ABSTRACT
RESUMO Objetivo: Determinar os fatores de risco para contrair infecções da corrente sanguínea associadas a cateter de acesso central em unidades de terapia intensiva pediátrica, e investigar a incidência e a etiologia dessas infecções nas unidades de terapia intensiva pediátrica com diferentes perfis. Métodos: Este foi um estudo prospectivo de coorte, conduzido em três hospitais. Um deles é um grande hospital público metropolitano, com duas unidades de terapia intensiva pediátrica que contabilizam 19 leitos; o segundo é um hospital regional com oito leitos em unidade de terapia intensiva pediátrica; e o terceiro é um hospital privado com 15 leitos de terapia intensiva pediátrica. Incluíram-se pacientes com idades entre 1 mês e 18 anos, que utilizaram cateter de acesso venoso central por pelo menos 24 horas. Registramos a evolução diária dos pacientes. Colheram-se dados gerais sobre o paciente e sobre o cateter, utilizados como variáveis. Todos os dados foram analisados com utilização do pacote estatístico Statistical Package for Social Science (SPSS), versão 13.0, para comparação de pacientes com infecção da corrente sanguínea associada a cateter com ou sem fatores de risco. Resultados: Durante o período do estudo admitiram-se às unidades de terapia intensiva 728 pacientes; deles, 170 tiveram cateter de acesso venoso central instalado por, no mínimo, 24 horas. A mediana de idade foi de 32 meses, e 97 (57%) dos pacientes eram do sexo masculino. A taxa de incidência de infecções da corrente sanguínea relacionadas a cateter foi de 3,9/1.000 cateteres venosos centrais-dias. A incidência variou entre os hospitais, sendo de 1,6 a 6,6. A taxa geral de mortalidade foi de 11,1%, e as taxas de mortalidade com e sem infecções da corrente sanguínea relacionadas a cateter foram, respectivamente, de 12,9% e 10,7%. Na análise multivariada, os fatores de risco para ocorrência de infecções da corrente sanguínea relacionadas a cateter foram maior tempo de uso do cateter venoso central (OR: 1,07; IC95% 1,00 - 1,14; p = 0,019) e o uso de mais de um cateter venoso central de uma vez (OR: 2,59; IC95% 1,17 - 5,73; p = 0,048). Conclusão: Maior duração do uso de cateter venoso central e mais de um cateter venoso central de uma vez foram os principais fatores de risco para infecções da corrente sanguínea associadas a cateter em unidades de terapia intensiva pediátrica.
ABSTRACT Objectives: To determine the risk factors for acquiring central line-associated blood stream infections (CLABSI) in pediatric intensive care units and to investigate the incidence and etiology of CLABSI in pediatric intensive care units with different profiles. Methods: The study was a prospective cohort study in three hospitals. One of the hospitals is a large metropolitan public hospital with two pediatric intensive care units and a total of nineteen pediatric intensive care unit beds, another is a regional hospital with eight pediatric intensive care unit beds, and the third is a private hospital with fifteen beds. Patients between the ages of 1 month old and 18 years old who used a central venous catheter for over 24 hours were included. We recorded patients' daily progress. General patient and catheter-related data were collected and used as variables. All the data were analyzed using Statistical Package for Social Science (SPSS), version 13.0, to compare patients with CLABSI with or without risk factors. Results: A total of 728 patients were admitted to the pediatric intensive care units, and 170 had a central line in place for at least 24 hours. The median age was 32 months, and 97 (57%) of the patients were males. The CLABSI incidence rate was 3.9/1000 central venous catheter-days. The incidence among hospitals varied from 1.6 to 6.6. The overall mortality rate was 11.1%, and the CLABSI and non-CLABSI mortality rates were 12.9% and 10.7%, respectively. In multivariate analysis, independent risk factors for CLABSI were a longer duration of central venous catheter use (OR: 1.07; 95%CI 1.00 - 1.14; p = 0.019) and the use of more than one central venous catheter at once (OR: 2.59; 95%CI 1.17 - 5.73; p = 0.048). Conclusion: A longer duration of central venous catheter use and the use of more than one central venous catheter at once were the main risk factors for CLABSI in pediatric intensive care units.
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Catheterization, Central Venous/adverse effects , Intensive Care Units, Pediatric , Catheter-Related Infections/epidemiology , Central Venous Catheters/adverse effects , Time Factors , Catheterization, Central Venous/methods , Incidence , Multivariate Analysis , Prospective Studies , Risk Factors , Cohort Studies , Catheter-Related Infections/etiology , Catheter-Related Infections/mortalityABSTRACT
Background: The primary aim of this study was to compare the incidence of accidental arterial puncture during right internal jugular vein (RIJV) cannulation with and without ultrasound guidance (USG). The secondary end points were to assess if USG improves the chances of successful first pass cannulation and if BMI has an impact on incidence of arterial puncture and the number of attempts that are to be made for successful cannulation. Settings and Design: Prospective observational study performed at a single tertiary cardiac care center. Material and methods: 255 consecutive adult and pediatric cardiac surgical patients were included. In Group I (n = 124) USG was used for the right internal jugular vein cannulation and in Group II (n = 81) it was not used. There were 135 adult patients and 70 pediatric patients. Statistical analysis: Demographic and categorical data were analyzed using Student ‘t’ test and chi- square test was used for qualitative variables. Results: The overall incidence of accidental arterial puncture in the entire study population was significantly higher when ultrasound guidance was not used (P < 0.001). In subgroup analysis, incidence of arterial puncture was significant in both adult (P = 0.03) and pediatric patients (P < 0.001) without USG. First attempt cannulation was more often possible in pediatric patients under USG (P = 0.03). In adult patients USG did not improve first attempt cannulation except in underweight patients. Conclusions: USG helped in the avoidance of inadvertent arterial puncture during RIJV cannulation and simultaneously improved the chances of first attempt cannulation in pediatric and in underweight adult cardiac surgical patients.