Peripheral Line Research Articles

Purposeful Hourly Rounding to Decrease Peripheral Intravenous Infiltrations and Extravasations in Pediatrics

PurposePediatric patients are at high risk for peripheral intravenous infiltrations and extravasations (PIVIE) resulting in patient harm. Structured hourly rounding has demonstrated to improve quality outcomes. The purpose of this quality improvement project was to implement structured hourly rounding to decrease the median rate of moderate PIVIE rates from 3.13 to 2.58 per thousand patient days over a 6-month time period in pediatric patients with infusing continuous IV fluids. Design and methodsA pilot was conducted to hardwire hourly assessments for peripheral intravenous lines (PIV) in pediatric patients with continuous fluids utilizing a structured hourly rounding process. Bedside nurses utilized the P.A.T.H. model to assess pain management (P), assess PIVs for early PIVIE recognition (A), address things patient and family may need (T), and reduce the occurrence in hospital acquired conditions (H). Data was collected on unit nurse sensitive indicators and compliance to hourly rounding. ResultsStructured hourly rounding using the P.A.T.H. model successfully hardwired hourly PIV assessments. The unit reduced their median moderate PIVIE rate to 1.83 per thousand patient days, an 41% improvement. The pilot also had positive unintended consequences of improved pain reassessment from 67% to 100%, increased patient satisfaction scores of 67% to 97% and reduced patient falls by 29%. ConclusionsStructured hourly rounding using the P.A.T.H. model can positively hardwire hourly PIV assessments in pediatric patients. Practice implicationsSustainability of hourly rounding requires leadership support and nursing commitment to impact quality metrics. Organizations should consider implementing focused hourly rounding to address PIVIEs.

Safety in Dermatologic Procedures: Hypertensive Crises and Potentially Fatal Arrhythmias

As dermatologic surgeons often have to perform long surgeries with local anesthetic only, they should be familiar with the fundamentals of how to manage 2 potentially serious complications: Hypertensive crises and intraoperative arrhythmias.Hypertensive crises can be classified as 1) hypertensive urgencies, characterized by a significant spike in blood pressure (>180/110 mmHg) without target-organ dysfunction or 2) hypertensive emergencies, characterized by a blood pressure above 180/110 mmHg with progressive target-organ damage. In emergencies, the blood pressure needs to be reduced immediately whereas in urgencies the goal is to reduce it over several days. Care must still be taken not to reduce the blood pressure excessively rapidly in emergencies, however, to avoid ischemic injury to vascular beds that have adapted to a high blood pressure.We recommend that dermatologic surgeons use captopril in hypertensive emergencies because of its safety profile and ease of use. Asymptomatic intraoperative bradycardia does not require treatment, but patients should always be checked to ensure they are alert and responsive. The first step in clinically stable patients with tachycardia is to measure the width of the QRS complex and notify the anesthetist when this is wide.Dermatologic surgeons should also be familiar with the drugs available in the operating room, ensure that they are easily accessible, and identify the most essential ones so they can familiarize themselves with indications and dosage. Patients should be monitored throughout the operation, and material to secure a peripheral intravenous line should be prepared in case of need. Finally, the dermatologic surgeon should know all the staff working in the operating room and be able to locate the specialist in anesthesia and resuscitation.

Accuracy of Noninvasive Blood Pressure Versus Central Aortic Pressure in Patients Supported on Left Ventricular Assist Device Therapy.

Accuracy of Noninvasive Blood Pressure Versus Central Aortic Pressure in Patients Supported on Left Ventricular Assist Device Therapy.

Establishment and genomic characterization of a sporadic malignant peripheral nerve sheath tumor cell line

Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive Schwann cell-derived neoplasms that occur sporadically or in patients with neurofibromatosis type 1 (NF1). Preclinical research on sporadic MPNSTs has been limited as few cell lines exist. We generated and characterized a new sporadic MPNST cell line, 2XSB, which shares the molecular and genomic features of the parent tumor. These cells have a highly complex karyotype with extensive chromothripsis. 2XSB cells show robust invasive 3-dimensional and clonogenic culture capability and form solid tumors when xenografted into immunodeficient mice. High-density single nucleotide polymorphism array and whole exome sequencing analyses indicate that, unlike NF1-associated MPNSTs, 2XSB cells have intact, functional NF1 alleles with no evidence of mutations in genes encoding components of Polycomb Repressor Complex 2. However, mutations in other genes implicated in MPNST pathogenesis were identified in 2XSB cells including homozygous deletion of CDKN2A and mutations in TP53 and PTEN. We also identified mutations in genes not previously associated with MPNSTs but associated with the pathogenesis of other human cancers. These include DNMT1, NUMA1, NTRK1, PDE11A, CSMD3, LRP5 and ACTL9. This sporadic MPNST-derived cell line provides a useful tool for investigating the biology and potential treatment regimens for sporadic MPNSTs.

Incidence of Phlebitis Following the Use of Peripheral IV Line at X Hospital

Introduction: Intravenous (IV) line infusion therapy is a therapy given to patients who are admitted or having a specific therapy. The IV-line therapy may include fluid therapy, medication administration and blood therapy. Based on the data found in Hospital X, there were 30 incidence of phlebitis in 2017. This study aimed to describe the factors of phlebitis incidence in X hospital. Method: This study was a retrospective study using 50 clinical record of the inpatient patients. The inclusion criteria were all documents of those who are hospitalized at least three days. Result: The result describes three factors following the incidence of phlebitis, such as intrinsic factors, chemical factors, and mechanical factors. The Intrinsic factors included age, gender and medical diagnosis. While Mechanical factors consist of the size of catheter, location and length of infusion. The Chemical factors were of infusion fluid type and infusion rate. Conclusion: The conclusion of this study was the three factors are modifiable factors. Thus, nurses need to assess and evaluate patients’ infusion in order to prevent a higher case of phlebitis. As a recommendation for further study is to analyze the correlation between those factors to the incidence of phlebitis.

A184 INCIDENCE OF VENOUS THROMBOTIC EVENTS AND RISK FACTORS IN CHILDREN HOSPITALIZED WITH INFLAMMATORY BOWEL DISEASE: A RETROSPECTIVE, CASE-CONTROL STUDY

Abstract Background Limited research has been published to describe the incidence of venous thromboembolism (VTE) and relevant risk factors in Canadian children with inflammatory bowel disease (IBD). Aims The present study aimed to investigate the incidence of VTE amongst hospitalized pediatric IBD patients over a 10-year period and identify risk factors for the development of VTE. Methods A retrospective, matched case-control study was performed at McMaster Children’s Hospital. Hospitalized pediatric patients with IBD (<18 years old) from September 2009 to August 2020 were selected. Inpatient data was extracted from the medical record database, including baseline demographic data, thromboembolic events and potential risk factors for VTE. Results There were 890 hospitalizations of IBD patients during the study period. 15 (1.69%) were diagnosed with a VTE, including 4 males and 11 females (mean age 13.4±2.9 years old). 12 ulcerative colitis (UC) (80%) and 3 Crohn’s disease (CD) (20%) hospitalizations were comprised in the VTE group. There was a significant difference in VTE rate between females (2.7%) and males (0.8%) (P = 0.03). The VTE rate in the UC group (4.2%) was significantly higher than in the CD group (0.6%) (P = 0.001). The incidence of VTE amongst hospitalized IBD patients did not vary over the 10-year period (P = 0.496). Length of stay in hospital, albumin level and central venous catheter were shown to be significantly different, although they were not identified as independent risk factors (P >0 .05). Of the 15 hospitalizations with VTE, 6/15 (40%) were superficial VTEs in the extremities and 9/15 (60%) had a deep vein thrombosis (DVT) including 6 in the extremities and 3 in the abdomen. VTEs were associated with a peripheral line in 7 patients and with a PICC line in 4 hospitalizations. 2 of 9 (22%) with extremity DVT developed symptomatic pulmonary embolism. An inherited thrombotic condition was identified in 2 of 15 with VTEs. 12/15 (80%) with VTEs were symptomatic and all VTE related symptoms happened in patients with extremity thrombosis and pulmonary embolism. 7 of 15 (47%) VTEs were treated with anticoagulation therapy for 1–6 months. VTE related symptoms and repeat imaging tests significantly improved, and no patient developed a bleeding complication as a result of treatment. Conclusions The VTE rate in pediatric IBD patients was relatively low at McMaster Children’s hospital. Children with VTE were disproportionately females with ulcerative colitis compared with children with no VTE. Central venous line insertion may be correlated with the risk for VTE in children with IBD. Most VTEs and related symptoms happened in patients with extremity thrombosis and secondary pulmonary embolus. Anticoagulation therapy in children with IBD with active disease appears to be safe. Funding Agencies Kids Dig Health Funding from McMaster Children’s Hospital, McMaster University

