Catéteres centrales en pediatría / Central catheters in pediatrics

Se estudian las indicaciones de la colocación de catéteres centrales en pediatría. Se describen las téncicas de colocación y retirada de los catéteres umbilicales en el neonato por vía venosa y arterial. Se detalla la canalización percutánea venosa central y la técnica de Seldinger para accesos vasculares centrales

The indications for placement of central catheters in pediatrics are studied. Venous and arterial placement and removal techniques of the umbilical catheters in the newborn are described. Central venous percutaneous canalization and the Seldinger technique for central vascular accesses are detailed

[Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life]. / Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida.

INTRODUCTION: A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. PATIENTS AND METHODS: The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling--baseline period--and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. RESULTS: Although incubator temperature was raised by a mean of 3 degrees C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 degrees C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 degrees C was observed in 87.4 % of recordings and a fall to less than 36 degrees C was observed in 45.5 %; axillary temperature remained below 36.5 degrees C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc - Tp), an indicator of thermal stress, was more than 1 degrees C for a mean duration of more than 80 min and > 2 degrees C for more than 20 minutes in both the first and second weeks of life. CONCLUSIONS: During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature.

Repercusión del aseo en la estabilidad térmica del recién nacido de extremado bajo peso durante las primeras dos semanas de vida / Effect of hygiene interventions on the thermal stability of extremely low-birth-weight newborns in the first two weeks of life

El objetivo del estudio fue examinar los cambios térmicos que tienen lugar durante un conjunto de acciones agrupadas en relación con el aseo corporal en los RNEBP durante las primeras 2 semanas de vida. Pacientes y métodos. El estudio se realizó durante 10 meses consecutivos en el Servicio de Neonatología del Hospital Universitario La Paz. Se estudiaron todos los RNEBP ingresados consecutivamente que cumplieron los siguientes criterios: a) peso adecuado a la edad gestacional; b) sobrevivir al menos una semana, y c) no presentar malformaciones congénitas mayores o rasgos dismórficos. Los niños incluidos en el estudio fueron manejados según los protocolos de cuidado estándar dirigidos a mantener la estabilidad térmica y evitar el estrés por frío. La temperatura central (Tc) se midió en el hueco axilar y la periférica (Tp) en la planta de un pie. Ambas temperaturas se monitorizaron de forma continua durante: a) un período de no manipulación programada (período basal), y b) durante y después de un conjunto de intervenciones agrupadas que denominamos "aseo". Durante ambos períodos se monitorizaron de forma continua la Tc y la Tp, registrándose a intervalos de 10 min durante los primeros 30 min y posteriormente cada 30 min hasta completar un período de registro de 180 min. Resultados. A pesar que durante el aseo la temperatura de la incubadora se incrementó casi 3 °C por término medio, el aseo conllevó un patrón de cambio en la temperatura corporal similar durante todo el período de estudio; la Tc y la Tp descendieron aproximadamente 1 °C por término medio respecto a la temperatura basal. Se observó una caída de la temperatura axilar por debajo de 36,5 °C en el 87,4 % de los registros y por debajo de 36 °C en el 45,5 % y la temperatura axilar permaneció inferior a 36,5 °C durante prácticamente una hora por término medio. Además, la temperatura diferencial (Td 5 Tc ­ Tp), un indicador de estrés térmico, fue superior a 1 °C durante más de 80 min y a 2 °C durante más de 20 min por término medio, tanto en la primera como en la segunda semana de vida. Conclusiones. Durante el aseo de los RNEBP tiene lugar un marcado descenso de la temperatura corporal, tanto central como periférica. Tras el aseo, estos recién nacidos presentan una Td indicativa de estrés térmico, durante períodos prolongados. Estos cambios térmicos tienen lugar aun siguiendo protocolos de aseo estandarizados dirigidos a evitar o aminorar la potencial repercusión de este en la temperatura del recién nacido

Introduction. A prospective study was performed of a cohort of extremely low-birth-weight (ELBW) premature neonates (birth weight 500 to 1,000 g) consecutively admitted to the neonatal intensive care unit. The aim of this study was to examine the thermal changes that occur during all the hygiene-related interventions in ELBW infants in the first 2 weeks of life. Patients and methods. The study was carried out for 10 consecutive months in the Neonatology Service of La Paz University Hospital. We studied all consecutively admitted ELBW infants who satisfied the following criteria: a) adequate weight for gestational age; b) survival for at least 1 week, and c) no major congenital malformations or dysmorphic features. The infants included in the study were managed according to a standard care protocol for maintaining thermal stability and preventing cold-induced stress. Central temperature (Tc) was measured in the axilla and peripheral temperature (Tp) was measured on the sole of the foot. Both temperatures were continuously monitored for a) a period of scheduled non-handling ­baseline period­ and b) during and after a series of "hygiene interventions". In each of these periods, Tc and Tp were continuously monitored and recorded at 10 min intervals for the first 30 minutes and then at 30 min intervals until completing a 180 min period. Results. Although incubator temperature was raised by a mean of 3 °C during hygiene interventions, hygiene was accompanied by a change in body temperature that remained fairly constant throughout the study period; Tc and Tp decreased by a mean of 1 °C with respect to baseline temperature. A fall in axillary temperature to less than 36.5 °C was observed in 87.4 % of recordings and a fall to less than 36 °C was observed in 45.5 %; axillary temperature remained below 36.5 °C for a mean duration of almost 1 hour. The differential temperature (Td 5 Tc ­ Tp), an indicator of thermal stress, was more than 1 °C for a mean duration of more than 80 min and > 2 °C for more than 20 minutes in both the first and second weeks of life. Conclusions. During hygiene interventions, ELBW infants experienced a sharp fall in central and peripheral body temperature. After hygiene interventions, these neonates had a Td suggestive of prolonged thermal stress, despite the use of standardized care protocols designed to avoid or minimize the potential effects of hygiene interventions on neonatal temperature