Cannula In Neonates Research Articles

Risk factors contributing to weaning failure from continuous positive airway pressure to high flow nasal cannula in neonates with respiratory distress syndrome

Background Respiratory distress syndrome (RDS) is one of the most frequent causes of mortality and morbidity in neonates. High flow nasal canule (HFNC) is a step ladder modality of alternative oxygen therapy for weaning to reduce the workload of breathing and the need for intubation.
 Objective To identify the risk factors contributing to weaning failure from continuous positive airway pressure (CPAP) to HFNC in neonates with RDS.
 Methods This study was a retrospective observational study in neonates aged less than 36 weeks weighing less than 2500 grams who underwent CPAP to HFNC weaning from 2019 to 2021 in Dr. Kariadi Hospital, Semarang, Central Java, Indonesia.
 Results There were 108 patients included in this study. Our bivariate analysis found significant differences in gestational age, age at the start of weaning, body weight at the start of weaning, FiO2 levels, history of maternal chorioamnionitis, patent ductus arteriosus (PDA), anemia, apnea of prematurity (AOP), and sepsis in neonates with RDS. Multivariate analysis showed that the most dominant factors were FiO2 levels of more than 25% at the start of weaning (OR11.16; 95%CI 1.83 to 63.12; P=0.009), anemia (OR 7.70; 95%CI 1.39 to 42.67; P=0.019), AOP (OR 19.64; 95%CI 4.27 to 90.35; P<0.001), and sepsis (OR 10.93; 95%CI 2.37 to 45.53; P=0.002)
 Conclusion FiO2 setting of more than 25% at the start of weaning, anemia, AOP, and sepsis produce a significant probability of HFNC weaning failure.

Non-invasive ventilation using RAM’S cannula in neonates-what difference does it make?

Background: Neonates undergo transition at birth from breathing fluid to breathing air. If this change is not tolerated by neonate, need of assisted ventilation arises. Non-invasive ventilation (NIV) refers to any mode of respiratory support provided through nasal airway. Using RAM’S cannula as an interface, complications of invasive ventilation can be prevented, and therefore it can be impactful in improving respiratory care in neonates. Aims and Objectives: The aim of the study was to find the association of clinicoetiological factors and the outcome of NIV using RAMS’s cannula in neonates. Materials and Methods: This prospective observational study was done from March 1, 2021 to August 31, 2022 at Neonatal Intensive Care Unit of a Tertiary care center in Central India. Neonates given NIV through Ram’s cannula were enrolled. Primary diagnosis of subjects and clinical parameters - birth weight, gestational age, duration of NIV given, and severity of respiratory distress were recorded and analyzed to find an association with the outcomes. Informed consent was obtained from parents. Results: 100 neonates (62 male) were given NIV. 78 neonates were weaned off from NIV and 22 needed intubation. Duration of NIV, gestational age, severity of respiratory distress, and birth weight were found to be statistically significant. Weaning was more in gestation >34 weeks, weight >1 kg, duration of NIV given <3 days, and neonate having mild respiratory distress. Conclusion: NIV through RAM’s cannula is useful in both respiratory and non-respiratory illness. Higher rates of NIV failure were seen in the duration of NIV >7 days, weight <1 kg, and gestation <34 weeks.

Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial.

To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC.Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. Splint application did not affect functional PIVC duration and its related complications in neonates.

Incidence of nasal trauma in nasal continuous positive airway pressure versus heated humidified high flow nasal cannula in neonates, our experience in Government Medical College Srinagar

Background: The nCPAP (nasal continuous positive airway pressure) is noninvasive mode of ventilation that decreases the need for mechanical ventilation in neonates. The newer device heated humidified high flow nasal cannula (HHHFNC) delivers heated (to body temperature, 37 °C) and humidified (near 100% relative humidity) gas at flow rates of more than 1 liter/min through small bi-nasal prongs, that is more physiological. Methods: This was a retrospective study conducted in neonatal intensive care unit. The eligible neonates who were put on HHHFNC or nCPAP depending upon the availability of any of these devices at the time of admission. The details regarding complications were recorded from the admission files of these patients from medical record section of the hospital. Results: There was no statistically significant difference in complications like shock, NEC, pulmonary air leak, apnea, PDA, ROP, IVH or PVL for nCPAP or HHHFNC. However, nasal trauma was present in 18 (18%) patients in nCPAP group but in no patient in HHHFNC. Conclusions: There is no significant differences in complication in nCPAP vs HHHFNC except nasal trauma which is more common in nCPAP.

