Ultrasound guided vascular access in pediatric cardiac critical care

Safely obtaining vascular access in the pediatric population is challenging. This report highlights our real-world experience in developing a safer approach to obtaining vascular access using ultrasound guidance in children and infants with congenital heart disease. As part of a quality initiative, we prospectively monitored outcomes of all vascular access attempts guided by ultrasound from January 2010 to September 2010. Variables monitored included age, weight, the time from first needle puncture to wire insertion, site of insertion, number of attempts, type of line, and complications. There were 77 attempts [15 arterial and 62 venous] to obtain vascular access in 43 patients. The mean age was 15 months [6 days-11 years; median 2.5 months]. The mean weight was 7.2 kg [2-46 kg, median 3.8]. Success rates were 93% and 95% for arterial and venous cannulation, respectively. Mean time from first needle puncture to wire insertion was 3.9 min [0.5-15 min, median 2 min]. Fifty-five [75%] central line cannulations were successful from the first puncture; 17[23%] were successful from the second puncture; and one case [2%] required three punctures. Thirty patients [45%] weighed less than 3.5 kg. This lower body weight did not affect success rate, which was unexpectedly high [96.6%]. There were no associated complications. Ultrasound guided vascular cannulation in critically ill pediatric patients is safe, effective and efficient. This approach had a high success rate, and was associated with zero complications in our setting

rapid and accurate method for prevention and control of methicillin-resistant staphylococcus aureus in the ICU

Methicillin-resistant S. aureus [MRSA] oxacillin - resistant S. aureus [ORSA] is frequently encountered in health-care settings. Early screening for MRSA nasal colonization can identify patients requiring isolation and can be part of an effective infection control program. This study aimed to provide same-day results to facilitate rapid diagnosis and therapy MRSA to avoid hospital-acquired infections. A total of 80 patients from the medical intensive care units [ICUs] of El-Demerdash Hospital, Cairo Egypt, were screened for MRSA colonization. Two nasal swabs were collected from each patient, the first vortexed in the Liquid Stuart medium and two aliquots of 200 micro l were collected from the medium and tested. For direct culture, the 200 micro l aliquot was inoculated directly onto MRSA screening medium agar plate and incubated at 35[degree sign]C for 24-48h. The other 200 micro l aliquot was first cultured in a pre-enrichment broth medium for 24 hours at 35[degree sign]C, thereafter cultured onto MRSA screening medium agar for another 24-48 hr at 35[degree sign]C. The second swab was used to screen MRSA by a qualitative real-time PCR. Sixty six swabs [82.5%] were negative by culture and real time PCR for MRSA. Fourteen swab samples [17.5%] were positive by both methods. None was positive by culture only [0%], while the PCR assay detected additional four MRSA positive specimens [i.e 5%]. The sensitivity, specificity, positive-predictive value and negative-predictive value for PCR were 100%, 93.9%, 77.8% and 100%, respectively. Real-time PCR testing of nasal specimens can be used as a rapid and reliable technique for MRSA surveillance programs in the ICUs

Early outcome of tetralogy of fallot repair in the current era of management

Traditional use of trans-annular patch [TAP] to release right ventricular outflow tract [RVOT] obstruction during tetralogy of Fallot [TOF] repair may lead to a harmful pulmonary regurgitation. Different approaches have been used to release RVOT obstruction and spare the pulmonary valve [PV] function. In this study, we aim to evaluate the post-operative course of patients who had TOF repair in the current era that emphasizes on protective strategy of releasing RVOT obstruction and preserving PV function. A retrospective study of all TOF cases repaired in our institute between March 2002 and December 2007 was conducted. Cases were classified into two groups; group I included patients that had a TAP, while group II included cases that had simple TOF repair without TAP. Group I was subdivided into two groups, group [A] which include patients who had TAP without a valve. Group [B] includes those who had TAP with a monocuspid valve [Contegra]. We compared postoperative care and outcome of all groups. Eighty-three patients fulfilled the study criteria. There were 64 cases [77%] in group I, and 19 cases [23%] in group II. All children tolerated surgical repair and did well. We observed no statistically significant difference in the post-operative ICU care, complications rates and morbidity between all groups. There was no surgical mortality in all groups. Children undergoing TOP repair had excellent short-term outcome with the current protective strategy aiming to spare valvular function, and conserving myocardial function. Applying a monocuspid patch technique did not show clear short-term benefits. Long term follow up is needed to evaluate future difference in different techniques