The Effect of Focus of Attention on Error Detection Ability

The teaching of error detection is a complicated process, made more so by our evolving understanding of the psychological processes involved with attention itself. The purpose of this study was to explore the impact of listener attention on the error detection process. Guiding research questions were as follows: (1) In what ways does directing attention influence one’s ability to detect errors? and (2) Does voicing of error influence participants’ ability to detect the error? Participants ( N = 64) at six universities listened to 40 recorded excerpts of three-part Haydn divertimenti, either focusing on one line or holistically, while marking errors on a printed score. Participants were better able to detect errors in lines of focus than in peripheral lines and were similarly better at detecting errors in an unfocused listening condition versus focusing on any one of the lines. Additionally, participants were most successful in detecting peripheral errors when focusing on the middle staff and were least successful in detecting errors in the bass line, even when focusing on the bass line. Suggestions for future research and implications for music education are discussed.

Safety of administration of norepinephrine through peripheral vein line in patients with septic shock

To analysis the risk factors and safety of administration of norepinephrine (NE) via peripheral vein line (PVL) in patients with septic shock. A single-center retrospective study was conducted. According to the Lanzhou University Second Hospital information system (HIS) and nursing adverse events report cards, patients with septic shock administrated with NE via PVL to correct the hypotension from January 1st 2015 to December 31st, 2019 were enrolled. The patients' general information, placement location of peripheral venous catheter and venousneedle type, characteristics of NE usage and patient general condition when extravasation occurred were collected. The univariate analysis and Logistic regression were used to analyze risk factors associated with extravasation. Also, the receiver operator characteristic curve (ROC curve) was drawn, and the predictive value of risk factors for extravasation was analyzed. A total of 1 022 cases with NE were enrolled. After a preliminary screening, a total of 910 cases with NE were used to correct low blood pressure, including 116 cases of peripheral venous infusion. The average age was (52.91±18.69) years old, with majority of female (77 cases, 66.4%). Basic diseases were mainly chronic obstructive pulmonary disease (COPD, 100 cases, 86.2%), followed by hypertension (91 cases, 78.4%), coronary heart disease (87 cases, 75.0%), type 2 diabetes (74 cases, 63.8%) respectively, the primary disease was septic shock in 109 cases (94.0%). A total of 147 peripheral venous catheters were inserted, and the most common site of puncture was the forearm [78.9% (116/147)], followed by the hand [12.2% (18/147)] and the median cubital vein [8.8% (13/147)]. 89.9% of the needles were 20 G in diameter, and 75 cases (64.7%) were converted to central venous catheters (CVC) during subsequent treatment due to continuous infusion of NE. Six patients (5.2%) had extravasation, the median time of extravasation was 29 (23-39) hours, and the median time of NE was 23 (11-53) hours, including 2 patients with an infusion concentration of 60 mg/L and 4 patients with an infusion concentration of 120 mg/L.The infusion speed was 0.5-1.0 μg×kg-1×min-1, and the average speed of infusion was (0.75±0.04) μg×kg-1×min-1 when extravasation. Univariate and binary Logistic regression analysis showed that the risk factors related to the occurrence of extravasation included: (1) patient factors: the presence of basic diseases, hypertension [odds ratio (OR) = 3.11, 95% confidence interval (95%CI) was 3.09-3.12, P = 0.001] and edema (OR = 1.79, 95%CI was 1.32-2.99, P = 0.032). (2) Factors of infusion fluid itself: long-term (> 24 hours) infusion (OR = 2.91, 95%CI was 1.04-5.96, P = 0.040), infusion concentration > 60 mg/L (OR = 1.88, 95%CI was 1.32-3.99, P = 0.024), infusion speed > 0.3 μg×kg-1×min-1 (OR = 2.43, 95%CI was 2.38-2.51, P = 0.029) and diameter of needles < 20 G (OR = 3.11, 95%CI was 3.09-3.22, P = 0.033). (3) Medical personnel factors: lack of observation and assessment (OR = 1.09, 95%CI was 1.03-6.77, P = 0.043). The ROC curve analysis showed that: edema, long-term infusion (> 24 hours), infusion rate > 0.3 μg×kg-1×min-1 and diameter of needles < 20 G had a certain predictive value for extravasation of NE through peripheral venous infusion in patients with septic shock, the area under ROC curve (AUC) was 0.610, 0.762, 0.672, 0.629, 95%CI was 0.508-0.713, 0.675-0.849, 0.571-0.772, 0.525-0.732, and P values were 0.044, 0.000, 0.002, 0.019, respectively. Hypertension, edema, long-term infusion (> 24 hours), infusion concentration > 60 mg/L, infusion speed > 0.3 μg×kg-1×min-1, diameter of needle < 20 G, and lack of observation and evaluation by medical staff regularly were risk factors affecting the safety of peripheral intravenous NE in patients with septic shock. Peripheral NE should be avoided in the presence of the above risk factors.

