Catheters In Pediatric Patients Research Articles

Intra-procedural continuous dialysis to facilitate interventional catheterization in pediatric patients with severe renal failure.

Interventional catheterization procedures may be needed for patients with severe renal failure who are dependent on dialysis. To avoid the risk of fluid overload and electrolyte derangement during complex procedures in this oliguric/anuric patient population, we performed intra-procedural dialysis, either continuous renal replacement therapy (CRRT) or continous cycling peritoneal dialysis (CCPD). We performed a retrospective review of a cohort of pediatric patients, ages 0-18 years, with dialysis-dependent renal failure who received CRRT or CCPD during catheterization procedures from January 2013 to March 2016. Eight patients underwent a total of nine interventional catheterization procedures while receiving intra-procedural dialysis. Median age was 4.5 years (range 8 months to 17 years) and weight, 11.6 kg (11.2-62.6 kg). Six patients had end-stage renal disease (ESRD) and two patients had acute kidney injury (AKI), one due to hepatorenal syndrome and one due to multifactorial causes associated with congenital heart disease. The most common reason for catheterization was occlusive venous thrombosis requiring recanalization. CRRT was used during five cases and CCPD during four cases. Median procedure time was 337 min (95-651 min) and median contrast dose 4.2 mLkg-1 (1.2-8.2 mLkg-1 ). Euvolemia was maintained based on pre- and post-catheterizations weights, and no significant electrolyte abnormalities occurred based on lab monitoring during and post-procedure. Intra-procedural dialysis using CRRT or CCPD enables even small pediatric patients with severe renal failure to undergo long and complex interventional catheterizations by reducing the risk of fluid overload and electrolyte abnormalities. Collaboration between nephrology, cardiology, and dialysis teams is necessary for successful management of this challenging patient population.

A Prospective, Randomized Study comparing the Efficacy and Safety of Adhesive Strip (Steri-Strips™) Fixation vs Subcutaneous Tunneling for securing Epidural Catheters in Pediatric Patients

ABSTRACT Introduction Effective epidural catheter fixation is a key aspect of postoperative pain management in pediatric patients. We conducted a prospective, randomized study comparing the efficacy and safety of adhesive strip (Steri-Strips™) vs subcutaneous tunneling for successful epidural catheter fixation. Materials and methods American Society of Anesthesiologists (ASA) grades I and II patients between the age group of 1 day and 12 years were included in the study. The parameters studied were inward and outward migration, and dislodgment of catheter. Erythema, induration, catheter snapping, catheter obstruction, total duration of epidural infusion, and catheter tip culture were also recorded. Feedback from the operator for ease of fixation technique was noted and reviewed. Results This study was performed in 64 patients posted for various abdominal, thoracic, and genital surgeries, requiring postoperative epidural analgesia. The epidural catheter was successfully placed in the first attempt in 61 patients. Outward migration was seen in six patients with Steri-Strips-taped catheters and in one patient with a tunneled catheter. Accidental removal was done in five patients with tunneled catheters and one patient with strip-taped catheter. Rescue analgesics were required in these patients. No inward migration of catheter was seen in both the groups. Bleeding from tunneling site was seen in five patients. Conclusion In comparison with a tunneling technique for epidural catheter fixation, a simple method of applying Steri-Strips™ to epidural catheters significantly reduces the incidence of accidental removal. How to cite this article Kulkarni KS, Dave NM, Kulkarni SS, Nataraj G, Shinde S, Chincholi I, Garasia M. A Prospective, Randomized Study comparing the Efficacy and Safety of Adhesive Strip (Steri-Strips™) Fixation vs Subcutaneous Tunneling for securing Epidural Catheters in Pediatric Patients. Res Inno in Anesth 2017;2(2):40-44.

Cardiac Catheterization in Pediatric Patients Supported by Extracorporeal Membrane Oxygenation: A 15-Year Experience.

