Indian J Pediatr DOI 10.1007/s12098-014-1430-7
ORIGINAL ARTICLE
Factors Influencing the Peripheral Venous Catheter Survival in Critically Ill Children in a Pediatric Intensive Care Unit Sangeetha Shenoy & B. P. Karunakar
Received: 9 July 2013 / Accepted: 19 March 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objectives To study the duration of the peripheral venous catheter access and the effect of variables such as intravenous fluid, medications and blood products on the life span of the catheter in authors’ pediatric intensive care unit. Methods All peripheral intravenous lines established in sick children aged 1 mo to 15 y admitted to authors’ intensive care were included and details of cannula gauge, insertion site, sampling, drugs administered and the mode of administration were noted. The cannulas were monitored regularly for signs of infiltration till removal. The time of insertion and removal along with the reason for termination was noted and the life span was calculated. Mann Whitney test was used to test for differences in median survival time with respect to drugs administered and Kaplan Meir survival analysis was used to compare the survival of the cannula at different time periods for each drug. Results One hundred seventy four catheters were placed on 102 children aged 1 mo to 15 y over a period of 2 mo; of which 63 got infiltrated. The mean life span of the catheter was 39+24.4 h. Administration of phenytoin (13.2 vs. 40 h, p=0.000) and mannitol (14.5 vs. 80 h, p=0.034) significantly decreased the survival and infusion of blood (66.5 vs. 31.5 h, p=0.002) prolonged the survival of the catheters. Conclusions The catheters in the index study lasted on an average for 39 h. Phenytoin, mannitol, blood and blood products were found to significantly influence the survival of the catheters.
Introduction
Keywords Pediatric intensive care unit . Peripheral venous catheter . Infiltration
Material and Methods
S. Shenoy (*) : B. P. Karunakar Department of Pediatrics, M.S. Ramaiah Medical College, M.S.R. Nagar, MSRIT post, Bangalore 560054, Karnataka, India e-mail: [email protected]
An intravenous access is an important requirement to provide care to critically ill children. Establishment of intravenous access is one of the most important and frequently performed procedures in an intensive care unit. Apart from administration of intravenous fluids, drugs, blood products and parenteral nutrition, it is also inserted prophylactically before procedures and in unstable patients for emergency use [1]. Securing a peripheral venous catheter (PVC) in pediatric age group is often very difficult and can at times be very time consuming and frustrating. PVC placement in pediatrics has been reported as the leading cause of procedure related pain [2] on par with postsurgical pain. Moderate to severe discomfort has been reported in a significant number of children and adolescents on blood sampling [3, 4]. The life span of PVC is an important issue in the pediatric intensive care units (PICU) and its survival depends on many variables including the size, frequency of usage, methods of administration of medications and fluids, splinting and others. It is noticed that when certain drugs are administered, the PVC gets infiltrated faster. Factors affecting the life span of PVC have been studied in newborns and infants [5–8]. Heparin [9] and limb splinting [10] have been used in an attempt to prolong duration of the PVC. The present study attempts to study the effect of certain variables on the life span of PVCs in the PICU.
All consecutively admitted children between 1 mo to 15 y, fulfilling the criteria for admission to authors’ PICU which is a tertiary care hospital, were included in the study after written informed consent. PVCs established outside were excluded as were children on heparin infusion. The study was carried out
Indian J Pediatr
over a period of 2 mo and was approved by the institutional ethics committee. The PVCs were inserted by experienced nurses or junior residents using aseptic precautions after identifying the most suitable vein. Twenty, 22, 24 or 26 gauge Teflon over the needle PVC of a single brand was used, depending on the nurse’s discretion. Details regarding the needle gauge, site of insertion, number of attempts at securing the PVC, cannula wastage and whether the line was used for sampling, were noted in a predesigned proforma every time PVC was secured. Details of all the medications administered and the mode of administration (infusion or bolus), fluids, and blood products were recorded. Limb splinting is not practiced as a routine in authors’ PICU and hence, its effect could not be studied. The PVC site was monitored regularly for signs of inflammation, extravasation and blockage and removed, when any complications developed or selectively when not required. The date and time of removal along with the reason for termination was noted. The life span of the PVC was calculated from the time of insertion to the time of removal. The children discharged or transferred out of the PICU with the PVC in situ were also noted but they were not followed up in the wards. These PVCs were labeled as the non-infiltrated cases. All the quantitative parameters such as weight and age were summarized as mean ± standard deviation. Median life span of the PVC along with interquartile range was calculated according to the medication used, since the data did not follow the normal distribution. Non parametric test of significance (Mann Whitney) was employed to test for difference in the median survival time with each of the drugs used among the infiltrated group. Kruskal Wallis test was employed to test for the differences in the median survival time with respect to the different gauges of the PVC. Qualitative variables were expressed as percentages. A p value of
