Catheterization In Infants Research Articles

Central venous catheter insertion profile and complications among neonates in Saudi Arabia: a cross-sectional study.

To compare complications in neonates who had umbilical venous catheter (UVC) versus peripherally inserted central catheter (PICC), percentage of non-elective removal of central catheters, and to compare complications of PICC in the upper limb compared with the lower limb. A prospective cross-sectional cohort study. Neonatal intensive care unit (NICU) in Prince Sultan Military Medical City in Riyadh, Saudi Arabia. All infants who are admitted to the unit requiring central catheter insertion were included in the study. Complications of central catheters in infants admitted to the NICU. A total of 415 central catheters were involved in this study (206 UVCs and 209 PICCs (85 in the lower limb, 99 in the upper limb and 25 in the head and neck). The median birth weight of the neonates was 1470 grams (1000-2215). Low birth weight was the most common reason for central catheter insertion, which accounted for 59.8%. Neonatologists were the main insertor for the majority of the cases. The median dwell days for the study sample were 11.00 (7.00-16.50) days. Complications were more common across PICC cases compared with UVC cases (p=0.001). There was non-elective removal of PICC (32.1%) compared with UVC (22.8%) (p=0.035). Phlebitis, occlusion, local infiltrate and leakage were more common in PICC compared with UVC (p<0.05). However, malposition was more commonly associated with the use of UVC (mainly to the liver) (p<0.01). Central line-associated bloodstream infection (CLABSI) rate in 1000.00 dwell days was higher in the upper limb 4.6 compared with the lower limb 2.72 but was not statistically significant (p=0.63), and there was no statistically significant difference in the proportion of other complications between the upper limb and the lower limb (p>0.05). Close monitoring during extended dwell times is crucial. Our findings underscore the importance of raising awareness of CLABSI risk factors and adhering to best practices for central catheter maintenance. Healthcare professionals should be vigilant about the differences in complication rates between PICC and UVC, tailoring their approach accordingly.

Performance of tunnelled, non-cuffed central venous catheters in infants: A scoping review.

To summarise and critique existing knowledge and evidence relating to the utility, and post-insertion complications surrounding tunnelled non-cuffed central venous catheters (tncCVCs) in infants. A scoping review of original research studies reporting the use of, and post-insertion complications associated with, tncCVCs in infants was completed. MeSH terms were used to formulate a systematic search, and data were extracted using a customised data extraction form. Data were analysed descriptively across key themes based on the research questions. Study quality was evaluated using the Mixed Methods Appraisal Tool. The systematic search generated 3994 studies, of which 9 studies met final inclusion criteria. Studies included 644 tncCVCs in infants based in the USA, Europe and Australia. Most studies were retrospective cohort studies. The most common vein of insertion, where individually specified, was the internal jugular (n = 177). Tunnel length, where reported, was 2.5-5 cm. Infection rates were most commonly reported (eight studies), with results ranging from 0 to 12.8%, and device dislodgements of up to 20% reported. Participant follow-up and definition of complications varied greatly between studies. Study quality across all papers was sound. This review has identified only a small number of studies, with small participant numbers, reporting the performance of tncCVCs in infants. Definitions of complications measured varied significantly between studies, and vastly different patient follow-up protocols were reported. Further larger-scale studies on the performance of tncCVC, employing internationally recognised reporting standards is warranted to ensure clinicians can make informed choices for medication and infusion delivery.

The Role of Ultrasound in Epicutaneo-Caval Catheter Insertion in Neonates: Systematic Review, Meta-Analysis and Future Perspectives.

Chest and abdominal X-rays after the insertion of an epicutaneo-caval catheter in infants are the standard method of checking the tip location in many neonatal intensive care units. The role of ultrasound in the tip location of the epicutaneo-caval catheter in neonates has been the subject of many recent studies. This systematic review investigates the accuracy of epicutaneo-caval catheter tip location by comparing ultrasound and conventional radiology. We performed a systematic literature search in multiple databases. The selection of studies yielded nineteen articles. The systematic review and meta-analysis were performed according to PRISMA (Preferred Reporting Items for Systematic reviews and Meta-analysis). The analyses showed that ultrasound is a better imaging technique for epicutaneo-caval catheter tip location in the neonatal intensive care unit than conventional radiology. By improving operator training and selecting a standardized echography protocol, ultrasound could become the gold standard for visualizing the epicutaneo-caval catheter tip in the neonatal intensive care unit. This would have some important benefits: (1) increased accuracy in tip location (2); a more rapid use of the central venous access (3); and a significant reduction in radiation exposure.