Cardiac catheterization is commonly performed in patients being supported by extracorporeal membrane oxygenation (ECMO). We aimed to evaluate the safety, benefit, and outcomes of catheterization in pediatric patients supported by ECMO. Retrospective review of cardiac catheterizations performed in patients ≤18years of age while on ECMO at a large tertiary care center between January 2000 and May 2015. A total of 55 catheterizations were performed on 51 patients during 53 unique ECMO courses. Indications for ECMO include ventricular dysfunction (22), cardiac arrest (20), inability to wean from cardiopulmonary bypass (7), and persistent cyanosis (4). Catheterizations included purely diagnostic studies (11), atrial septostomies (34), stenting of vessels or surgical shunts (6), adjustment of a stent (1), coil embolization (1), and endomyocardial biopsy (1). Septostomy was elective in 58.8% of cases (20) and emergent in 41.2% (14). Forty-six catheterizations had either surgical or catheter intervention during the same or subsequent study (83.6%). High severity complications occurred in three patients (5.6%), including one death due to hemothorax after pulmonary artery stent placement. There were no complications during patient transport. In total, 38 out of 53 (71.7%) ECMO courses resulted in decannulation, 29 (54.7%) patients survived to discharge from the hospital, and 25 (47.2%) were alive at follow-up. Cardiac catheterization can be safely performed on patients supported by ECMO. Cardiac catheterization is a critical tool in the early recognition, diagnosis, and direct treatment of hemodynamic/anatomic abnormalities in patients supported by ECMO.

Contemporary Insertion of Central Venous Access Catheters in Pediatric Patients: A Retrospective Record Review Study of 538 Catheters in a Single Center.

To analyze the rate of infections and complications after surgeon-performed, largely ultrasound-guided, central venous catheter (CVC) placement in a pediatric population and to identify patients at high risk of complications. All children aged between 4 months and 19 years with a percutaneous CVC inserted between January 1, 2000, and July 31, 2013, were included. Patient records were reviewed retrospectively for the occurrence of infection and other complications until CVC removal or the last outpatient clinic visit and compared between patient groups and with the recent literature. A total of 538 CVCs were placed in 345 patients. Eight patients (1.5%) suffered complications during placement. There were 84 cases of a suspected CVC infection (15.6%). Catheter-related infections with a positive catheter tip culture occurred in 25 cases (4.6%). Older patients (odds ratio [OR] 0.88; 95% confidence interval [CI] 0.78-0.98) or patients with a double-lumen 7 French Bard-Hickman catheter (OR 0.32; 95% CI 0.11-1.00) had a significantly lower risk of infection. Older patients (OR 0.94; 95% CI 0.89-0.99) and patients with beta-thalassemia (OR 0.35; 95% CI 0.17-0.71) also had a significantly lower risk of suspected infection. In general, infection rates in our series were similar to those in the recent literature. Younger patients seem to be at higher risk for CVC removal because of infection prior to the end of treatment. Patients with beta-thalassemia or receiving a double-lumen 7F Bard-Hickman catheter had a lower risk of infection.

The changing profile of safe techniques for the insertion of a central venous catheter in pediatric patients – improvement in the outcome with the experiences of 500 insertions in a single institution

BackgroundThe ability to safely insert a central venous catheter (CVC) is critical to avoid associated complications. The aim of this study was to explore appropriate technique to maintain the safety of pediatric patients during CVC. MethodsWe reviewed the surgical records of CVC insertion techniques and associated complications of 503 tunneled CVC insertions performed from 2000 to 2015. ResultsTwo hundred thirty CVCs (45.7%) were inserted into the subclavian vein using the landmark technique for 10years (first period). Only two pneumothoraxes (0.9%) were experienced. In 2009, we adopted ultrasound-guided venous catheterization from the internal jugular vein, and 103 CVCs (20.5%) were inserted (second period). This procedure led to penetration into the innominate vein (1.0%) by dilater sheath. Patient underwent repair of the penetrated vessel. After this serious complication, 170 CVCs (33.8%) were inserted using the venous cutdown procedure except two catheters. We had two cases whose accessible veins were occluded because of frequent catheterization using venous cutdown technique. No mechanical complications were experienced. ConclusionsThe venous cutdown method is the safest technique for inserting a tunneled CVC in pediatric patients. However, multiple vein occlusions because of repeated catheterizaion by venous cutdown lead to the exhaustion of accessible vessels. Level of evidenceTreatment Study – Level IV

Variables decreasing tip movement of peripherally inserted central catheters in pediatric patients.

