Çocuk Yoğun Bakımda Kateter Kullanmak Güvenli mi?

Amaç: Damar içi kateter yerleştirilmesi gerek yoğun bakım üniteleri gerekse servislerde hasta çocukların yönetiminde giderek artan sıklıkta kullanılmaktadır. Çalışmada amaç, çocuk yoğun bakım hastalarında kateter yerleştirilmesi ile ilişkili komplikasyonlar ve risklerin değerlendirilmesidir. Gereç ve Yöntemler: 15 Ekim 2016 ile 15 Haziran 2017 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesi, Çocuk Yoğun Bakım Ünitesinde yatan 262 hastanın dosyası geriye dönük incelendi. Kateter takılan hastaların demografik bulguları, kateter takılma endikasyonları, takılma yeri ve kalış süresi, kateter takılma sırasında ve sonrasında gelişen komplikasyonlar, enfeksiyon oranları ve kateterin çekilme nedeni incelendi. Bulgular: Hastaların 123’üne toplam 148 adet kateter yerleştirildi. Kateterlerin 57’si %38,5 kız, 91’i %61,5 erkek hastaya takıldı. Hastaların yaş dağılımları 3 gün ile 17 yaş arasında olup ortalama kateter takılma yaşı 4,0±5,0 yıldı. Hastaların tartıları 2,2 ile 75 kilogram arasında idi. Hastaların 115’inde %77,7 başvuru anında enfeksiyon vardı. Takılma nedenlerinden en sık üç neden 83 %56,1 hastada damar yolu bulunamaması, 26’sında %17,6 hemodiyaliz uygulanması ve 39’unda %26,4 ilaç ve sıvı tedavisi idi. Hastalara takılan kateterlerin 94’ü %63,5 femoral ve 54’ü %36,5 jugulerdi. Kateterlerin 112’si %75,7 acil şartlarda takıldı. Hastaların 3’ünde %2,1 enfeksiyon dışı komplikasyon gözlendi. Kateter takılma sırasında ölen hastamız olmadı. Hastaların 2’sinde %1,4 kateter sepsisi gelişti. Bin kateter gününe düşen kateter enfeksiyon sıklığı ise 1,6 olarak hesaplandı. Kateterlerin 124’ü %83,8 gereksinimin ortadan kalkması nedeniyle çekildi.Sonuç: Çocuk hastalarında önem taşıyan kateterin tecrübeli kişiler tarafından yerleştirilmesi ve bakımı ile komplikasyon oranları azaltılabilmektedir

Anahtar Kelimeler:

Kateter, Çocuk, Komplikasyon

Catheterization in the Pediatric Intensive Care Unit: Is it Safe?

Objective: Intravascular catheters are being increasingly used both in intensive care units and inpatient care for the management of children. Herein, we aimed to determine the risk factors and the complications associated with the intravascular catheter placement.Material and Methods: The medical records of 262 patients hospitalized in Okmeydanı Training and Research Hospital’s Pediatric Intensive Care Department between October 2016 and June 2017 were evaluated retrospectively. The demographic data, indications for catheterization, the location and duration of catheterization, the complications including the rate of infection, and the reasons for removing the catheters were evaluated.Results: A total of 148 intravascular catheters were placed for 123 patients. We found that 57 catheters 38.5% had been used in female and 91 61.5% in male patients. The age range was 3 days to 17 years and the weight range 2.2 to 75 kilograms. The mean age at catheter insertion was 4.0±5.0 years. Signs of infection at presentation were present in 115 patients 77.7% . The reasons for catheterization were lack of vascular access in 83 56.1% patients, hemodialysis in 26 17.6% patients and replacement of drugs and fluids in 39 26.4% patients. Access sites were the femoral vein 63.5% and jugular vein 36.5% Urgent catheterization was required for 112 75.7% catheters. Noninfectious complications developed in 3 patients 2.1% . We did not experience any death during catheterization. Catheter sepsis developed in 2 patients 1.4% . The rate of infection was 1.6 for 1000 catheter days. A total of 124 catheters 83.8% were removed as they were no longer required. Conclusion: The expertise of the doctor performing the procedure and nursing care are important factors in reducing the complication rate of catheterization.