Combination of ketamine and fentanyl (KetaFent) for safe insertion of ultrasound-guided central venous catheters in infants.

Centrally inserted central catheters (CICCs) are placed by ultrasound guided puncture of the internal jugular or brachio-cephalic vein. It is crucial to achieve a good level of sedation and analgesia in order to keep the babies still thus reducing the risk of procedural failure. The aim of this study is to evaluate the efficacy of the combination of ketamine and fentanyl during the CICC placement procedure. We retrospectively collected data from 72 infants who underwent CICC insertion after sedation with KetaFent protocol. The primary outcome was to assess the success of the procedure defined as CICC placement. Secondary outcome was intubation during the procedure in non-ventilated infants (noninvasive ventilation or spontaneous respiration), need for repeat doses of study medications to complete the procedure, time to complete the procedure, the level of analgesia assessed using vital parameters. The procedure was completed in 100% of cases. There were no cases of hypotension during and at the end of the procedure. No intubation was performed on non-ventilated infants. The combination of ketamine and fentanyl for sedation and analgesia in infants requiring insertion of a CICC is 100% successful. It is associated with a low risk of side effect like apnea and intubation. Insertion of a central venous catheter is a painful procedure for infants. Adequate sedation is mandatory to keep the baby still thus reducing the risk of procedural failure.

Long-axis in-plane combined with short-axis out-of-plane technique in ultrasound-guided arterial catheterization in infants: A randomized controlled trial

Study objectiveTo determine whether the long-axis in-plane (LAX-IP) combined with short-axis out-of-plane (SAX-OOP) technique is more suitable than modified dynamic needle tip positioning (MDNTP) technique for ultrasound-guided radial artery catheterization in infants. DesignA randomized controlled trial. SettingDepartment of Anesthesiology, Children's Hospital of Chongqing Medical University. PatientsOverall, 72 patients, aged 1–12 months old, who were primarily undergoing thoracic or cardiac surgery in the Children's Hospital of Chongqing Medical University between July 1, 2021, and March 31, 2022, were selected. These patients were randomly divided into two groups: i) the MDNTP group and ii) the LAX-IP combined with SAX-OOP group. InterventionsRadial artery cannulation in the two groups was performed using ultrasound-guided MDNTP or LAX-IP combined with SAX-OOP technique. MeasurementsThe primary outcome was first-time success rate, and the secondary outcomes included total success rate, cannulation time, and incidence of complications. Main resultsIn the LAX-IP combined with SAX-OOP group, the first-time success rate was 75.0% (n = 27), total success rate was 97.2% (n = 35), cannulation time was 91.39 ± 102.60 s, puncture attempts was 1.5 ± 1.3 times, and local hematoma was formed on the first day in one (2.8%) infant. In the MDNTP group, the first-time success rate was 36.1% (n = 13) (P = 0.001; RR, 2.08; 95% confidence interval, 1.29–3.34), total success rate was 91.7% (n = 33) (P = 0.303; RR, 1.06; 95% confidence interval, 0.95–1.19), cannulation time was 181.00 ± 146.72 s(P = 0.047; Median difference,-89.61; 95% confidence interval, −149.12 to −30.10), puncture attempts was 2.3 ± 1.6 times (P = 0.133; Median difference,-0.81), and local hematoma was formed on the first day in nine (25%) infants (P = 0.006; RR, 0.11; 95% confidence interval, 0.01–0.83). No thrombosis occurred in any group. ConclusionsThe ultrasound-guided LAX-IP combined with SAX-OOP technique for radial arterial catheterization in infants, which was performed by anesthesia residents, exhibited an increased first-time success rate, reduced cannulation time, and lower incidence of complications than the MDNTP technique.

Comparison of dwell time and complications between peripheral venous catheters and midline catheters in infants weighing ≥ 1500 g at birth.