The position of the tip of a peripherally inserted central catheter (PICC) is crucial; malposition can lead to malfunction of the line or life-threatening events (e.g., arrhythmias, perforation). To determine what factors other than arm position and accessed vein might influence the tip position of a PICC. Inclusion criteria were upper limb PICC placement, body weight <20kg, intraoperative imaging with the arm in 0°, 45° and 90° abduction and an arm view marking the skin entry site relative to the shoulder. Evaluated variables included patient demographics, and PICC and insertion site characteristics. We measured central tip movement in rib units. We included 112 children who received a PICC (42 girls/70 boys, mean age 31±13months, mean weight 6.5±4.9kg). The overall range of central tip movement was -1 to +4 rib units (mean +0.8±0.7 rib units). Silicone PICCs moved significantly less than polyurethane PICCs (P<0.05). PICCs placed in the cephalic vein moved significantly less than those placed in other veins (P<0.05). Patient demographics and PICC characteristics (size, number of lumens, left or right arm accessed, length of the line) did not influence the range of central tip movement of a PICC (P>0.05). Silicone PICCs and PICCs inserted into the cephalic vein move less than PICCs made of polyurethane and PICCs inserted into the brachial and basilic veins. These findings might assist operators in deciding which PICC to place in children in a given clinical context.

Proper tip position of central venous catheter in pediatric patients.

In this study, we analyzed the thin-section pulmonary computed tomographic (CT) angiogram scans of pediatric patients to determine the normative length of superior vena cava (SVC) and the distance between carina and cephalad of SVC or cavocatrial junction. Consecutive child patients, under 13 years of age in whom the central catheters were inserted under ultrasound guidance from December 2004 to April 2005 were evaluated retrospectively. In the 14 cases, the mean age was 7.2 ± 4.21 years. The mean length and diameter of the SVC in the pediatric patients were 45.6 ± 23.03 and 13.7 ± 3.62 mm, respectively. The distance from the carina to the cavoatrial junction was 22.0 ± 9.98 mm. The mean distance from the superior margin of the SVC to the carina was 23.7 ± 16.70 mm. The mean distance from the carina to the catheter tip was 38.9 ± 18.60 mm. In no case was the cavoatrial junction cephalad with respect to the carina. Carina to cavoatrial junction junction was significantly associated with age, height, and weight, respecitively (r = 0.750; p = 0.005, r = 0.763; p = 0.004; r = 0.777; p = 0.003). The carina is a good landmark for the upper border of the cavoatrial junction. Length of carina to cavoaterial juction was associated with age. The rates of malposition and re-intervention and the patient's exposure to radiation can be reduced by using ultrasound during the catheter insertion.

A novel method for ultrasound-guided radial arterial catheterization in pediatric patients.