Peripheral intravenous cannulae in neonates: To splint or not?

To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates. Level II Neonatal Intensive Care Unit (NICU). Consecutive babies with presumed need of peripheral intravenous access of at least 24 h. Enrolled subjects were randomized to "splint" or "splint-less" group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter. Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) (p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome. Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.

Bubble Nasal Continuous Positive Airway Pressure (bCPAP) versus Control in Neonates with Respiratory Distress.

To compare the effectiveness of bubble continuous positive airway pressure (bCPAP) and oxygen inhalation via nasal cannula in neonates presenting with respiratory distress, using Silverman Anderson Retraction Score (SARS). Randomised clinical trial. Department of Paediatrics, Unit-1, KEMU/Mayo Hospital, Lahore, Pakistan, from April 2017 to June 2018. A total of 120 neonates fulfilling inclusion and exclusion criteria were enrolled and were randomly allocated in two groups: Group A and Group B. In group A, neonates were given bCPAP for respiratory support, while neonates in group B were given nasal oxygen as control group. Neonates in both groups were followed for 48 hours. The effectiveness was determined by the reduction in SARS, up to or less than score 3, at the end of a 48-hour period. Data were collected and analysed by SPSS version 20.0. P-value ≤0.05 was taken as significant. In Group A, effectiveness was found to be 93.3%, and in Group B effectiveness was 71.7% (p = 0.003). Median reduction in SARS from 00 to 48 hours, in group A (bCPAP) was 4 (4 - 5) while in group B (control), it was 3 (2 - 3); statistically significant (p <0.001). Bubble CPAP was more effective than nasal oxygen alone, in treatment of respiratory distress among neonates. This study suggested that bCPAP should be used more frequently in NICUs of Pakistan to reduce burden of neonatal morbidity due to respiratory distress. Key Words: Bubble CPAP, Respiratory distress, Neonates, Silverman Anderson Retraction Score.

Elective replacement of intravenous cannula in neonates-a randomised trial.

Peripheral intravenous cannula (PIVC) insertion is one of the most common invasive procedures performed in neonates and is frequently associated with adverse events. There are no studies in the neonatal population looking at the possibility of reducing the risk of PIVC-related complications by elective replacement of PIVC. A randomised, non-blinded, control trial was conducted in a tertiary level neonatal unit in Melbourne, Australia, to examine rates of extravasation in neonates with elective replacement of PIVC as compared to standard practice. Neonates born at 32weeks of gestation or more were randomly assigned to have their PIVC replaced electively (every 72-96h) or when clinically indicated in a 1:1 allocation ratio after parental consent. Primary outcome studied was rate of extravasation. Secondary outcomes included rates of phlebitis, leakage or spontaneous dislodgement of PIVC. One hundred thirteen infants were enrolled. Extravasation was noted in 33 (60%) of standard practice group vs. 28 (48.3%) of elective replacement (RR 0.80, CI 0.57-1.13, p = 0.21) infants. Time to first extravasation was similar between the groups (hazard ratio 0.69, CI 0.42-1.15). Extravasation events per 1000 IV hours were also similar between groups. Similar results were seen by both intention to treat and per protocol analyses. There was an increase in leaking rates (HR1.98, CI 1.03-3.81, p = 0.04) in the elective group, while phlebitis and spontaneous dislodgement rates were similar to standard group.Conclusion: Elective replacement of PIVC in neonates is not associated with reduction in extravasation rates.Trial registration: This trial has been registered with the Australian and New Zealand Clinical Trials Register. Identifier: ACTRN12615000827538. What is Known: • The reported incidence of extravasation injury is as high as 70% in the neonatal and paediatric population and has an association with cannula dwell time. • Adult studies have done to look at the possibility of reducing intravenous cannula-related complications with routine replacement of the cannulas but no similar studies have been done in the neonatal population. What is New: • Routine replacement of intravenous cannula in neonates between 72 and 96h of use does not reduce the rate of extravasation injuries. • There might be some added complications associated with such a practice.