Newborns in the neonatal intensive care unit (NICU) often require infusion therapy immediately after admission. In such cases, the catheter must be selected according to the condition of the neonate. The aim of this study was to compare the performance of a peripheral venous catheter (PVC) in terms of dwell time, number of catheter replacements required, and complication rate with that of a midline catheter (MC) in neonates weighing ≥1500 g and requiring care in a NICU. The study had a retrospective observational design and included neonates with a birthweight of ≥1500 g who were admitted to a level III NICU between April 2019 and May 2021 and received infusion therapy via a PVC or MC. Patient, maternal, and infusion-related data were collected from the medical records. The outcomes were compared between the PVC and MC groups according to type of catheter used. Univariate analyses of the infusion-related data demonstrated that neonates in the MC group (n = 52) had significantly longer dwell times, required fewer catheter replacements, and had a greater probability of completing therapy with less risk of extravasation than those in the PVC group (n = 54). These findings confirm that the MC has advantages over the PVC, including a longer dwell time, fewer catheter replacements, and less risk of extravasation in newborns with a birthweight of ≥1500 g.

Ultrasound versus intracavitary electrocardiography for intraprocedural tip location during central venous catheterization in infants and children: A prospective clinical study.

Both intracavitary electrocardiography (IC-ECG) and ultrasound (US) have been proven to be safe and accurate for intraprocedural tip location during central venous catheterization, and both are known to be easily applicable and feasible in pediatric patients. Though, no prospective clinical study has directly compared the two methods as regards their applicability, feasibility, and procedural time. This study prospectively enrolled all children requiring a central venous access device in non-emergency situations, during a period of 1 year. All devices were inserted according to a well-defined insertion bundle including both IC-ECG and US-based tip location. The primary endpoint of the study was to compare the two methods in terms of applicability, feasibility and time required. This study included 100 consecutive central venous catheterizations in children of age ranging from 1 month to 18 years. The applicability of IC-ECG based tip location was 98% and its feasibility 100%; the time required for IC-ECG was 1.9 ± 2 min. The applicability of US-based tip location was 96% and its feasibility was 100%; the maneuver required 2.2 ± 3 min. US is an appropriate alternative method for intraprocedural tip location in children. The combined use of US and IC-ECG (both maneuvers being accurate, inexpensive, cost-effective, non-invasive, and equally fast to perform) should be recommended for tip location in pediatric patients, and it will avoid completely the use of fluoroscopy or of post-procedural x-ray.

Combined short-axis out-of-plane and long-axis in-plane approach versus long-axis in-plane approach for ultrasound-guided central venous catheterization in infants and small children: A randomized controlled trial.

The ultrasound-guided long-axis in-plane approach for central venous catheterization in infants and small children can prevent posterior wall penetration. The combined short-axis out-of-plane and long-axis in-plane approach reportedly prevents such penetration in adults. To test the hypothesis of non-inferiority of the combined approach to the long-axis in-plane approach, we compared the two approaches in infants and small children. Patients were randomized based on whether they underwent ultrasound-guided internal jugular vein catheterization using the combined or long-axis in-plane approach. Posterior wall penetration rates, first-attempt success rates, overall success rates within 20 min; scanning, puncture, and procedure durations; and number of attempts were compared between the groups. In the combined and long-axis in-plane groups (n = 55 per group), the posterior wall penetration rates were 5.5% (3/55) and 3.6% (2/55) (P = 0.65), the first-attempt success rates were 94.5% (52/55) and 92.7% (51/55) (P = 0.70), and the overall success rates within 20 min were 100% (55/55) and 98.2% (54/55) (P = 0.32), respectively. In the combined and long-axis in-plane groups, the median (interquartile range) scanning durations were 21 (16.5–34.8) s and 47 (29.3–65) s (P<0.0001), the puncture durations were 114 (83–170) s and 74 (52.3–117.3) s (P = 0.0002), and the procedure durations were 141 (99–97.8) s and 118 (88.5–195.5) s (P = 0.14), respectively. The median number of attempts was 1 (interquartile range: 1–1, range: 1–3) in both groups (P = 0.72). Similar to the long-axis in-plane approach, the combined approach for internal jugular vein catheterization prevented posterior wall penetration in infants and small children.Trial registration: This trial was registered before patient enrollment in the University Hospital Medical Information Network Clinical Trials Registry, registration number UMIN000039387 (https://upload.umin.ac.jp/cgi-bin/ctr/ctr_view_reg.cgi?recptno=R000044907).

