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Persistent left superior vena cava and the correct interpretation of a peripherally inserted central catheter tip position
The case reported here of an infant with a PICC tip residing in a PLSVC posed local debate about the best course of action to take. Nevertheless, this experience has raised awareness of the need for practitioners to be aware of the potential for unusual features like PLSVC, to confound the practice expectations and prompted exploration of whether to adopt newer technologies (such as bedside ultrasound) into the PICC insertion practice portfolio.
Authors :
Matheus van Rens1 Director of Nursing and Vascular Access, NICU mrens@hamad.qa
Kevin Hugill2 Director of Nursing (Education)
Aala Eldin Fawzy Mohamed El Fakharany1 Consultant Radiologist, Clinical Imaging Department
Krisha Leigh Garcia1 Nurse Educator, NICU1Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
2Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar -
Chest-to-arm tunneling technique for central venous access devices in neonates
Chest-to-arm (CTA) tunneling technique has been described recently as an alternative option to exit site of the catheter in the infraclavicular area.
The authors report their experience with ultrasound-guided centrally inserted central catheters (CICCs) placed using CTA tunneling in six neonates. All central venous catheters were positioned with ultrasound guidance and real-time tip location.
There were no insertion-related complications; all devices were correctly positioned at the first attempt. During the follow-up, they found no catheter-related thrombosis, infections, or catheter malfunction. No tip position-related complications. Only one case of secondary malposition was reported.
Their conclusion is, in their experience, the CTA tunneling technique is reliable, safe, and feasible in the neonate even from the first hours of life, as well as for preterm newborns; it could be a valid alternative to the usual exit site.Authors :
Carmen Rodriguez Perez, Elena Pezzotti, and Francesco Maria Risso
Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili, Brescia, Italy
Carmen Rodriguez Perez, Neonatal Intensive Care Unit, Children’s Hospital, ASST Spedali Civili, Piazzale Spedali Civili 1, 25123 Brescia, Italy. Email: carmen.rodriguez@asst-spedalicivili.it
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Securement of Umbilical Venous Catheter Using Cyanoacrylate Glue: A Randomized Controlled
The objective of the study was to evaluate the role of cyanoacrylate glue in reducing dislodgement of umbilical venous catheters (UVCs).
It was a single-center, randomized, controlled, non-blinded trial. All infants requiring an UVC according to the local policy were included in the study. Infants with a UVC with a centrally located tip as verified by real-time ultrasound were eligible for the study. Primary outcome was the safety and efficacy of securement by cyanoacrylate glue plus cord-anchored suture (SG-group) vs. securement by suture alone (S-group), as measured by reduction in dislodgment of the external tract of the catheter. Secondary outcomes were tip migration, catheter-related bloodstream infection, and catheter-related thrombosis.
In the first 48 hours after UVC insertion, dislodgement was significantly higher in the S-group than in the SG-group (23.1% vs. 1.5%, P<0.001). The overall dislodgement rate was 24.6% in the S-group vs 7.7% in the SG-group (P=0.016). No differences were found in catheter-related bloodstream infection and catheter-related thrombosis. The incidence of tip migration was similar in both groups (S-group 12.2% vs. SG-group 11.7%).
The authors conclude that in the single-center study, cyanoacrylate glue was safe and effective for securement of UVCs, and particularly effective in reducing early catheter dislodgments.Authors : Vito D’Andrea 1, Giorgia Prontera 2, Giovanni Pinna 3, Francesco Cota 2, Simona Fattore 2, Simonetta Costa 2, Martina Migliorato 2, Giovanni Barone 4, Mauro Pittiruti 5, Giovanni Vento 2
1. Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy. Electronic address: vito.dandrea@policlinicogemelli.it
2. Neonatology Unit, Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “Agostino Gemelli” IRCCS, Rome, Italy.
3. Neonatal intensive care unit, maternal-fetal department, “S. Camillo-Forlanini” Hospital, Rome, Italy.
4. Neonatal Intensive Care Unit, Infermi Hospital, Rimini, AUSL Romagna, Rimini, Italy.
5. Department of Surgery, Fondazione Policlinico Gemelli, Rome, Italy.The Journal of Pediatrics (2023)
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Ultrasound guided percutaneous catheterization of the brachiocephalic vein by small caliber catheter: An alternative to epicutaneo-caval catheter in newborn and premature infants.
Umbilical Venous Catheter (UVC) and Epicutaneo-Caval Catheters (ECC) are reference catheters in the neonatal period. However, many factors such as the corpulence of neonates, poor venous capital, and anatomical variants can complicate ECC insertion or make it impossible. In newborns with failed ECC insertion, they developed an hybrid technique that combines the insertion of a long-lasting silicone or polyurethane small caliber catheter, usually used as a ECC in newborns, with the ease and speed of ultrasound guided puncture of the brachiocephalic vein (BCV).
Echo guided percutaneous catheterization of the brachiocephalic vein with a long lasting silicone or
polyurethane small caliber catheter is a safe alternative to the ECC if insertion has failed. However, it requires a mastery of ultrasound-guided insertion technique in term and premature neonates.Authors : Zied Merchaoui , Quitterie Laudouar, Clémence Marais, Luc Morin, Narjess Ghali, Ramy Charbel, Nada Seeman, Mostafa Mokhtari and Pierre Tissières
Pediatric and Neonatal Intensive Care Unit, Bicêtre Medical Centre, Paris Saclay University, AP HP, Le Kremlin Bicêtre, France
Corresponding author: Zied Merchaoui, Pediatric and Neonatal Intensive Care Unit, Bicêtre
Medical Centre, Paris Saclay University, AP HP, 78, rue du General
Leclerc, Le Kremlin Bicêtre 94275, France.
