ABSTRACT
OBJECTIVE: Central venous cannulation of the internal jugular vein is difficult in paediatric patients because of the small size of the vein and anatomic variations. Many studies have shown the accuracy of various formulae for calculating the depth of placement. The aim of this study was to assess the most reliable method for central venous catheter (CVC) tip placement in paediatric patients. METHODS: Sixty-nine patients in the age groups from 0 to 12 years were divided in three groups for three published techniques for catheter tip placement. In Group E, catheter tip was placed at the distance measured from entry point to sternal angle. In Groups P and H, Peres and trans-oesophageal echocardiography (TEE)-derived formulae, respectively, were used for catheter placement. Post-procedure chest radiograph was performed for all patients, and tip position was recorded. Appropriate catheter tip position was considered just above or at the level of carina. The number of attempts and complications were recorded. Chi-square test was used for statistical analysis. RESULTS: Of 69 patients, 65% of patients in Group P, 52% in group H and 91% in group E had appropriate CVC tip placement. The chi-square test showed that the difference in the number of patients with appropriately positioned CVC tip among the three groups was statistically significant (p=0.0134), with intergroup analysis showing Group E to be superior. One patient had an episode of arrhythmia during guide wire insertion and was resuscitated successfully. CONCLUSION: Catheter tip placement by external distance or landmark technique is a more accurate method for catheter placement than the Peres and TEE-based formulae. It does not require measurement of patients' height and reduces the chances of repositioning of catheter.
ABSTRACT
BACKGROUND AND AIMS: The laryngoscope is a common piece of equipment used by anaesthesiologists. It has been identified as a potential source of cross infection. Although guidelines exist regarding appropriate disinfection practices, recent reviews suggest ineffectiveness of current methods of disinfection and poor compliance with the established protocols. We conducted a questionnaire-based survey to study the current disinfection practices being followed by a cross section of anaesthesiologists. METHODS: A simple questionnaire containing 13 questions was distributed amongst anaesthesiologists in an anaesthesia conference. Data were analysed with percentage analysis. RESULTS: Out of 250 delegates who attended the conference, 150 submitted the completed questionnaires. Residents constituted 41% and 46% were consultants. Eighteen (12%) used only tap water for cleaning and 132 (88%) used a chemical agent after rinsing with water. Out of 132, 76 (51%) used detergent/soap solution, 29 (19%) would wash and then soak in disinfectant or germicidal agents (glutaraldehyde, povidone iodine and chlorhexidine) and 18 (12%) would wipe the blade with an alcohol swab. With respect to disinfection of laryngoscope handles, 70% respondents said they used an alcohol swab, 18% did not use any method, 9% were not aware of the method being used, while 3% did not respond. CONCLUSION: Our results indicate wide variation in methods of decontamination of laryngoscopes. Awareness regarding laryngoscope as a potential source of infection was high. We need to standardise and implement guidelines on a national level and make available resources which will help to improve patient safety.