Fourth thoracic vertebra as landmark for depth of right internal jugular vein catheterization in infants

The carina is considered a reliable marker for the depth of right internal jugular vein catheterization in infants on chest radiograph. In adult anatomy, the carina is typically located at the level of the fifth thoracic vertebra. We are not aware of a positional relationship between infant carina and thoracic vertebrae. Thus, we evaluated that a vertebral body may be at the same level as carina and can be as radiographic landmarks for the depth of right internal jugular vein catheterization in infants. In this retrospective analysis, 108 infants (aged 1–12 months) who underwent congenital heart surgery between January 1, 2019 and June 30, 2019 were included. We analyzed the post-operative chest radiographs of those who underwent right internal jugular vein catheterization and assessed the positional relationship of the carina and vertebral bodies. We measured the vertical distance of the central venous catheter (CVC) catheter tip from the carina (below the carina 22 mm, it may be close to or into the right atrium). In total, 95 children were enrolled; The carina was located at the third thoracic vertebra in two cases (2%) and at the fourth thoracic vertebra in 93 cases (98%). The distance between the tip of CVC and the carina was 10 (4, 15) mm, and 6.3% (6 cases) had the catheter tip at more than 22 mm below the carina. Most fourth thoracic vertebrae were at the same level as the carina on chest radiographs. Therefore, it has potential as a radiographic landmark for the depth of right internal jugular vein catheterization in infants on chest radiograph.

Evaluating the Sensitivity and Specificity of Echocardiography in Determining the Appropriate Position of Peripherally Inserted Central Catheters in Infants

Background: In this study, we aimed to evaluate the accuracy of echocardiography compared to plain radiography in determining the appropriate line tip position of peripherally-inserted central catheters (PICC). Also, we aimed to evaluate the relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and related complications with PICC line tip position. Methods: In this prospective observational study, which was performed in the neonatal intensive care units of teaching hospitals affiliated with Iran University of Medical Sciences in 2019, 50 out of 96 neonates were non-randomly selected based on inclusion criteria. The radiographic and echocardiographic tests were simultaneously performed, and the data were analyzed. Results: The findings of this study showed that there was an agreement between radiography and echocardiography in determining the PICC line tip position in 43 neonates (86%). The sensitivity and specificity of echocardiography in determining the ectopic position of the catheter were 81% and 77%, respectively. In 32 neonates (64%), a second radiograph prevented the following line manipulation using echocardiography. In addition, there was no significant relationship between independent predictors (chronological age, birth weight, gestational age, and gender) and PICC line complications. Conclusions: The results of the present study showed that echocardiography was a useful tool for determining the position of the catheter’s tip in LBW neonates. It also minimizes radiation exposure on subsequent radiographs and obviates the need for additional radiographs following catheter manipulation by echocardiography.

B-36 | Abnormal Abdominal Venous Anatomy May Complicate Catheterization in Infants with Right Congenital Diaphragmatic Hernias and/or Hepatopulmonary Fusion

Children with a right congenital diaphragmatic hernia (CDH) may require right heart catheterization for pulmonary hypertension assessment. The extent of abnormal systemic venous return complicating access to the right heart in this population has not been well described.

The Clinical and Cost Utility of Cardiac Catheterizations in Infants with Bronchopulmonary Dysplasia

To evaluate the cost-utility of catheterization-obligate treatment in preterm infants with pulmonary hypertension, as compared with empiric initiation of sildenafil based on echocardiographic findings alone. A Markov state transition model was constructed to simulate the clinical scenario of a preterm infant with echocardiographic evidence of pulmonary hypertension associated with bronchopulmonary dysplasia (BPD) and without congenital heart disease under consideration for the initiation of pulmonary vasodilator therapy via one of two modeled treatment strategies-empiric or catheterization-obligate. Transitional probabilities, costs and utilities were extracted from the literature. Forecast quality-adjusted life-years was the metric for strategy effectiveness. Sensitivity analyses for each variable were performed. A 1000-patient Monte Carlo microsimulation was used to test the durability of our findings. The catheterization-obligate strategy resulted in an increased cost of $10 778 and 0.02 fewer quality-adjusted life-years compared with the empiric treatment strategy. Empiric treatment remained the more cost-effective paradigm across allscenariosmodeled through one-way sensitivity analyses and the Monte Carlo microsimulation (cost-effective in 98% of cases). Empiric treatment with sildenafil in infants with pulmonary hypertension associated with BPD is a superior strategy with both decreased costs and increased effectiveness when compared with catheterization-obligate treatment. These findings suggest that foregoing catheterization before the initiation of sildenafil is a reasonable strategy in preterm infants with uncomplicated pulmonary hypertension associated with BPD.

