[Invasive catheters in neonates]. / Catéteres invasivos en el recién nacido.

OBJECTIVE: The care of very sick babies requires the use of invasive catheters in the neonatal intensive care unit. Our objective was to review the invasive catheters placed (umbilical and epicutaneous) between 1994 and 1998 and describe the guidelines used to take care of the intravenous lines. PATIENTS AND METHODS: Two periods were compared (January 1994 until June 1997 and July 1997 until September 1998) and characteristics of the patient and catheter were analyzed. During the first period, sepsis related to the catheter was diagnosed according to clinical and analytical criteria and required a positive blood culture. The same criteria were required in the second period, but coincidence of the organisms in the peripheral and catheter blood culture was also needed. RESULTS: A total of 1,285 central catheters were studied in 958 newborn admissions. Umbilical catheter were used in 6% of the cases and epicutaneous in 23%, most of which were in the upper extremities. The most frequent reason to remove the catheter was the end of the indication. The incidence of catheter related sepsis in the first period was 1% and during the second period 6%. Strict diagnostic criteria used in the second period were more predictive for sepsis. If premature babies were considered alone, the incidence increased to 14%. The most frequent organism isolated was Staphylococcus epidermidis. CONCLUSIONS: To decrease the incidence of sepsis related to catheters, a strict protocol for placement and maintenance must be followed.

[Silastic catheters: pinpointing the end tip of the catheter by means of electrocardiographic monitoring]. / Catéteres de silastic. Localización del extremo distal mediante monitorización electrocardiográfica.

The placement of catheters with a silastic center has been a common procedure in neonatal intensive care units for several years. Nonetheless, this procedure, like many others, bears its risks and complications if not properly carried out. The majority of complications, which are described in medical journals, include arrhythmias, myocardiac perforations, thrombosis, hemorrhage in the pleura, etc., and these are related with the catheter and its possible movement inside the blood vessel where it was originally inserted. The usual exploratory procedure to pinpoint the end tip of the catheter has been an ordinary x-ray, but often this x-ray does not allow one to see precisely where the catheter tip is located. This problem is caused by the tiny catheter calibre which does not allow for all the necessary contrast; because of this, it is frequently necessary to administer a radiopaque contrasting sub-stance and then repeat the x-ray in order to ensure that the catheter tip is located exactly where it should be. By means of electrocardiographic monitoring, a three-pronged key with an electrode and a 5.85% sodium chloride solution, it is possible to pinpoint the end tip of the catheter without resorting to an x-ray nor administering a contrasting solution.