Keywords:

Catheter, Child, Complication,

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Çıtak A. Çocuk yoğun bakımda komplikasyonlar. ANKEM Derg 2009;23:58-62.
Ares G, Hunter CJ. Central venous access in children: Indications, devices, and risks. Curr Opin Pediatr 2017;29:340-6.
McKee C, Berkowitz I, Cosgrove SE, Bradley K, Beers C, Perl TM, Winner L, Pronovost PJ, Miller MR. Reduction of catheter-associated bloodstream infections in pediatric patients: Experimentation and reality, Pediatr Crit Care Med 2008;9:40-6.
King MA, Garrison MM, Vavilala MS, Zimmerman JJ, Rivara FP. Complications associated with arterial catheterization in children, Pediatr Crit Care Med 2008;9(4):367-71.
Aprili D, Erb TO. Avoidance of complications when dealing with central venous catheters in the treatment of children. Anaesthesist 2017;66:265-73.
Mclaws ML, Berry G. Nonuniform risk of bloodstream infection with increasing central venous catheter-days. Infect Control Hosp Epidemiol 2005;26:715-9.
O’Grady NP, Alexander M, Burns LA, Dellinger EP, Garland J, Heard SO, Lipsett PA, Masur H, Mermel LA, Pearson ML, Raad II, Randolph AG, Rupp ME, Saint S; Healthcare Infection Control Practices Advisory Committee. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2011;39:1–34.
Tomar S, Lodha R, Das B, Sood S, Kapil A. Risk Factors for central line associated bloodstream infections. Indian Pediatr 2016;53:790-2.
Chuengchitraks S, Sirithangkul S, Staworn D, Laohapand C. Impact of new practice guideline to prevent catheter related blood stream infection (CRBSI): Experience at the Pediatric Intensive Care Unit of Phramongkutklao Hospital. J Med Assoc Thai 2010;93:79-83.
Abramczyk ML, Carvalho WB, Medeiros EA. Preventing catheter-associated infections in the Pediatric Intensive Care Unit: impact of an educational program surveying policies for insertion and care of central venous catheters in a Brazilian teaching hospital. Braz J Infect Dis 2011;15:573-7.
Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Gottl U, Vesely SK. Antithrombotic therapy in neonates and children: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence- Based Clinical Practice Guidelines. Chest 2012; 141:e737S-801S
Costello JM, Morrow DF, Graham DA, Potter-Bynoe G, Sandora TJ, Laussen PC. Systematic intervention to reduce central line-associated bloodstream infection rates in a pediatric cardiac intensive care unit. Pediatrics 2008;121:915-23.
Gallagher RA, Levy J, Vieira RL, Monuteaux MC, Stack AM. Ultrasound assistance for central venous catheter placement in a pediatric emergency department improves placement success rates. ACAD Emerg Med 2014;21:981-6.
Rey C, Alvarez F, De La Rua V, Medina A, Concha A, Díaz JJ, Menéndez S, Los Arcos M, Mayordomo-Colunga J. Mechanical complications during central venous cannulations in pediatric patients. Intensive Care Med 2009;35:1438-43.
Collignon P, Soni N, Pearson I, Sorrell T, Woods P. Sepsis associated with central vein catheters in critically ill patients. Intensive Care Med 1988; 14: 227-31.
Brun-Buisson C, Abrouk F, Legrand P, Huet Y, Larabi S, Rapin M. Diagnosis of central venous catheter related sepsis: Critical level of quantitative tip cultures. Arch Intern Med 1987;147: 873-7.
Deshpande KS, Hatem C, Ulrich HL, Currie BP, Aldrich TK, Bryan-Brown CW, Kvetan V. The incidence of infectious complications of central venous catheters at the subclavian, internal jugular, and femoral sites in an intensive care unit population. Crit Care Med 2005; 33:13-20.
Reyes JA, Habash ML, Taylor RP. Femoral central venous catheters are not associated with higher rates of infection in the pediatric critical care population. Am J Infect Control 2012;40:43-7.