Sedation versus General Anesthesia for Cardiac Catheterization in Infants: A Retrospective, Monocentric, Cohort Evaluation.

Background: Children with congenital heart disease require repeated catheterization. Anesthetic management influences the procedure and may influence outcome; however, data and recommendations are lacking for infants. We studied the influence of sedation versus general anesthesia (GA) on adverse events during catheterization for children <2 years old. Methods: We conducted a monocentric, retrospective study of all catheterization procedures (2008–2013). High-severity adverse event (HSAE) rates were compared using propensity-score-adjusted models, including pre- and intra-procedural variables. Results: 803 cases (619 patients) (368 (46%) GA, 435 (54%) sedation) with a mean age of 6.9 ± 6.1 months were studied. The conversion rate (GA after sedation) was 18 (4%). Hospital stay was 4.9 ± 4.0 and 4.1 ± 2.5 (p = 0.01) after GA or sedation, respectively. HSAE occurred in 75 (20%) versus 40 (9%) (p < 0.01) in GA versus sedation procedures, respectively. Risk factors (multivariable analysis) were older patients (p = 0.05), smaller weights (p < 0.01), palliated status (OR 3.2 [1.2–8.9], p = 0.02), two-ventricle physiology (OR 7.3 [2.7–20.2], p < 0.01), cyanosis (OR 4.6 [2.2–9.8], p < 0.01), pulmonary hypertension (OR 5.6 [2.0–15.5], p < 0.01), interventional catheterization (OR 1.8 [1.1–3.2], p = 0.02) and procedure-type risk category 4 (OR 28.9 [1.8–455.1], p = 0.02). Sedation did not increase the events rate and decreased the requirement for hemodynamic support (OR 5.2 [2.2–12.0], p < 0.01). Conclusion: Sedation versus GA for cardiac catheterization in children <2 years old is safe and effective with regard to HSAE. Sedation also decreases the requirement for hemodynamic support. Paradoxical effects (older age and two-ventricle physiology) on risk have been found for this specific age cluster.

Time-Driven Cost Analysis of Noncuffed Venous Catheter Placement in Infants: Bedside versus IR Suite

PurposeTo compare the direct bundled costs of interventional radiology (IR) suite versus bedside placement of noncuffed central venous catheters in infants. MethodsA single-center retrospective review was performed of all noncuffed upper extremity (peripherally inserted central venous catheter [PICC]) and tunneled femoral (tunneled femoral central venous catheter [TCVC]) catheters placed in infants between January 1, 2018, and December 31, 2018. Propensity score matching was performed adjusting for age, birth weight, procedure weight, and catheter days. Process maps for each procedure were created based on location and sedation type. Technical success and complications were recorded for each placement. The total direct bundled cost for each catheter placement was calculated by summing the procedure and complication costs. ResultsA total of 142 procedures were performed on 126 matched patients with a technical success of 96% at the bedside and 100% in the IR suite (P = .08). The complication rates did not significantly differ between the 2 groups (P = .51). The total direct bundled costs for catheter placement were $1421.3 ± 2213.2 at the bedside and $2256.8 ± 3264.7 in the IR suite (P = .001). ConclusionsThe bundled cost of bedside femoral catheter placement is significantly less than that of fluoroscopic TCVC and PICC placement performed in the IR suite, mainly related to differences in sedation costs.

Atypical use of PICC as centrally inserted central catheter in infants and neonates: Report of a 10-year experience.