P0536 / #750: PERIPHERAL INOTROPES - IS IT SAFE?

Aims & Objectives: Inotropes are ideally infused through central line in PICU. However during an emergency and prior to securing a central venous access vasoactive medications are frequently infused through peripheral line. The aim of the study was to estimate the safety of peripheral vasoactive inotropes use in PICU. Methods: All children admitted to PICU from 1st January 2018 to 1st October 2018 needing peripheral inotrope infusions were included in this study. Data were collected through a retrospective review of the medical records and the frequency of local tissue injury due to peripheral vasoactive medications was determined. Peripheral inotrope infusion concentration was lower (half diluted) than the concentration of central line inotrope infusion. Results: A total of 51 children (M/F: 25/26) were included in the study. The median age was 32 months (IQR: 7 - 75 months). 22 gauge peripheral venflon catheter was used for all the infusions. Vasoactive medications used were Adrenaline (35/51), Nor Adrenaline (33/51), Dopamine (4/51), Dobutamine (6/51), Milrinone (4/51) and Vasopressin (2/51). The mean duration of vasoactive medications was for 12 hours (range: 1 -72 hours) and the mean peak vasoactive infusion score was 26 (range:5 - 105). 6% of children (3/51) developed extravasation injury, of which two had local tissue necrosis that was managed conservatively. Conclusions: Our study shows that extravasation injury due to peripheral inotrope infusion is very low and it can be safely administered in children at a low concentration (half dilution than central line concentration).

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

Disinfection of Ultrasound Transducers Used for Percutaneous Procedures: Intersocietal Position Statement.

SiO2 stimulates macrophage stress to induce the transformation of lung fibroblasts into myofibroblasts and its relationship with the sphingomyelin metabolic pathway.

Silicosis is a serious occupational disease with the highest incidence in China. However, its pathogenesis has not been fully elucidated. Studies have shown that the sphingomyelin signaling pathway may play an important role in different fibrotic diseases but its role in silicosis-mediated fibrosis is still unclear. In this study, the supernatant of human peripheral blood mononuclear cell line (THP-1)-derived macrophages exposed to silica (SiO2 ) was used to stimulate the transformation of human embryonic lung fibroblast cell line (HFL-1) into myofibroblasts, and the intervention effect of recombinant human acid ceramidase (rAC) was observed. The results showed that SiO2 stimulated the production of reactive oxygen species and malondialdehyde in the supernatant of THP-1-derived macrophages and increased the secretion of TGF-β1, TNF-α, and IL-8. In addition, we found that the expression levels of α-SMA, FN, Col I, and Col III in HFL-1 cells increased. Meanwhile, the activities of ASMase and ACase and the expression levels of Cer, Sph, and S1P were increased. Intervention by rAC can suppress these changes to different degrees. In conclusion, the present study shows that SiO2 dust poisoning may stimulate HFL-1 cell differentiation into myofibroblasts by inducing oxidative stress in THP-1-derived macrophages, thereby promoting the secretion of a variety of inflammatory factors and activating the sphingolipid signaling pathway in HFL-1 cells. Exogenous rAC can effectively interfere with the stimulation of HFL-1 cells by silica in vitro.