ORIGINAL ARTICLE
Factors Influencing the Peripheral Venous Catheter Survival in Critically Ill Children in a Pediatric Intensive Care Unit Sangeetha Shenoy & B. P. Karunakar
Received: 9 July 2013 / Accepted: 19 March 2014 # Dr. K C Chaudhuri Foundation 2014
Abstract Objectives To study the duration of the peripheral venous catheter access and the effect of variables such as intravenous fluid, medications and blood products on the life span of the catheter in authors’ pediatric intensive care unit. Methods All peripheral intravenous lines established in sick children aged 1 mo to 15 y admitted to authors’ intensive care were included and details of cannula gauge, insertion site, sampling, drugs administered and the mode of administration were noted. The cannulas were monitored regularly for signs of infiltration till removal. The time of insertion and removal along with the reason for termination was noted and the life span was calculated. Mann Whitney test was used to test for differences in median survival time with respect to drugs administered and Kaplan Meir survival analysis was used to compare the survival of the cannula at different time periods for each drug. Results One hundred seventy four catheters were placed on 102 children aged 1 mo to 15 y over a period of 2 mo; of which 63 got infiltrated. The mean life span of the catheter was 39+24.4 h. Administration of phenytoin (13.2 vs. 40 h, p=0.000) and mannitol (14.5 vs. 80 h, p=0.034) significantly decreased the survival and infusion of blood (66.5 vs. 31.5 h, p=0.002) prolonged the survival of the catheters. Conclusions The catheters in the index study lasted on an average for 39 h. Phenytoin, mannitol, blood and blood products were found to significantly influence the survival of the catheters.
Introduction
Keywords Pediatric intensive care unit . Peripheral venous catheter . Infiltration
Material and Methods
S. Shenoy (*) : B. P. Karunakar Department of Pediatrics, M.S. Ramaiah Medical College, M.S.R. Nagar, MSRIT post, Bangalore 560054, Karnataka, India e-mail: [email protected]
An intravenous access is an important requirement to provide care to critically ill children. Establishment of intravenous access is one of the most important and frequently performed procedures in an intensive care unit. Apart from administration of intravenous fluids, drugs, blood products and parenteral nutrition, it is also inserted prophylactically before procedures and in unstable patients for emergency use [1]. Securing a peripheral venous catheter (PVC) in pediatric age group is often very difficult and can at times be very time consuming and frustrating. PVC placement in pediatrics has been reported as the leading cause of procedure related pain [2] on par with postsurgical pain. Moderate to severe discomfort has been reported in a significant number of children and adolescents on blood sampling [3, 4]. The life span of PVC is an important issue in the pediatric intensive care units (PICU) and its survival depends on many variables including the size, frequency of usage, methods of administration of medications and fluids, splinting and others. It is noticed that when certain drugs are administered, the PVC gets infiltrated faster. Factors affecting the life span of PVC have been studied in newborns and infants [5–8]. Heparin [9] and limb splinting [10] have been used in an attempt to prolong duration of the PVC. The present study attempts to study the effect of certain variables on the life span of PVCs in the PICU.
All consecutively admitted children between 1 mo to 15 y, fulfilling the criteria for admission to authors’ PICU which is a tertiary care hospital, were included in the study after written informed consent. PVCs established outside were excluded as were children on heparin infusion. The study was carried out
Indian J Pediatr
over a period of 2 mo and was approved by the institutional ethics committee. The PVCs were inserted by experienced nurses or junior residents using aseptic precautions after identifying the most suitable vein. Twenty, 22, 24 or 26 gauge Teflon over the needle PVC of a single brand was used, depending on the nurse’s discretion. Details regarding the needle gauge, site of insertion, number of attempts at securing the PVC, cannula wastage and whether the line was used for sampling, were noted in a predesigned proforma every time PVC was secured. Details of all the medications administered and the mode of administration (infusion or bolus), fluids, and blood products were recorded. Limb splinting is not practiced as a routine in authors’ PICU and hence, its effect could not be studied. The PVC site was monitored regularly for signs of inflammation, extravasation and blockage and removed, when any complications developed or selectively when not required. The date and time of removal along with the reason for termination was noted. The life span of the PVC was calculated from the time of insertion to the time of removal. The children discharged or transferred out of the PICU with the PVC in situ were also noted but they were not followed up in the wards. These PVCs were labeled as the non-infiltrated cases. All the quantitative parameters such as weight and age were summarized as mean ± standard deviation. Median life span of the PVC along with interquartile range was calculated according to the medication used, since the data did not follow the normal distribution. Non parametric test of significance (Mann Whitney) was employed to test for difference in the median survival time with each of the drugs used among the infiltrated group. Kruskal Wallis test was employed to test for the differences in the median survival time with respect to the different gauges of the PVC. Qualitative variables were expressed as percentages. A p value of