The aim was to determine the success, safety and post procedure complications of peripherally inserted central catheters as centrally inserted central catheters (CICC). One hundred and sixty-one consecutive infants and neonates, who underwent image guided tunnelled central venous catheter insertion were retrospectively evaluated between April 2008 and April 2018. Patient's demographics, site of access and procedure details were recorded. Outcomes included technical success and post procedure complications. One hundred and eighty-two CICCs were inserted in 161 patients (49.7%, n = 80 male). Mean patient age was 100 days (range: 0-342) with a mean weight of 4.20 kg (range 1.80-9.40). The most common indication was for antibiotics administration (41%; n = 66). Technical success was 99% (181/182). Early complications (<7 days) were seen in 8.8% (n = 13). This included inadvertent line removal in 5.5%, catheter-related bloodstream infection in 1.1% and catheter occlusion in 2.2% (n = 4). Average line functional duration prior to removal was 26 days (range 0-180). 77.5% of the lines lasted for the intended duration of treatment. In the neonate subgroup, 84.1% (37/44 lines) of lines remained in situ for the intended duration of treatment. Tunnelled central venous catheters using non-cuffed peripherally inserted central catheters in infants is a safe technique with excellent success rate and minimal complications rates.

A retrospective comparison for prediction of optimal length of right subclavian vein catheterization in infants: landmark-based estimation vs. linear regression model.

BackgroundThe optimal insertion length for right subclavian vein catheterization in infants has not been determined. This study retrospectively compared landmark-based and linear regression model-based estimation of optimal insertion length for right subclavian vein catheterization in pediatric patients of corrected age < 1 year.MethodsFifty catheterizations of the right subclavian vein were analyzed. The landmark related distances were: from the needle insertion point (I) to the tip of the sternal head of the right clavicle (A) and from A to the midpoint (B) of the perpendicular line drawn from the sternal head of the right clavicle to the line connecting the nipples. The optimal length of insertion was retrospectively determined by reviewing post-procedural chest radiographs. Estimates using a landmark-based equation (IA + AB – intercept) and a linear regression model were compared with the optimal length of insertion.ResultsA landmark-based equation was determined as IA + AB – 5. The mean difference between the landmark-based estimate and the optimal insertion length was 1.0 mm (95% limits of agreement –18.2 to 20.3 mm). The mean difference between the linear regression model (26.681 – 4.014 × weight + 0.576 × IA + 0.537 × AB – 0.482 × postmenstrual age) and the optimal insertion length was 0 mm (95% limits of agreement –16.7 to 16.7 mm). The difference between the estimates using these two methods was not significant.ConclusionsA simple landmark-based equation may be useful for estimating optimal insertion length in pediatric patients of corrected age < 1 year undergoing right subclavian vein catheterization.

Landmark guided internal jugular vein catheterization in infants undergoing congenital heart surgery

Objectives: Central venous catheterization is an important procedure for infants undergoing heart surgery. Ultrasound-guided methods have been shown to decrease failure and complications. The goal of the present study was investigate the effect of anatomical landmark technique during internal jugular vein access in low-weight infants undergoing congenital heart surgery. Methods: A total 98 infants (median age was 16.5 days, median weight was 3275 g) who underwent internal jugular vein catheterization between January 2017 and October 2019 were retrospectively analyzed. All catherizations were performed by a pediatric heart surgeon. Data including demographic characteristics of the infants, success rate, and catheter-related adverse events were recorded. Results: Success rate was 94.9% (n = 93). There were three arterial puncture (3.1%) and hematoma occurred in five patients (5.1%). Central venous catheterization of 78 (79.6%) patients were successful at the first attempt. Conclusions: Our study suggest that landmark technique still seems useful by experienced operators and is safe and effective in infants weighing less than 5 kg undergoing congenital heart surgery.

A randomized double-blind trial comparing the effect on pain of an oral sucrose solution versus placebo in children 1-3 months old needing bladder catheterization.

The efficacy of oral sweet solutions to decrease pain in infants during painful procedures remains uncertain. This study aimed to compare the efficacy of an oral sucrose solution versus placebo in reducing pain during bladder catheterization in infants in the Emergency Department (ED). A randomized, double-blind clinical trial was conducted in a pediatric university-affiliated hospital ED. Infants 1-3 months old were recruited and randomly allocated to receive 2 ml of sucrose or placebo, 2 min before bladder catheterization. The primary outcome measure was the difference in pain scores as assessed by the Face, Legs, Activity, Cry and Consolability (FLACC) Pain Scale during procedure. Secondary outcome measures were the difference in pain scores using the Neonatal Infant Pain Scale (NIPS), crying time, variations in heart rate and adverse events. Eighty-three participants were recruited and completed the study, 41 and 42 in the sucrose and placebo groups, respectively. The mean difference in FLACC scores compared to baseline was 5.3 in the sucrose group vs. 6.4 in the placebo group during catheterization. There were no differences in FLACC scores or NIPS scores measured at 1, 3 and 5 min post procedure. Mean crying times were similar: 97 vs. 110 s. No significant difference was found in participants' heart rate variations. No adverse events were reported. In infants undergoing bladder catheterization in the ED, administration of an oral sweet solution was not associated with lower pain as measured by the FLACC and NIPS scales. Participants' heart rate variations and crying times did not change when sucrose was provided.