Email: moez_zied_merchaoui@yahoo.fr
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Brachial vein cannulation in a 1000 gr baby – live case
A new tutorial made by our expert Dr. Christian Breschan
Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria
Active member of the NEVAT -
Treatment of a Neonatal Peripheral Intravenous Infiltration/Extravasation (PIVIE) Injury With Hyaluronidase: A Case Report
In this case report, M. van Rens, member of the NEVAT together with his colleagues, reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. They discuss the condition, their successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology.
Authors :
Matheus van Rens, RN, MaANP (ORCID 0000-0001-9359-0895) Nursing and Vascular Access, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Kevin Hugill, RN, BSc, MSc, PhD (ORCID 0000-0002-3096-9635) Nursing and Midwifery Education Department, Hamad Medical Corporation, Doha, Qatar
Airene L. V. Francia, RN, BSc (ORCID 0000-0003-0698-1498) Vascular Access and Neonatal Transport, Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Abdellatif Hamdy Abdelwahab, MD (ORCID 0000-0003-1724-8750) Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
Krisha L. P. Garcia, RN, BSc (ORCID 0000-0001-8041-8551) Neonatal Intensive Care Unit, Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, QatarCorrespondence concerning this article should be addressed to matheusvanrens@gmail.com
Copyright © 2021 Association for Vascular Access.
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The neonatal DAV-expert algorithm: a GAVeCeLT/GAVePed consensus for the choice of the most appropriate venous access in newborns
The choice of the most appropriate venous access device (VAD) is particularly difficult in neonates. In fact, in this population, though a reliable venous access is often indispensable for the infusion of drugs, fluids, parenteral nutrition, and blood products, the venous patrimony is limited, and all devices are prone to frequent complications.
In the last decade, three algorithms [1–3] have been published about the choice of VADs in the neonatal population. However, all of them have relevant limitations. As none of these algorithms was fully satisfying, the GAVePed (which is the pediatric interest group of the most important Italian group on venous access: GAVeCeLT) decided to develop a new algorithm called “Neonatal DAV-Expert.”Authors : Giovanni Barone · Vito D’Andrea · Gina Ancora · Francesco Cresi · Luca Maggio · Antonella Capasso · Rossella Mastroianni · Nicola Pozzi · Carmen Rodriguez Perez · Maria Grazia Romitti · Francesca Tota · Ferdinando Spagnuolo · Francesco Raimondi · Mauro Pittiruti
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Retrospective evaluation of 599 brachiocephalic vein cannulations in neonates and preterm infants
This is the most recent study of Dr. C. Breschan, member of the NEVAT.
Ultrasound guidance permits the placement of relatively large bore central venous catheters (2-4 French) into the brachiocephalic vein in very small infants. These catheters also enable haemodynamic monitoring, blood sampling, and high-flow infusions. The aim of this retrospective analysis was to confirm the clinical feasibility of supraclavicular ultrasound-guided (USG) cannulation of the brachiocephalic vein in neonates weighting <3.5kg and the implications of increasing experience with this cannulation technique. All cannulations were performed under general anaesthesia by three anaesthesiologists.Authors : Christian Breschan1, *, Gudrun Graf1 , Christoph Arneitz2 , Haro Stettner3 , Stefan Neuwersch1 , Christian Stadik4 , Markus Koestenberger1 , Sandra Holasek5 and Rudolf Likar1
1 Department of Anaesthesia, Klinikum Klagenfurt, Klagenfurt, Austria,
2 Department of Pediatric Surgery, Klinikum Klagenfurt, Klagenfurt, Austria,
3 Department of Statistics, University of Klagenfurt, Klagenfurt, Austria,
4 Department of Neurorehabilitation, Krankenhaus Hermagor, Klagenfurt, Austria and
5 Institute of Pathophysiology, Medical University of Graz, Graz, Austria*Corresponding author. E-mail: christian.breschan@kabeg.at
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Ultrasound guided central venipuncture in the newborn
During the 5th GAVePed Conference in Rimini, Dr. Christian Breschan, active member of the NEVAT, presented ultrasound guided central venipuncture in the newborn.
He concluded that the first choice is the BCV by using RaCeVA.
An important message from him : Never ever lose RESPECT!!Authors : Dr. Christian Breschan
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Octyl-butyl-cyanoacrylate glue for securement of peripheral intravenous catheters: A retrospective, observational study in the neonatal population
Evidence-based insertion and maintenance strategies for neonatal vascular access devices (VAD) exist to reduce the causes of VAD failure and complications in neonates. Peripheral intravenous catheter failure and complications including, infiltration, extravasation, phlebitis, dislodgement with/without removal, and infection are majorly influenced by catheter securement methods.
The study is a retrospective, observational study using routinely collected data on intravenous device use in a large neonatal intensive care unit in Qatar.
A 6-month historical cohort was compared with a 6-month cohort after the introduction of an octyl-butyl-cyanoacrylate glue (CG).
They concluded that the risk of developing device-related phlebitis and premature device removal, increased significantly if CG was not used for adjunct catheter securement. In parallel with the currently published literature, this study’s findings support the use of CG for vascular device securement. When device securement and stabilization concerns are most pertinent CG is a safe and effective adjunct to reducing therapy failures in the neonatal patient population.Authors : Matheus Fpt van Rens1, Timothy R Spencer2, Kevin Hugill3, Airene Lv Francia1, Fredericus Hj van Loon45, Mohammad Aa Bayoumi1
1. Women’s Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
2. Global Vascular Access LLC, Scottsdale, AZ, USA.
3. Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar.
4. Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.
5. PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
To see the presentation during the 5th GAVePed congress in Rimini, follow this link