Radial arterial catheterization in pediatric patients is occasionally difficult despite ultrasound guidance. We therefore assessed the factors affecting catheterization and tested an intervention designed to improve its success. For initial assessment, we performed multiple logistic regression analyses using 102 pediatric patients. Dependent variables included first-attempt and overall success or failure; independent variables were systolic blood pressure, weight, ASA physical status, trisomy 21, arterial diameter, and subcutaneous depth of the radial artery (<2, 2-4, ≥4 mm). The effect of subcutaneous arterial depth on cannulation success was assessed using Kaplan-Meier curves with log-rank and Dunn tests. We then assessed catheterization success in 60 patients who were randomized to no treatment or subcutaneous saline injection, as necessary, to increase the subcutaneous arterial depth from <2 to 2 to 4 mm. Subcutaneous arterial depth of 2 to 4 mm was derived as a significant independent predictor of initial and overall success from the multiple logistic regression analyses. The 2 to 4 mm group had a significantly shorter catheterization time compared with the other 2 groups in the log-rank test (2-4 vs <2 mm group; P = 0.01, 2-4 vs ≥4 mm group; P < 0.001), and higher success rate in the first attempt (<2 [43.8%] vs 2-4 mm [76.9%], P = 0.02; 2-4 [76.9%] vs ≥4.0 mm [19.4%], P < 0.001), and the overall attempt (<2 [62.5%] vs 2-4 mm [89.7%], P = 0.04; 2-4 [89.7%] vs ≥4.0 mm [51.6%], P = 0.002). Injecting subcutaneous saline to bring arterial depth from <2 mm to 2 to 4 mm significantly shortened catheterization time (P = 0.002), and improved the success rate in the first-attempt (saline injection [85.0%] vs <2 mm [30.0%], P < 0.001), and the overall attempt (saline injection [90.0%] vs <2 mm [55.0%], P = 0.02). Ultrasound-guided radial artery catheterization in pediatric patients was fastest and most reliable when the artery was 2 to 4 mm below the skin surface. For arteries located <2 mm below the skin surface, increasing the depth to 2 to 4 mm by subcutaneous saline injection reduced catheterization time and improved the success rate.

Pediatric Blood Sample Collection From a Pre-Existing Peripheral Intravenous (PIV) Catheter

Aiming to minimize pain in a hospitalized child, the purpose of this observational study was to describe characteristics of blood samples collected from pre-existing peripheral intravenous (PIV) catheters in pediatric patients. One hundred and fifty blood samples were reviewed for number of unusable samples requiring a specimen to be re-drawn. Success of the blood draw and prevalence of the loss of the PIV following blood collection was also measured. Findings included one clotted specimen, success rate of 91.3%, and 1.3% of PIVs becoming non-functional after collection. Obtaining blood specimens from a pre-existing PIV should be considered in a pediatric patient.

Ultrasound‐guided approach to the paravertebral space for catheter insertion in infants and children

Paravertebral perineural blocks are used to prevent pain in the thoracoabdominal dermatomes. Traditionally, a landmark-based technique is used in children, while ultrasound-guided (UG) techniques are being employed in adult patients. To describe an UG technique for placement of thoracic paravertebral nerve block (TPVNB) catheters in pediatric patients. Retrospective chart review of a series of 22 pediatric patients' ages 6months to 17years with weights from 6.25kg to 135kg using a transverse in-plane technique. Catheters were placed both bilateral and unilateral for a variety of thoracic and abdominal procedures. A linear ultrasound transducer was used in all cases with frequency of oscillation and transducer length chosen based on individual patient characteristics of age, weight, and BMI. The median pain scores at 12, 24, 36, and 48h were 1.2 (interquartile range, 4.5), 0.84 (interquartile range 3.0), 1.6 (interquartile range 2.9), and 0.83 (interquartile range 1.74), respectively. The median dose of opioid expressed as morphine equivalents consumed during the first 24h after surgery was 0.14mg·kg(-1) (interquartile range, 0.78mg·kg(-1) ) and from 24 to 48h the median dose was 0.11mg·kg(-1) (interquartile range 0.44mg·kg(-1) ). No complications were noted, and catheters were left an average of 3days with a range of 1-5days with good pain relief. This technical description demonstrates the feasibility of placing PVNB catheters using a transverse in-line ultrasound-guided technique in a wide range of pediatric patients.

The Effect of Simulation Teaching on Baccalaureate Nursing Students' Self-confidence Related to Peripheral Venous Catheterization in Children: A Randomized Trial.

In recent decades, nursing instructors have tended to use simulation rather than traditional methods due to benefits such as increased self-confidence. However, little academic literature is available to verify this claim. The procedure of establishing peripheral venous catheterization in pediatric patients is of great importance. Therefore, the researchers attempted to review the effect of the simulation teaching method on nursing students' self-confidence related to peripheral venous catheterization in pediatric patients. In this trial, 45 students in the 5(th) and 6(th) semester of nursing school in the first half of school year 2012 from the Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Iran, were randomly assigned to three groups (a control group, and two intervention groups). They were trained in establishing peripheral venous catheterization in pediatric patients through simulation teaching method and practical training. The students' self-confidence was assessed by C-Scale before and after the intervention. The students' self-confidence score showed a significant increase in the simulation group after the intervention in comparison to other groups (p = 0.03). RESULTS revealed a significant increase in self-confidence of nursing students related to peripheral venous catheterization in pediatric patients by simulation. This substantiates the assertion that simulation can improve self-confidence. Due to the low sample size, further studies with larger population are suggested.

