Effects of Topical Anesthetics to Reduce Pain in Preterm Infants During Percutaneous Cental Venous Catheterization (PCVC) / 대한주산의학회잡지

PURPOSE: The purpose of this study is to prove the effects of topical anesthetics (EMLA) to control pain in preterm infants during invasive procedure (percutaneous central venous catheterization, PCVC). METHODS: A total of 18 preterm infants of birth weight <2,000 g and gestational age <36 weeks born at EulJi University Hospital, at Daejeon in 2010 were randomly included in this study. EMLA was applied in nine preterm infants 40 minutes before starting PCVC and placebo was applied in another nine preterm infants. Based on PIPP (preterm infant pain profile), we evaluated their heart rate, oxygen saturation before, 15 seconds during and 30 seconds after procedure. Behavioral responses were also recorded for 2 minutes after procedure. RESULTS: Experimental group showed significantly less behavioral response during procedure (P=0.005) and 2 min after procedure (P=0.001). Also, experimental group showed less increase in heart rate (P=0.033) and reduction of behavioral state (P=0.017). CONCLUSION: Despite limitation of small size in this study, experimental group showed lower pain score compared with placebo control group during catheterization. In neonatal care unit (NICU), we recommend the use of topical anesthetics such as EMLA to control pain during invasive procedures.

Effects of Percutaneous Central Venous Catheterization in very Low Birth Weight Infants

PURPOSE: The present study was aimed to investigate the clinical effects of percutaneous central venous catheterization (PCVC) such as frequency of venipuncture, duration of fluid therapy and changes of weight gain in very low birth weight infants. METHODS: The subjects were 70 very low birth weight infants, weighing from 1,000 to 1,500 g, hospitalized in the neonatal intensive care unit at Chonnam University Hospital during the period from January 1998 to December 1999. The control group of 35 infants was subjected to a conventional peripheral venipuncture during the first one year, and the study group of 35 infants used PCVC during the later one year. Data were analyzed using repeated measures of GLM and Student' t-test in SAS program. RESULTS: The frequency of venipuncture was significantly lower in PCVC group than in the control (P=0.0001). Duration of total parenteral nutrition was significantly longer in PCVC group than in the control (P=0.03). The weight gain after the initial weight loss was significantly greater in PCVC group than in the control (P=0.009). CONCLUSION: It is suggested that PCVC may reduce the stress of repeated venipucture. In addition, PCVC may keep the parenteral nutrition longer and may enhance the weight gain in very low birth weight infants.

Clincal Trial of Percutaneous Central Vein Catherization Via Great Saphenous Vein

PURPOSE: We performed a comparative study on clinical impacts in the neonatas in the neonatal intensive care unit (NICU), who received vascular access through percutaneous central venous catheterization (PCVC), between one group via vessels of upper extremity, and the other group via the great saphenous vein. METHODS: We evaluated a total of 158 PCVC cases performed in the NICU of Soonchunhyang Chunan Hospital over 1 year 8 months from January, 1997 to September, 1998. The 134 cases of PCVC were performed via veins located on upper extremity and 34 cases of this procedures were performed via veins located on the great saphenous vein. We have compared success rates, clinical characteristics, indwelling time, causes of removal of the catheters, and associated complication between both upper extremity group and the great saphenous vein group retrospectively. RESULTS: There were no significant differences in the mean gestational age, birth weight, weight at the time of insertion between two groups. There were no significant differences in indwelling time between two groups, 20.0+/-12.8 days in upper extremity group, and 13.1+/-4.4 days in great saphenous vein group respectively (P<0.1). The overall success rate of insertions was 94.9% (150/158), the success rate of upper extremity group was 96.3% (129/134) and great saphenous vein group was 87.5% (21/24) and there were no significant differences. The most common site of tip of catheter was right atrium in both groups, that was confirmed by radiologic evaluation after venous access. The common cause of removal of the catheter was elective in both groups. Another secondary common cause of removal was mechanical complication, the rate of which was 17.1% in upper extremity group, 33.3% in great saphenous vein group. CONCLUSION: We found that there were no significant differences on success rate of insertion of central venous catheter between two groups and the rate of removal of catheter from mechanical complication caused by obstruction of it were higher in great saphenous vein group, than upper extremity group in comparison. Accordingly, further study should be performed about handling and management of central venous catheter after catherization via great saphenous vein.