Internship commencement during COVID-19: the impact of an extended induction model

BackgroundThe COVID-19 pandemic necessitated an enforced 8-week induction period (18 May to 12 July 2020) for all new interns in Ireland. These unprecedented circumstances presented a unique opportunity to assess this induction period.AimTo assess the impact of a prolonged induction period on the technical abilities of interns embarking on their clinical careers.MethodWe distributed a 12-item questionnaire to new interns at our institution during the COVID-19 pandemic. Section 1 of the questionnaire was designed to assess the rate of self-reported improvement in the successful and independent execution of practical ‘intern’ tasks. Section 2 of the questionnaire captured the subjective experience of interns during this time in relation to the effectiveness of an 8-week induction period with senior intern support available. Statistical analysis of categorical predictor and ordinal outcome variables was performed using the two-sample Wilcoxon rank-sum (Mann-Whitney) test.ResultsOur results demonstrated a statistically significant improvement in the proficiency at first attempt phlebotomy in week 8 compared with week 1 (p < 0.0001). There was a significant improvement in placing first-attempt peripheral IV lines in week 8 compared with week 1 (p < 0.001). Regarding the need for senior assistance, we demonstrated a statistically significant reduction in week 8 compared with week 1 (p = 0.046). There were 95.56% (n = 43) of interns that said they would recommend the induction period for future incoming interns.ConclusionThe COVID-19 pandemic has inadvertently identified a model of internship induction that benefits interns, their colleagues and their patients through the production of more technically capable interns.

The impact of an outpatient parenteral antibiotic therapy (OPAT) clinic for adults with cellulitis: an interrupted time series study.

Emergency department (ED) patients with cellulitis requiring intravenous antibiotics may be eligible for outpatient parenteral antibiotic therapy (OPAT). The primary objective was to determine whether implementation of an OPAT clinic results in decreased hospitalizations and return ED visits for patients receiving OPAT. We conducted an interrupted time series study involving adults with cellulitis presenting to two EDs and treated with intravenous antibiotics. The intervention was the OPAT clinic, which involved follow up at 48-96h with an infectious disease physician to determine the need for ongoing intravenous antibiotics (implemented January 1, 2014). The primary outcomes were hospital admission and return ED visits within 14days. Secondary outcomes were treatment failure (admission after initiating OPAT) and adverse peripheral line or antibiotic events. We used an interrupted time series design with segmented regression analysis over one-year pre-intervention and one-year post-intervention. 1666 patients were included. At the end of the study period, there was a non-significant 12% absolute increase in hospital admissions (95% CI - 1.6 to 25.5%; p = 0.084) relative to what would have been expected in the absence of the intervention, but a significant 40.7% absolute reduction in return ED visits (95% CI 25.6-55.9%; p < 0.001). Treatment failure rates were < 2% and adverse events were < 6% in both groups. Implementation of an OPAT clinic significantly reduced return ED visits for cellulitis, but did not reduce hospital admission rates. An ED-to-OPAT clinic model is safe, and has a low rate of treatment failures.

Seguridad en procedimientos dermatológicos: crisis hipertensiva y arritmias potencialmente malignas

As dermatologic surgeons often have to perform long surgeries with local anesthetic only, they should be familiar with the fundamentals of how to manage 2 potentially serious complications: Hypertensive crises and intraoperative arrhythmias.Hypertensive crises can be classified as 1) hypertensive urgencies, characterized by a significant spike in blood pressure (>180/110mmHg) without target-organ dysfunction or 2) hypertensive emergencies, characterized by a blood pressure above 180/110mmHg with progressive target-organ damage. In emergencies, the blood pressure needs to be reduced immediately whereas in urgencies the goal is to reduce it over several days. Care must still be taken not to reduce the blood pressure excessively rapidly in emergencies, however, to avoid ischemic injury to vascular beds that have adapted to a high blood pressure.We recommend that dermatologic surgeons use captopril in hypertensive emergencies because of its safety profile and ease of use. Asymptomatic intraoperative bradycardia does not require treatment, but patients should always be checked to ensure they are alert and responsive. The first step in clinically stable patients with tachycardia is to measure the width of the QRS complex and notify the anesthetist when this is wide.Dermatologic surgeons should also be familiar with the drugs available in the operating room, ensure that they are easily accessible, and identify the most essential ones so they can familiarize themselves with indications and dosage. Patients should be monitored throughout the operation, and material to secure a peripheral intravenous line should be prepared in case of need. Finally, the dermatologic surgeon should know all the staff working in the operating room and be able to locate the specialist in anesthesia and resuscitation.