The Effect of Musical Mobile on Pain Perception Used During Peripheral Intravenous Catheterization in Infants (3-6 Months)

Amaç: Bu araştırma, 3-6 ay arası bebeklerde, periferik intravenöz kateterizasyon uygulaması sırasında kullanılan müzikli dönencenin ağrı algısına etkisini belirlemek amacıyla gerçekleştirilmiştir. Gereç ve Yöntem: Yarı deneysel olarak 3-6 ay arası toplam 112 bebek ile yürütülen çalışma 2.11.2017 ve 31.01.2018 tarihlerinde bir hastanenin çocuk servisinde gerçekleştirilmiştir. Deney grubunda intravenöz kateterizasyon işlemi sırasında müzikli dönence kullanılırken, kontrol grubuna sadece kateterizasyon uygulanmıştır. Bebek Tanıtıcı Bilgi Formu ve Face Legs Activity Cry Consolability (FLACC) Ağrı Ölçeği ile veriler toplanmıştır. Her iki grupta işlem öncesi, işlem sırası ve işlem sonrasında birbirinden bağımsız iki gözlemci eş zamanlı ağrı ölçeğini puanlamıştır. Bulgular: Araştırma kapsamına alınan bebeklerin %52.7’si (n=59) kız, %47.3’ü (n=53) erkektir. Bebeklere ilişkin genel özelliklerin (yaş, tartı, boy) deney ve kontrol grupları arasında benzerlik gösterdiği saptanmıştır. İşlem öncesi (p:0.011; p&amp;lt; 0.05), işlem sırası (p:0.001; p&amp;lt; 0.01) ve işlem sonrasında (p:0.001; p&amp;lt;0.01) kontrol grubunun FLACC ağrı puanları, deney grubu FLACC ağrı puanlarına göre istatistiksel olarak anlamlı düzeyde yüksek bulunmuştur. Sonuç: Periferik intravenöz kateterizasyon uygulaması sırasında ağrı algısının azaltılmasında müzikli dönence etkili bulunmuştur ve güvenle kullanılabilir.

Point-of-Care Ultrasound for the Evaluation and Management of Febrile Infants.

Febrile infants frequently present to the emergency department (ED) and account for a vulnerable population at significant risk for serious bacterial infection. Appropriate evaluation and management are key to favorable outcomes but can present challenges for providers, especially in EDs where ill children are infrequently seen and pediatric-trained staff may not be available. Point-of-care ultrasound (POCUS) is integrated into the care of adults in the ED but is less commonly used for infants. We present a review of the current literature and proposed approach to using POCUS for bladder catheterization, lumbar puncture (LP), and vascular access in the resuscitation and evaluation of febrile infants. Point-of-care ultrasound can be a useful adjunct in the evaluation of febrile infants by facilitating higher success rates of infant bladder catheterization, LP, and intraosseous and intravenous (IV) line placement. Ultrasound has been shown to be a reliable method of evaluating bladder volumes before the catheterization of infants, reducing the number of attempts needed to obtain an adequate urine sample for testing and culture. Point-of-care ultrasound has also been shown to improve the yield of LPs in infants. Ultrasound is a rapid and accurate way of identifying the appropriate location and depth of needle insertion. Point-of-care ultrasound has also been shown to facilitate obtaining IV access in infants as well as confirming the proper placement of intraosseous lines. A growing body of evidence suggests that POCUS is a useful adjunct in the initial evaluation and resuscitation of febrile infants. It is the position of both the American Academy or Pediatrics, American College of Emergency Physicians, and the authors of this article that emergency physicians should be familiar with the indications and applications of POCUS in children. This technology should be used as an adjunct to improve success rates when performing bladder catheterization, LP, and obtaining intravenous/intraosseous access for infants.