Feeds: a randomised controlled trial

et al. 2017

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BackgroundIn the UK, 1–2% of infants are born very preterm (<32 weeks of gestation) or have very low birth weight (<1500 g). Very preterm infants are initially unable to be fed nutritional volumes of milk and therefore require intravenous nutrition. Milk feeding strategies influence several long and short term health outcomes including growth, survival, infection (associated with intravenous nutrition) and necrotising enterocolitis (NEC); with both infection and NEC being key predictive factors of long term disability. Currently there is no consistent strategy for feeding preterm infants across the UK. The SIFT trial will test two speeds of increasing milk feeds with the primary aim of determining effects on survival without moderate or severe neurodevelopmental disability at 24 months of age, corrected for prematurity. The trial will also examine many secondary outcomes including infection, NEC, time taken to reach full feeds and growth.Methods/designTwo thousand eight hundred very preterm or very low birth weight infants will be recruited from approximately 30 hospitals across the UK to a randomised controlled trial. Infants with severe congenital anomaly or no realistic chance of survival will be excluded. Infants will be randomly allocated to either a faster (30 ml/kg/day) or slower (18 ml/kg/day) rate of increase in milk feeds. Data will be collected during the neonatal hospital stay on weight, infection rates, episodes of NEC, length of stay and time to reach full milk feeds. Long term health outcomes comprising vision, hearing, motor and cognitive impairment will be assessed at 24 months of age (corrected for prematurity) using a parent report questionnaire.DiscussionExtensive searches have found no active or proposed studies investigating the rate of increasing milk feeds. The results of this trial will have importance for optimising incremental milk feeding for very preterm and/or very low birth weight infants. No additional resources will be required to implement an optimal feeding strategy, and therefore if successful, the trial results could rapidly be adopted across the NHS at low cost.Trial registrationISRCTN Registry; ISRCTN76463425 on 5 March, 2013.

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Percutaneous Central Venous Catheterization

Cited by 89 publications

References 20 publications

Moving CLABSI Prevention beyond the Intensive Care Unit: Risk Factors in Pediatric Oncology Patients

Moving CLABSI Prevention beyond the Intensive Care Unit: Risk Factors in Pediatric Oncology Patients

The use of in-line intravenous filters in sick newborn infants

The Speed of Increasing milk Feeds: a randomised controlled trial

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