■中央血管的导管插入术可能与早期和晚期有关,潜在的致命并发症。必须采取积极的方法来减少不良事件的频率和程度。最近,GAVeCeLT提出了一项名为SICA-PED(即在儿科患者中安全插入中央通道)的方案,其中包括7项循证策略.
■通过单中心前瞻性观察研究,作者希望巩固这些方案在新生儿中的有效性和安全性.在一系列104个新生儿中,应用方案的七个步骤(1)RaCeVA静脉的术前超声研究,(2)正确的无菌技术,(3)超声引导静脉穿刺,(4)术中导管尖端定位与TTE(ECHOTIP)和(iECG)腔内心电图,(5)合理的选择植入出口与RAVESTO隧道技术,(6)无缝线锚固,(7)使用胶水和透明半透膜保护出口点。作者在点(6)中包括了进一步的预防措施,皮下锚固系统增加了导管翼的反固定,我们将其称为6PlusPoint。
■所有需要植入选择性我们引导的中心静脉通路的婴儿均纳入研究。104个植入的中心静脉导管均未出现早期并发症(意外动脉穿刺,PNX,原发性错位);罕见的晚期并发症,如瘀斑,CRBSI,观察到出口部位感染或移位,未观察到导管相关的血栓形成现象。CRBSI导管相关性感染率为2.47×1000天导管病例。
■这项前瞻性研究的结果加强了SICA-Ped方案的可行性和有效性。证明了基于证据的七步植入策略的系统应用提高了成功率,尽量减少早期和晚期并发症,这增加了患者的安全性。
UNASSIGNED: Catheterization of central vessels can be associated with early and late, potentially fatal complications. A proactive approach is imperative to reduce the frequency and magnitude of adverse events. Recently, the GAVeCeLT has proposed a protocol called SICA-PED (i.e. Safe Insertion of Central Access in Pediatric patients) and includes seven evidence-based strategies.
UNASSIGNED: Through a single-center prospective observational
study, the authors wanted to consolidate the efficacy and safety of these protocol in newborns. In a series of 104 newborns, the seven steps of the protocol were applied (1) pre-procedural ultrasound
study of the RaCeVA veins, (2) correct aseptic technique, (3) ultrasound-guided venipuncture, (4) intraprocedural localization of the tip of the catheter with TTE (ECHO TIP) and (iECG) intracavitary electrocardiogram, (5) reasoned choice of the implant exit site with the RAVESTO Tunneling technique, (6) anchoring without stitches, and (7) exit point protection with the use of glue and transparent semipermeable membrane. The authors have included a further precaution in point (6) the subcutaneous anchoring system has added the counter-fixation of the catheter wings that we will call 6Plus Point.
UNASSIGNED: All infants requiring implantation of elective us-guided central venous access were enrolled in the
study. None of the 104 implanted central venous catheters experienced early complications (accidental arterial puncture, PNX, primary malposition); rare late complications such as ecchymosis, CRBSI, exit site infection or dislodgement were observed, No catheter-related thrombotic phenomena were observed. The CRBSI catheter-related infection rate was 2.47 × 1000 days catheter cases.
UNASSIGNED: The results of this prospective
study strengthen the feasibility and efficacy of the SICA-Ped Protocol. Demonstrating that the systematic application of the evidence-based seven-step implantation strategy increases the success rate, minimizes early and late complications, which result in increased patient safety.