Electric Field Stimulation for the Functional Assessment of Isolated Dorsal Root Ganglion Neuron Excitability.

Genetically encoded calcium indicators have proven useful for characterizing dorsal root ganglion neuron excitability in vivo. Challenges persist in achieving high spatial-temporal resolutions in vivo, however, due to deep tissue imaging and motion artifacts that may be limiting technical factors in obtaining measurements. Here we report an ex vivo imaging method, using a peripheral neuron-specific Advillin-GCaMP mouse line and electric field stimulation of dorsal root ganglion tissues, to assess the sensitivity of neurons en bloc. The described method rapidly characterizes Ca2+ activity in hundreds of dorsal root ganglion neurons (221 ± 64 per dorsal root ganglion) with minimal perturbation to the in situ soma environment. We further validate the method for use as a drug screening platform with the voltage-gated sodium channel inhibitor, tetrodotoxin. Drug treatment led to decreased evoked Ca2+ activity; half-maximal response voltage (EV50) increased from 13.4V in untreated tissues to 21.2, 23.3, 51.5 (p < 0.05), and 60.6V (p < 0.05) at 0.01, 0.1, 1, and 10µM doses, respectively. This technique may help improve an understanding of neural signaling while retaining tissue structural organization and serves as a tool for the rapid ex vivo recording and assessment of neural activity.

Investigation of a new oxazolidine derivative in human resistance acute leukemia cells: deciphering its mechanism of action by label-free proteomic.

The present study aimed to evaluate the mechanism of action of the antineoplastic activity of an oxazolidine derivative, LPSF/NB-3 (5-(4-cloro-benzilideno)-3-etil-2-tioxo-oxazolidin-4-ona). Cytotoxicity assays were performed in peripheral blood mononuclear cells (PBMCs) and resistant acute leukemia cell line (HL-60/MX1) by the MTT method. LPSF/NB-3 exhibited cytotoxicity in HL-60/MX1, but it was not toxic to healthy cells in the highest dose tested (100 μM). The protein extract of HL-60/MX1 cells treated with LPSF/NB-3 was subjected to proteomic analysis using two-dimensional chromatography coupled to mass spectrometry. We could identify a total of 2652 proteins, in which 633 were statistically modulated. Within the group of protein considered for the quantitative analysis with the established criteria, 262 were differentially expressed, 146 with increased expression and 116 with decreased expression in the sample treated with LPSF/NB-3 compared to the control. The following differentially expressed pathways were found: involving regulation of the cytoskeleton, DNA damage, and transduce cellular signals. Networks that were highlighted are related to the immune system. The ELISA technique was used to assess the immunomodulatory potential of LPSF/NB-3 in PBMCs. We observed significant decrease of IFNγ (p < 0.01) and dose-response pattern of the cytokines IL-6, IL-17A, IL-22, and IL-10. Therefore, results suggest that LPSF/NB-3 appears to modulate important pathways, including cell cycle and immune system regulatory pathways.

