Percutaneous central venous catheterization in children, is it efficient?

To evaluate the frequent use of percutaneous central venous catheters [CVCs] in pediatric age group. Retrospectively we reviewed the records of all children that had percutaneous CVCs in the pediatric surgical ward and pediatric intensive care unit at King Hussein Medical Center between January 2007 and December 2007 [one year]. Patients were evaluated with respect to their age, gender, catheter type, indication for CVC insertion, site of CVC insertion. The duration of catheter use and eventual complications were also taken into consideration. A total of 120 percutaneous CVCs were inserted in 104 children. Patient age ranged from one day to 14 years. The average catheter insertion time was 12.5 days. We noted 66 [18.8%] CVC- related complications. Complications related to percutaneous CVCs insertion were malposition of catheter [5.4%] and pneumothorax [0.9%]. Occlusion of CVCs [4.3%], catheter related bloodstream infections [CRBI] [4.0%], dislodgment [3.7%] and catheter damage [0.6%] were complications associated with length of CVCs use. We conclude that percutaneous central venous catheterization is a safe and efficient procedure that can be done at bedside with minimal complications in pediatric age group

Safety and efficacy of topical epinephrine solution 1/100,000 in hypospadias surgery

To evaluate the safety and the efficacy of topical epinephrine solution 1/100,000 in hypospadias surgery. Prospective study of 143 patients with variant types of hypospadias aged between 1-14 years who underwent different procedures for correction of hypospadias over 12 months period [August 2004-August 2005] were included in the study. Topical epinephrine solution 1/100,000 was used in 103 patients [group I], 40 patients were operated without topical epinephrine solution 1/100,000 [group II]. Heart rate, blood loss, skin ischemia, formation of haematoma operative time and wound infection were evaluated. Tourniquet was used in group I only for erection test in four patients with proximal penile hypospadias and two with penoscrotal hypospadias, Minimal use of bipolar diathermy in four patients, with complicated hypospadias where extensive dissection took place, was needed. There was minimal blood loss [average 5ml], and a negligible increase in heart rate and no skin ischemia. The average operative time was 100 minutes [range from 50 -150]. Tourniquet and bipolar diathermy were used in 36 patients in group II with average blood loss of [25m1]. The average operative time was 135 minutes [range from 60-185]. In group I, one patient developed hematoma after accidental trauma 5-days Post-operatively at home, 23 patients were discharged in the same day with or without urethral stent, 70 patients were discharged within 1 to 3 days post-operatively with urethral stent, 10 patients had 7-10 days hospital stay for major hypospadias repair with urinary catheter and suprapubic catheter for urinary diversion. One patient had wound infection. The majority of patients in group II were admitted for 7-10 days with urinary catheter. Few patients had suprapubic catheter as well for urinary diversion. Two patients had wound infection and four patients had post operative bleeding. Topical epinephrine solution 1/100000 is safe, decreases bleeding and wound hematoma in hypospadias surgery. It eliminates the need of tourniquet, minimizes the use of bipolar diathermy, and decreases the operative time, early hospital discharge and minimal complications