Safety of surgical pulmonary artery catheters in pediatric patients

Background: This study aims to evaluate the postoperative outcomes of surgical pulmonary artery catheters in pediatric patients and to discuss the safety of these catheters. Methods: Between January 2010 and June 2012, surgical pulmonary artery catheters were implanted in 55 patients (26 boys, 29 girls; mean age 23.7±7.1 months; range 1 to 70 months). A retrospective analysis of the patients for pathology, age, body weight, pulmonary and systemic arterial pressure, extubation time, catheter removal time, the amount of bleeding, mortality and morbidity was performed. Results: The mean body weight of the patients was 9.0±2.8 kg. All patients had preoperative pulmonary hypertension which was equal to systemic pressure. Thirtyseven patients received iloprost intravenous infusion via a pulmonary artery catheter. The mean extubation time was 24.5±16.6 hours, while the mean time for pulmonary artery catheter removal was 45.5±19.6 hours. The mean drainage following catheter removal was 23.7±14.4 mL. None of the patients required any revision due to bleeding. No pulmonary artery catheter-related complication was observed in the patients. Conclusion: Surgical pulmonary artery catheterization is a simple technique which can be used for both continuous pressure monitorization and drug infusion. We conclude that this is a safe and contributing method for an effective management of postoperative pulmonary hypertension in pediatric patients.

Alteplase for the Treatment of Catheter Occlusion in Pediatric Patients

To review the literature pertaining to the efficacy of alteplase for restoration of patency of occluded venous and dialysis catheters in pediatric patients. A MEDLINE search was conducted and cross-referenced with an EMBASE search through November 2012. Search terms included alteplase, tissue plasminogen activator, and catheter. Search results were limited to humans, English language, and ages from neonates to 18 years. Pertinent studies discussing efficacy of alteplase for restoration of occluded venous or dialysis catheter function were included. Case reports, review articles, and studies that specified inclusion of hemophilia patients or more than 75% of children with malignancy were excluded. Fibrinolytics are the drug class of choice for restoration of patency (defined as the ability to withdraw a blood sample) of thrombus-occluded catheters. The trials used to support Food and Drug Administration approval of alteplase for central venous catheter (CVC) occlusions generally had low pediatric enrollment; however, additional small studies are available that support use of alteplase for this indication in children. Alteplase doses of 0.5-2 mg instilled into the lumen of a CVC with dwell times ranging from 30 to more than 240 minutes plus the potential for repeat dosing were reported. Overall efficacy ranged from approximately 50% to 90%, with greater efficacy generally reported with larger doses and longer dwell times. Alteplase doses of 2-2.5 mg with dwell times of 60-120 minutes were observed in 2 studies of occluded peritoneal or hemodialysis catheters, in which efficacy was reported in 57-100% of cases. Limitations of current studies of alteplase for catheter occlusion in children include small study populations and relative lack of pediatric-specific prospective trials. Alteplase appears to show efficacy for treatment of thrombus-related venous catheter occlusion in pediatric patients; however, data regarding its use in occluded dialysis catheters are limited.

