ABSTRACT
This pre-post intervention study was conducted in Neonatal Intensive Care Units in two Chinese hospitals. The objective was to evaluate the effectiveness and safety of intracavitary electrocardiogram (IC-ECG)-guided peripherally inserted central catheter (PICC) placement and tip positioning in premature infants. A total of 161 premature infants who required a PICC were enrolled and divided into two groups: pre-intervention group (n = 83) from October 2017 to July 2018 and post-intervention IC-ECG group (n = 78) from August 2018 to March 2019. Nurses were trained from May 2018 to July 2018. The reposition rate in the IC-ECG group and pre-interventions group was 3.85% and 19.28%, respectively (OR 5.970; 95% CI 1.666-21.395; p = 0.002). More infants achieved optimal tip position at the first attempt in the IC-ECG group than the pre-intervention group (93.59% vs 73.49%; OR 0.190; 95%CI 0.068-0.531; p = 0.001). The overall catheter-related complications in the pre-intervention group were 14.46% compared to 3.84% in the IC-ECG group (OR 2.962; 95%CI 1.013-8.661; p = 0.040). However, no significant differences were observed between the individual complication leakage, phlebitis and catheter-related blood stream infection.Conclusions: IC-ECG-guided peripherally inserted central catheter placement and tip positioning technology might decrease reposition rates, achieve more accurate tip positioning at the first attempt and might reduce catheter-related complications in premature infants. Further robust RCTs are needed to confirm the effectiveness of IC-ECG-guided PICC placement and tip positioning in neonates.What is Known:⢠Chest radiography is the gold standard for tip position confirmation of peripherally inserted central catheter placement.⢠Studies in adult patients have shown that electrocardiogram guidance in the placement of central venous catheters can be beneficial, while evidence in neonates is limited.What is New:⢠Intracavitary electrocardiogram-guided peripherally inserted central catheter placement might be superior to chest radiography in preterm infants.⢠Decreasing the repositioning rates and correct tip position of peripherally inserted central catheters might reduce catheter-related complications.
Subject(s)
Catheterization, Central Venous/methods , Catheterization, Peripheral/methods , Electrocardiography/methods , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/nursing , Catheterization, Peripheral/adverse effects , Catheterization, Peripheral/nursing , Central Venous Catheters , Controlled Before-After Studies , Female , Gestational Age , Humans , Infant, Newborn , Infant, Premature , Intensive Care Units, Neonatal , MaleABSTRACT
OBJECTIVE: To explore the risk factors on relapsing tuberculosis related to smear positive pulmonary tuberculosis which had been cured for five years. METHODS: Patients with smear positive pulmonary tuberculosis registered in 1995 from ten countries in Hubei province were studied and logistic regression was used for data analysis. RESULTS: The 5-year relapse rate of smear positive pulmonary tuberculosis was 3.85 percent. Risk factors related to relapse would include being non-modeled county, negative smear after treated for three months, the class of retreatment, management of non-DOTS, method of chemotherapy and patients that did not get treated by the tuberculosis institute, with odds ratios of 0.15, 4.62, 3.68, 5.88 and 6.47, respectively. CONCLUSION: Effect standard, regulation DOTS and the centralized management measure might have had effects on decreasing the relapse rate.