Factors that Affecting the Skin Necrotic due to Extravasation Injury and Modality Theraphy at Pediatric Inpatient Ward dr. Soetomo Hospital Surabaya (Januari - Desember 2019)

Background: Extravasation injury is the most common complication of intravenous therapy in children. Research in the NICU at UK, found extravasation injury caused skin necrotic 38/1000 neonates, 70% of preterm neonates. Extravasation injuries and their sequels can be more serious morbidity than the underlying disease, potentially for amputation. The research objective was to determine the factors that influence the incidence of skin necrotic due to extravasation injury and the types of treatment modalities in the pediatric hospital Dr. Soetomo Hospital Surabaya for the period January - September 2019.Methods: This research is descriptive analytic with cross sectional approach with collected data from medical records. The medical records of 44 pediatric patients undergoing treatment at the pediatric inpatient ward of Dr. Soetomo Hospital Surabaya with skin necrotic due to extravasation injury which was brought to the Reconstructive and Aesthetic Plastic Surgery Dr. Soetomo Hospital Surabaya for the January - December 2019 period was reviewed retrospectively. We analyzed patient characteristics, risk factors, types of wound care therapy modalities, and case outcomes.Results: There were 44 cases of skin necrotic injury due to extravasation injury, with the largest percentage of neonates group (34%), male gender (66%), hypertonic fluids / drugs (73%), most regions of dorsum and wrist dextra (17%) and the most used therapeutic modality was autolytic debridement (45%).Conclusions: From this study, several conclusions can be drawn regarding the prevalence of skin necrotic due to extravasation injury, there was a relationship between the incidence of skin necrotic injury due to extravasation injury with age, types of fluid/drug given, and the location of the peripheral venous line, whereas the incidence was not related to gender. The initial treatment modality that is still frequently used today is autolytic debridement.

Central Venous Access in Children: Technique and Complications

Children with complex diseases often need central venous catheter, not only for intraoperative use, but also for parenteral nutrition, multiple blood draw due to lab examination and to administer drugs that cannot be given via peripheral lines. Whereas the landmark driven vascular access was teached for years, nowadays the routine use of ultrasound based techniques can be called the gold standard. This article highlights standard locations for central venous access like cannulation of the internal jugular vein as well as novel alternatives such as the cannulation of the brachiocephalic vein. The correct insertion depth of central lines is essential to avoid serious complications. Several different formulas are available and can be used. Independent of the used formula, you have to make sure that complications due to incorrect depth of central venous line are a topic of the past. Finally, important tips and tricks to avoid failure and serious complications are discussed.

Trends of Healthcare-associated Infections in a Tuinisian University Hospital and Impact of COVID-19 Pandemic.

BackgroundAlthough efforts to manage coronavirus disease 2019 (COVID-19) pandemic have understandably taken immediate priority, the impacts on traditional healthcare-associated infection (HAI) surveillance and prevention efforts remain concerning.AimTo describe trends in HAIs in a Tunisian university hospital through repeated point prevalence surveys over 9 years, assess the impact of measures implemented for COVID-19 pandemic, and to identify associated factors of HAI.MethodsThe current study focused on data collected from annual point prevalence surveys conducted from 2012 to 2020. All types of HAIs as defined by the Centers for Disease Control and Prevention (CDC) were included. Data collection was carried out using NosoTun plug. Univariate and multivariate logistic analysis were used to identify HAI risk factors.ResultsOverall, 2729 patients were observed in the 9 surveys; the mean age was 48.3 ± 23.3 years and 57.5% were male. We identified 267 infected patients (9.8%) and 296 HAIs (10.8%). Pneumonia/lower respiratory tract infections were the most frequent HAI (24%), followed by urinary tract infection (20.9%).The prevalence of infected patients increased from 10.6% in 2012 to 14.9% in 2020. However, this increase was not statistically significant. The prevalence of HAIs increased significantly from 12.3% to 15.5% (P =.003). The only decrease involved is bloodstream infections (from 2% to 1%). Independent risk factors significantly associated with HAI were undergoing surgical intervention (aOR = 1.7), the use of antibiotic treatment in previous 6 months (aOR = 1.8), peripheral line (aOR=2), parenteral nutrition (aOR=2.4), urinary tract within 7 days (aOR=2.4), central line (aOR = 6.3), and prosthesis (aOR = 12.8), length of stay (aOR = 3), and the year of the survey. Young age was found as protective factor (aOR = .98).ConclusionContrary to what was expected, we noticed an increase in the HAIs rates despite the preventive measures put in place to control the COVID-19 pandemic. This was partly explained by the vulnerability of hospitalized patients during this period.

Infusion of vasoactive drug through peripheral line: A myth or fact?

Infusion of vasoactive drug through peripheral line: A myth or fact?