The Effects of Ranitidine and Hydrocortisone on the Complications of Femoral Artery Obstruction Treated by Streptokinase Following Cardiac Catheterization in Pediatric Patients with Congenital Heart Diseases

Background:The most important complication following cardiac catheterization required urgent therapeutic management is vessel obstruction and arterial thrombosis. The morbidity following this complication can be decreased by surgery intervention and/or thrombolytic drugs.Objectives:In this study we evaluated the effects of ranitidine and hydrocortisone on pediatric patients with congenital heart diseases who suffered from femoral artery obstruction following cardiac catheterization on decreasing the events after streptokinase administration.Materials and Methods:This semi experimental study was conducted on 47 patients among 600 cases who underwent cardiac catheterization from April 2002 to December 2011.The patients suffered from distal vessel obstruction following cardiac catheterization with no response to surgery intervention, were enrolled and divided in two groups. Streptokinase was administrated in both groups. Patients in group 2 (25 cases), received ranitidine and hydrocortisone before streptokinase administration. In group 1 (22 cases), the loading dose of streptokinase was 2000IU/kg/ in 20-30 minutes/ infusion and thereafter streptokinase was administrated 1000 IU /kg/hour. In group 2, the loading dose was 3000IU/kg in 20-30 minutes /infusion and 1500 IU/kg/hour as maintenance dose. The infusion dose of streptokinase was decreased and then terminated in 2-3 hours by the time arterial pulse was detected by pulse oximetry.Results:There were 13 (59, 1%) male and 9 (40.9%) female patients in group 1. In group 2, there were 15 (60%) male and 10 (40%) female cases (P = 0.949). Patients in both groups were matched well regarding age, body weight, height and the duration of streptokinase infusion (P < 0.05). The incidence of hematoma was higher in group 1 than group 2 (P = 0.032). the patients of Group 1 required more blood transfusion than group 2 because the incidence of bleeding was more in the first group (P = 0.042). 12 patients in group 1 required fresh frozen plasma transfusion versus 4 patients in group 2 (P = 0.049). Local oozing was detected more in group 1 (P = 0.042). Significant bleeding was occurred in 6 cases in group 1; however this event did not occurrin any patients in group 2 (P = 0.007). Although 4 patients in group 1 suffered from anaphylactic shock after streptokinase administration but no patients in group 2 did. (P = 0.041).Conclusions:Based on the results of this study, we concluded that streptokinase was able to remove the vessel thrombosis at the site of cardiac catheterization and ranitidine and hydrocortisone administration before streptokinase may be effective in order to reduce the complications related to thrombolytic drugs; however the experience of the performer is an issue of concern in this matter.

Ultrasound-guided subclavian catheterization in pediatric patients with a linear probe: a case series

Central venous catheterization (CVC) can be difficult, especially with pediatric patients in critical care. Accessing the subclavian vein (SCV) can cause serious complications, including pneumothorax, arterial puncture, and hemothorax. Recently, the ultrasonographic (USG) technique has gained popularity, but its efficiency is not yet confirmed. Subclavian venous catheterization (SCVC) through the supraclavicular approach (SCA) with USG or accessing the brachiocephalic vein through the infraclavicular approach (ICA) has been reported in the past. A useful technique is reported that involves the use of a 40 mm probe rather than the usual 25 mm probe in order to confirm the location of the needle while successfully performing subclavian venous catheterization in pediatric patients weighing 1.1 kg to 15.0 kg.

Ultrasound guidance for bedside placement of peripherally inserted central catheter in pediatric patients

Ultrasound guidance for bedside placement of peripherally inserted central catheter in pediatric patients

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Introduction: Alteplase (recombinant tissue plasminogen activator) is the primary therapeutic option to noninvasively salvage an occluded catheter due to thrombus. The use of alteplase as a local instillation (dwell) for clearing partial occlusions in central venous catheters is well documented in the literature; however, there is a paucity of information published regarding the use of continuous infusions. The purpose of this study was to evaluate the efficacy and safety of continuous low-dose alteplase infusions to clear partially occluded catheters. Hypothesis: The authors hypothesized that the use of continuous low-dose alteplase infusions was both effective and safe for clearance of partially occluded central venous catheters in pediatric patients. Methods: The medical record of pediatric intensive care unit patients who received a low-dose alteplase infusion as the primary treatment for a partial catheter occlusion was retrospectively reviewed for efficacy and safety. All types of pediatric central venous catheters were included. The typical alteplase regimen was to administer 0.1 mg/kg (max 2 mg) of alteplase in 25 mL of 0.9% sodium chloride over 3 hours. Efficacy was defined as documentation of positive blood return from the catheter at the conclusion of the alteplase infusion. Physician, nursing, and radiology documentation and laboratory values were reviewed to assess for bleeding events. Results: 85 low-dose alteplase continuous infusions were used throughout the study time period. 71 of 85 (84%) alteplase infusions resulted in an initial positive blood return from the catheter. Only 1 catheter that initially failed to resolve was re-dosed with alteplase within 24 hours of the first dose, resulting in positive blood return (combined efficacy of 85%). No bleeding events were attributed to the alteplase infusion. Conclusions: Overall, 72 central venous catheter lumens with partial occlusions were salvaged with low-dose alteplase infusions, supporting the efficacy of this practice. No adverse events due to alteplase were identified, supporting the safety of this practice. The use of an infusion may be of benefit to avoid a bolus of alteplase if the dwell is unsuccessful and offer potential cost savings.

