Incidence and risk factors of superficial and deep vein thrombosis associated with peripherally inserted central catheters in children.

Essentials Pediatric studies on peripherally inserted central catheter (PICC)-related thrombosis are scarce. This study analyzes incidence and risk factors for PICC-related venous thrombosis in children. PICC-related thrombosis is a common, and nearly always, asymptomatic complication. Echo-guided insertion and a catheter to vein ratio < 0.33 may notably decrease this complication. SUMMARY: Background Upper-extremity venous thrombosis is associated with the use of peripherally inserted central catheters (PICCs). Few pediatric studies have focused on this issue. Objectives To determine the incidence and risk factors for PICC-related superficial vein thrombosis (SVT) and deep vein thrombosis (DVT) in children. Patients/methods An observational follow-up cohort study was conducted at a single hospital between June 2012 and June 2015. All patients receiving a PICC were enrolled and followed up, with weekly Doppler ultrasound examination of the catheterized limb until PICC removal. Patient, procedural and follow-up data were analyzed. Results In the study period, 265 PICCs were inserted (median age of patients 6.5 years, interquartile range [IQR] 2.4-13 years; median weight 20 kg, IQR 11-38 kg; 54% males; 67.9% chronically ill), and patients were followed up for a total of 9743 days. The median indwelling time was 21 days (IQR 12-37 days). During follow-up, 88 (33.2% of insertions) PICC-related thromboses (incidence rate [IR] 9.03 per 1000 catheter-days) were diagnosed, 66 (24.9%) as isolated SVT, seven (2.6%) as isolated DVT, and 15 (5.7%) as SVT with associated DVT (IR 6.78, 0.71 and 1.54 per 1000 catheter-days, respectively). Only 9.9% of patients with SVT and 18.2% of those with DVT were symptomatic. The main risk factors for PICC-related SVT and DVT were a catheter/vein ratio of > 0.33 and thrombosis of the catheterized superficial vein, respectively. Conclusions PICC-related thrombosis is a common and nearly always asymptomatic complication in children, the SVT rate being approximately three times higher than the DVT rate. Optimal vein and catheter selection, yielding the lowest possible catheter/vein ratio, may decrease the rate of PICC-related thrombosis.

Novedades en RCP en el paciente cardiovascular / Novelties in CPR in the cardiovascular patient

No disponible

Paciente pediátrico crítico. Cuidados Intensivos Pediátricos, Hospital Infantil La Paz / Critical pediatric patient. Pediatric intensive cares, Hospital Infantil La Paz

Los Cuidados Intensivos Pediátricos (CIPs) iniciaron su actividad en el Hospital Infantil La Paz en el año 1074. El servicio actual dispone de 16 camas, cuatro de cuidados medios, ocho de cuidados intensivos y cuatro de aislamiento con exclusa y filtros HEPA (High Efficiency Particulate Air). En los últimos 6 años (2006-2010) se han atendido 3.674 pacientes, media de 612 pacientes año, con una ocupación media anual del 83,4% y mortalidad media anual del 4,9%. Al ser considerado un servicio polivalente, se ha establecido una estrecha colaboración prácticamente con la totalidad de los servicios y especialidades pediátricas médico-quirúrgicas del hospital, con mayor o menor frecuencia según las patologías asistidas, destacando entre las patologías asistidas, destacado entre las patologías quirúrgicas los pacientes con asistencia ventricular (Berlin Hear), ECMO (Extracorporeal Membrane Oxygenation) y trasplante cardiaco; así como tratamiento psotoepratorio de los trasplantes hepáticos, renales, intestinales y multiviscerales. Entre las líneas de trabajo, hay que destacar el tratamiento intracoronario con células progenitoras autólogas de médula ósea en pacientes con miocardiopatía dilatada e insuficiencia cardíaca; creación de un equipo mixto, médico y de enfermería para el abordaje guiado por ecografía, de accesos venosos centrales insertados periféricamente; registro de una patente europea de válvula de cierre ultrarrápido y sin fugas para respiradores; utilización a nivel pediátrico de la tecnología ventilatoria NAVA (Neurally Adjusted Ventilatory Asist); monitorización hemodinámica con el monitor PiCCO2 (Pulsion Medical System); la promoción de la ecuación médica basada en la simulación de ata fidelidad y la implantación de la asistencia ventricular externa en Pediatría (AU)

The Pediatric Intensive Care Unit of La Paz Universitary Hospital, was founded in 1974. It is now a polyvalent medical-surgical tertiary unit, equipped with 4 intermediate care beds, 8 intensive care beds and 4 isolation beds with airlock and HEPA filters for the treatment of transplanted and immunocompromised patients. In the last 6 years, 3674 patients have been treated (mean 612 patients/year) with a mean occupancy rate of 83,4% and a mortality rate of 4,9&. As the polyvalent unit it is, PICU staff maintains close and daily contact and cooperation with almost all the rest of the medical and surgical departments of the hospital. In this regard Critically ill cardiac patients are admitted in the PICU ( for the treatment with ECMO and ventricular assist devices (EXCOR Berlin Heart), as well as post-operative patients after cardiac, liver, renal, intestinal and multivisceral transplantation. Of all the achievements and current lines of work of the department, it can be highlighted the intracoronary treatment with autologous bone marrow derived progenitor cells in patients with dilated cardiomyopathy, the implantation development of a pediatric ventricular assist program, the echo guided cannulation of peripherally inserted central venous catheter by a especially trained intravenous therapy team, the registration of a European patent for a ultrarapid shutoff respirator valve, the incorporation of NAVA mode for mechanically ventilated patients and the PiCCO2 monitor for the hemodynamic monitorization of patient with cardiovascular dysfunction, and the promotion of medical education based on high-fidelity simulation (AU)