Clinical applications of high flow nasal cannula in neonates

The use of high flow nasal cannula(HFNC) therapy as a noninvasive respiratory support approach for preterm infants is rapidly increasing.HFNC is an alternative to nasal continuous positive airway pressure(nCPAP) for treating apnea of prematurity, primary respiratory support for neonates with respiratory distress, post-extubation support, facilitating nCPAP weaning in preterm infants.In this article, the proposed mechanisms of HFNC and the evidence from clinical trials of HFNC use in preterm infants were reviewed, and recommendations for evidence-based practice were established. Key words: High flow; Nasal cannula; Infant, newborn

Use of high-flow nasal cannula in neonates: Nationwide survey in Japan.

High-flow nasal cannula is a new modality of respiratory support and is increasing in popularity despite the lack of supporting evidence. We investigated the prevalence of its use in tertiary neonatal units in Japan. A paper-based survey was conducted. The response rate was 83%. High-flow nasal cannula was used in 46/80 units (58%), of which 96% used the high-flow nasal cannula without guidelines. It was used for several indications, including weaning off nasal continuous positive airway pressure and post-extubation respiratory support. The main perceived benefits of the cannula included better access to the neonate and reduced risk of nasal trauma. This survey found that high-flow nasal cannula is used without clear criteria and that clinical practice varies across neonatal units in Japan. Its use in neonates needs to be urgently evaluated.

Effect of joint immobilization on the lifespan of intravenous cannula: a randomised controlled trial

Background: The use of peripheral intravenous cannulas (IVCs) for the purpose of providing fluid and medications to the newborn is a consistent requirement in Neonatal Intensive Care Units (NICUs). Proper securement of cannulas can preserve catheter life. However; no consensus is available on the factors affecting the duration of patency. The present study was a randomized controlled trial designed to compare the effect of limb splinting versus non-splinting with the functional duration of peripheral IV cannula in neonates requiring IV infusion and/or medications. Methods: This prospective interventional study was conducted over a period of 5 months in the NICU of Father Muller Medical College. Eligible cannulations were randomised to either ‘‘splint’’ or ‘‘no-splint’’ group. In the splint group, firm splint covered with sterile gauze was used to immobilise the joint at the peripheral IV cannula site. No attempt was made to immobilise the limb in the no-splint group. Duration from time of insertion to removal on the basis of predefined criteria was measured. Results: A total of 449 peripheral IV cannulations in 390 newborns were randomized to either the splint (n= 230) or no-splint group (n=219). After exclusion, 202 cannulations in the splint group and 184 cannulations in the no-splint group were analyzed. The median survival time of IVC in the splint group was marginally more compared to the no-splint group (h; 51.08 hours (SD 32.6) vs. 50.93 (SD 33.1), mean difference 0.9 hours, p value 0.807). Extravasation at the peripheral infusion site was the commonest indication for cannula removal in both the groups occurring more in the splint group (93.6 % versus 85.3%). Conclusions: This study concludes that the application of limb splinting for intravenous cannulation only marginally prolongs the duration of the cannula and thus may not be useful. The authors believe that there is a need for more larger, planned RCTs involving specific variables to come to scientifically valid, evidence- based guidelines.

A case of avalon cannula malposition and successful conversion to V-A ECMO in a neonate

The Avalon Elite Bi-caval Dual Lumen cannula was designed for placement in the right internal jugular vein for veno-venous double lumen extracorporeal membrane oxygenation (VVDL ECMO). Despite the use of echocardiography, it is often difficult to correctly position the VVDL cannula in neonates due to patient size and anatomy. Cannula malposition may contribute to inadequate hemodynamic support necessitating conversion to veno-arterial (V-A) support. We report a case of successful conversion from VVDL ECMO to V-A ECMO using the 13-French Avalon cannula in a neonate. This case demonstrates that the 13 French-Avalon Elite Bi-caval Dual Lumen Cannula can be safely used as a venous cannula in neonates requiring conversion to V-A ECMO.

Limb splinting for intravenous cannulae in neonates: a randomised controlled trial

Objective:To evaluate the efficacy of peripheral intravenous (IV) cannula site joint immobilisation by splint application on functional duration of peripheral IV cannula in neonates.Design:Randomised controlled trial.Setting:Neonatal intensive care unit of...