Trimming long‐term tunneled central venous catheters in pediatric patients

Long-term tunneled central venous catheters (CVC) are employed in critically ill patients. Manufacturers do not provide patient-customized devices; therefore, trimming is required for pediatric use. Scanning Electron Microscopy (SEM) coupled with energy-dispersive X-ray spectroscopy and attenuated total reflection-Fourier transform infrared spectroscopy (ATR-FTIR) was used to assess changes induced by different trimming methods on single and double lumen Hickman-Broviac catheters. Increased roughness, exposure of inorganic macroaggreagates and increase in surface inorganic charges were generated by the trimming procedure, with the scalpel producing a smoother surface compared to scissors. Trimming produces changes on the CVC surface that may influence the rate of long-term complications.

Effective Radiation Dose in Computed Tomographic Angiography of the Chest and Diagnostic Cardiac Catheterization in Pediatric Patients

Computed tomographic angiography (CTA) and cardiac catheterization are useful adjuncts to echocardiography for delineating cardiovascular anatomy in pediatric patients. These studies require ionizing radiation, and it is paramount to understand the amount of radiation pediatric patients receive when these tests are performed. Modern dosimetry methods facilitate the conversion of radiation doses of varying units into an effective radiation dose. To compare the effective radiation dose between nongated CTA of the chest and diagnostic cardiac catheterization in pediatric patients. This is a retrospective cohort study of patients of patients who underwent either nongated CTA of the chest or diagnostic cardiac catheterization between July 2009 and April 2010. Fifty patients were included in each group as consecutive samples at a single tertiary care center. An effective radiation dose (mSv) was formulated using conversion factors for each group. The median effective dose (ED) for the CTA group was 0.74mSv compared with 10.8mSv for the catheterization group (p<0.0001). The median ED for children <1year of age in the CTA group was 0.76mSv compared with 13.4mSv for the catheterization group (p<0.0001). Nongated CTA of the chest exposes children to 15 times less radiation than diagnostic cardiac catheterization. Unless hemodynamic data are necessary, CTA of the chest should be considered in lieu of diagnostic cardiac catheterization in patients with known or presumed cardiac disease who need additional imaging beyond echocardiography.

A proactive risk assessment by utilizing Healthcare Failure Mode and Effect Analysis (HFMEA) for safe implementation for peripheral nerve catheters in pediatric patients

Introduction: In 2011, Nationwide Children’s Hospital began using peripheral nerve catheters (PNC) to provide postoperative analgesia to patients undergoing select orthopedic and abdominal surgeries. While PNCs provide a significant improvement in the quality of care that our patients receive, introducing this new technology and process within our hospital presents an inherent risk. Methodology: In order to assure that our patients received the safest care, we assembled a multi-disciplinary team to complete a proactive risk assessment by utilizing Healthcare Failure Mode and Effect Analysis (HFMEA). HFMEA was designed by the VA National Center for Patient Safety to identify potential failure modes within systems, and to study the consequences the failure modes have on customers. The result of this process identified and evaluated 96 failure modes and therefore 19 specific interventions were developed and deployed. Conclusion: The HFMEA process gives us confidence that new pain management techniques and their related processes can be safely and effectively implemented in order to provide the safest and highest quality care to our patients.