Peripheral insertion of double-lumen central venous catheter using the Seldinger technique in newborns.

OBJECTIVE: To report the experience of peripheral insertion of double-lumen central catheters (PIDLCC) in preterm and term newborn infants and to analyze the technical characteristics of the procedure and any observed complications. STUDY DESIGN: Retrospective review of 61 newborns that had a PIDLCC between 2003 and 2006. The study comprised clinical data analysis, anthropometrics, indications, duration, complications and reasons for withdrawal of the catheters. RESULT: Weight of the patients was <1 kg in 10%, and >2 kg in 75%. Catheters tip placement was as aimed, mostly superior cava vein (SCV), in 65.5%, and subclavian vein in remaining 34.5% and average duration of catheterization was 13.5+/-9.6 and 8.9+/-5.8 days, respectively. Blood sampling through both lumens was possible especially when the tip was at SCV. Reasons for catheter withdrawal were end of indication (45.9%), phlebitis/edema (21.3%), suspected infection (3.2%), accidental withdrawal (3.2%) and rupture of proximal end (3.2%). In three (4.9%) patients, withdrawal was due to serious complications (two cases of pleural leakage of infusion fluid and one breakage of the metallic guide). About 16.3% of the patients died with the catheter still in situ. Infection findings were positive tip culture (14.7%) and catheter-related sepsis (3.2%). CONCLUSION: Insertion of PIDLCC is possible in neonates. The incidence of complications, mostly mechanical, requires careful evaluation of indications, and strict adherence to the procedure of insertion and manipulation.

A cost evaluation of treatment alternatives for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil.

The first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil is currently activated prothrombin complex concentrate (aPCC), with recombinant activated factor VII (rFVIIa) used as second-line therapy or as a last resort. The aim of this study was to determine the cost and effectiveness of these treatments from the perspective of the Brazilian National Health Service. A decision analysis model was constructed to assess total direct medical costs (including drug costs, costs of outpatient or inpatient care, ambulance transportation and cost of concomitant medications) of first-line treatment with aPCC or rFVIIa. Clinical outcome and resource utilization data were obtained both retrospectively and prospectively and validated by the consensus of an expert panel of Brazilian haematologists. A total of 103 bleeds in 25 patients were included in the analysis. rFVIIa resolved bleeds more quickly (4.4 h) than aPCC (62.6 h) and was more effective (100% vs. 56.7% respectively). Mean total direct medical costs (from initiation to cessation of bleed) were estimated to be US$13 500 (aPCC) and US$7590 (rFVIIa). Extensive sensitivity analyses confirmed the cost-effectiveness of rFVIIa. Compared with aPCC, rFVIIa was more effective and less expensive when used as first-line treatment for mild-to-moderate bleeding episodes in patients with haemophilia and inhibitors in Brazil. rFVIIa should be considered a first-line treatment for the management of these patients.