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Published on: July 13, 2019
A GAVeCeLT bundle for central venous catheterization in neonates and children: A prospective clinical study on 729
Mauro Pittiruti1, Davide Celentano2, Giovanni Barone3
1Department of Surgery, University Hospital "A. Gemelli," Rome, Italy.
Insights
This study shows that a central venous catheterization bundle significantly reduces complications in pediatric patients. The evidence-based approach enhances safety for neonates and children undergoing these procedures.
Area of Science:
- Pediatric critical care
- Vascular access procedures
- Evidence-based medicine
Background:
- Central venous catheterization in children can lead to serious complications.
- Preventive strategies are crucial for safe catheter insertion.
- Evidence-based insertion bundles exist for adults but not for pediatric populations.
Purpose of the Study:
- To develop and evaluate an evidence-based insertion bundle for central venous catheterization in neonates, infants, and children.
- To assess the effectiveness and safety of the GAVeCeLT insertion bundle.
Main Methods:
- A prospective study was conducted on neonates, infants, and children requiring non-emergency central lines.
- The GAVeCeLT bundle includes seven evidence-based strategies: ultrasound guidance, aseptic technique, non-radiological tip confirmation, tunneling, sutureless securement, and exit site protection.
- Data on immediate, early, and late complications were collected.
Main Results:
- A total of 729 central line insertions were analyzed.
- No immediate complications (pneumothorax, arterial puncture, malposition) were observed.
- The incidence of early and late complications was 3.7%, with no catheter-related infections or thrombosis in the first two weeks.
Conclusions:
- The developed insertion bundle significantly optimizes the safety of central venous catheterization in pediatric patients.
- The bundle effectively reduces immediate, early, and late complications.
- This study provides strong evidence supporting the use of insertion bundles in pediatric central venous catheterization.
Background:
In the pediatric patient, central venous catheterization may be associated with relevant complications. Though, most of them may be prevented by a wise choice of materials, methods, and techniques. Evidence-based insertion bundles for central venous catheterization have been developed in the adult patient, but not in neonates and children.
Methods:
The Italian Group for Long Term Venous Access Devices (GAVeCeLT) has developed an insertion bundle for central venous catheterization in neonates, infants, and children, which includes seven evidence-based strategies: (1) preprocedural ultrasound evaluation, (2) appropriate aseptic technique, (3) ultrasound guided venipuncture, (4) intraprocedural tip location by non-radiological methods, (5) proper choice of the exit site by tunneling, (6) sutureless securement, and (7) protection of the exit site using glue and transparent membranes. The effectiveness and safety of this bundle has been tested in a prospective study.
Results:
All neonates, infants and children requiring a non-emergency central line (except for umbilical venous catheters and epicutaneo-cava catheters) were included in the study. Out of 729 central line insertions, there were no immediate complications (no pneumothorax, no arterial puncture, no malposition); the incidence of early and late complications (local ecchymosis, dislodgment, local pain, exit site infection) was 3.7%; in the first 2 weeks after insertion, no catheter-related bacterial infection or catheter-related thrombosis was recorded.
Conclusion:
The results of this prospective study strongly validate the hypothesis that an insertion bundle is highly effective in optimizing the safety of the maneuver, reducing immediate, early, and late complications.
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