Pharmacology Review

Extravasation or inadvertent infiltration of fluids into subcutaneous tissue from peripheral intravenous (IV) devices is a common adverse event in newborns. (1)(2) Although fluids occasionally extravasate from central venous lines, the complication is much more common from peripheral catheters, which are used widely in sick neonates. (3) This article focuses on extravasations from peripheral IV devices. Injury to the skin, even in a very immature neonate, results in an inflammatory response and heals by scar formation. (4) Although the scars from many of these injuries appear to improve with time, (5) tissue necrosis from extravasation injury could result in partial or complete skin loss, infection, and nerve and tendon damage, with the potential risk of permanent cosmetic and functional impairment. (6)(7)(8) The incidence of extravasations from Teflon® catheters has been reported to vary from 23% to 63%. (1) A recent survey of regional neonatal intensive care units in the United Kingdom recorded the prevalence of extravasation injury resulting in skin necrosis as 38 per 1,000 neonates, with 70% of these injuries occurring in infants of 26 weeks’ gestation or less. (2) The incidence of extravasation is related closely to the type of device used, insertion site, duration of therapy, infusate administered, patient activity, and gestational age. (1)(3)(9)(10) The fragility of the skin, particularly in the first 2 weeks after birth, and the lack of subcutaneous tissue in preterm neonates makes them uniquely susceptible to injury and skin loss. Extravasation may occur from the tip of the cannula or needle piercing the vessel wall. Alternatively, distal obstruction of the vein due to thrombosis or venoconstriction from irritation of the vessel wall may lead to increased back pressure and leakage from the entry point of the needle or …

Pressurized bag pump and syringe pump arterial flushing systems: an unrecognized hazard in neonates?

Hand-held flushing of radial arterial lines at 0.5 ml/s in neonates can result in retrograde embolization of flush solution into the central arterial circulation. We studied flush flow velocities during intermittent arterial line purging using a flow regulating device with an infusion bag pump and a syringe pump system. In this in vitro experiment we simulated flushing of a 24- and a 22-G cannula against a mean arterial pressure of 45 mmHg. Fluid flow velocities were gravimetrically measured during flushing from an infusion bag system pressurized to 100, 200, and 300 mmHg and from a syringe pump flush system after initialization of boluses of 0.5, 1.0, 1.5, 2.0, and 2.5 ml. The flow regulating device was opened for 1, 2, and 5 s. Both flush systems tested allowed delivery of flush flow velocities exceeding 0.5 ml/s (e.g., 22-G cannula; bag system, pressure 300 mmHg up to 0.64+/-0.08 ml/s; syringe pump, 2 ml bolus up to 0.74+/-0.05 ml/s). In syringe pump systems the main determinant of flow velocity was bolus size, in bag pump systems flushing time and bag pressure. Based on data about critical flow velocities through an radial arterial cannula in neonates, both tested flushing systems carry the risk of exceeding the critical value of 0.5 ml/s. They are likely to cause retrograde embolization of flushing solution into the central arterial circulation with the associated risk of clot and air embolization. In vivo studies should identify margins of safety to minimize the risk of retrograde flushing into the central arterial circulation.

Limb shortening secondary to complications of vascular cannulae in the neonatal period

Four cases of limb shortening presenting in childhood are described. All four children had been managed in a neonatal intensive care unit and had developed complications following the insertion of intravascular cannulae. In two, lower limb shortening and deformity were secondary to direct epiphyseal damage following extravasation of calcium or dextrose from a peripheral venous line. In the other two, forearm shortening followed ischaemia, secondary to either radial artery thrombosis from a radial artery cannula or spasm of the brachial artery following extravasation from a venous cannula in a neonate who also had a radial artery cannula. These cases highlight an important complication of the use of vascular cannulae in neonates and the problems this may pose to the orthopaedic surgeon.

Quantitative bacteriology of peripheral venous cannulae in neonates

Quantitative bacteriology of peripheral venous cannulae in neonates

Quantitative bacteriology of peripheral venous cannulae in neonates

In a study of 50 peripheral venous cannulae removed from neonates in the special care baby unit, quantitative and qualitative techniques for cannula culture were compared and the results correlated with detailed clinical information. High-density colonization was demonstrated on the external and internal surfaces of nine, and on the external surface alone of four, cannula tips. Internal surface colonization was always associated with heavy external surface growth. In predicting high-density colonization by quantitative methods, qualitative culture in broth was 100% sensitive and 89% specific. There was a significant association between high-density colonization of the cannula tip and hub colonization, surrounding skin colonization, longer duration of cannula insertion, and slower average infusion rate. Similar organisms were isolated more frequently from the cannula tip and the hub than from the cannula tip and surrounding skin. These findings indicate that peripheral venous cannulae are a potential source of infection in neonates, that there is no advantage of techniques that identify internal surface colonization, and that most cannula tip infections have their origin in a colonized hub.