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INTRODUCTION: Subcutaneous catheter is a device easy to assemble, which was created for the administration of insulin in diabetic patients, especially in children, aiming to reduce the number of punctures, pain and anxiety of patients and their parents. OBJECTIVE: To describe the experience using the catheter for subcutaneous administration of low molecular weight heparin (LMWH) in hospitalized pediatric patients. PATIENTS AND METHOD: A prospective descriptive study in 28 patients who used 87 subcutaneous catheters for the administration of LMWH in the Pediatric Service of the Universidad Catolica de Chile between July, 2010 and November, 2011. RESULTS: Complications associated with the catheter had an incidence of 33 % in total catheters evaluated; the most frequent complication was the presence of hematoma at the site of insertion (26%). These complications occurred more frequently in male (38% versus 31% in females) and younger patients (9 months versus 12 months), who received dalteparin (54% versus 30% of other types of heparin) administered every 24 hours (41% versus 30%, administered every 12 hours), and when the catheter was located on both thighs (36 % versus 32% in both arms); however, these differences were not statistically confirmed. CONCLUSION: The subcutaneous catheter is a good technique to be considered for LMWH in children as it presents minor complications for drug administration.

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Los padres de niños con cardiopatías congénitas sometidos a cirugía cardíaca presentan estrés provocado por la incertidumbre y la preocupación por el resultado quirúrgico, sumado al estrés propio de la hospitalización en una unidad de cuidados intensivos. La presente revisión bibliográfica tiene por objetivo describir los factores de estrés parental de niños con cardiopatías congénitas sometidos a cirugía cardíaca. Los factores de estrés parental se agruparon en factores derivados del paciente, de los padres, del ambiente y del equipo clínico. La pérdida del rol parental, la apariencia física y el comportamiento del hijo fueron identificados como los más estresantes. Un programa de intervención para ser entregado a los padres antes de la cirugía debería contener estos factores como aspectos centrales, lo que contribuiría a disminuir significativamente el estrés parental y es necesario incluirlo durante el proceso de hospitalización.

The caregivers of children with congenital heart disease undergoing cardiac surgery are under stress due to the uncertainty of the surgical outcome and the stressful experience of being admitted in an intensive care unit. The current review describes the factors associated with parental stress in patients with congenital heart disease undergoing cardiac surgery. These factors can be grouped into factors related to the patient, the parents, the environment and the clinical team. The loss of the parental role, the physical appearance and the child’s behavior during their stay in the intensive care unit are identified as the most powerful sources of stress. An information program to be given to the caregivers before cardiac surgery should include all these factors as a central part of its contents, should significantly reduce the levels of parental stress and must be included in the process of admitting a patient for congenital heart surgery.

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The caregivers of children with congenital heart disease undergoing cardiac surgery are under stress due to the uncertainty of the surgical outcome and the stressful experience of being admitted in an intensive care unit. The current review describes the factors associated with parental stress in patients with congenital heart disease undergoing cardiac surgery. These factors can be grouped into factors related to the patient, the parents, the environment and the clinical team. The loss of the parental role, the physical appearance and the child's behavior during their stay in the intensive care unit are identified as the most powerful sources of stress. An information program to be given to the caregivers before cardiac surgery should include all these factors as a central part of its contents, should significantly reduce the levels of parental stress and must be included in the process of admitting a patient for congenital heart surgery.

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Introduction: Subcutaneous catheter is a device easy to assemble, which was created for the administration of insulin in diabetic patients, especially in children, aiming to reduce the number of punctures, pain and anxiety of patients and their parents. Objective: To describe the experience using the catheter for subcutaneous administration of low molecular weight heparin (LMWH) in hospitalized pediatric patients. Patients and Method: A prospective descriptive study in 28 patients who used 87 subcutaneous catheters for the administration of LMWH in the Pediatric Service of the Universidad Catolica de Chile between July, 2010 and November, 2011. Results: Complications associated with the catheter had an incidence of 33 percentin total catheters evaluated; the most frequent complication was the presence of hematoma at the site of insertion (26 percent). These complications occurred more frequently in male (38 percent versus 31 percent in females) and younger patients (9 months versus 12 months), who received dalteparin (54 percent versus 30 percent of other types of heparin) administered every 24 hours (41percent versus 30 percent, administered every 12 hours), and when the catheter was located on both thighs (36 percent versus 32 percent in both arms); however, these differences were not statistically confirmed. Conclusion: The subcutaneous catheter is a good technique to be considered for LMWH in children as it presents minor complications for drug administration.

Introducción: El catéter subcutáneo es un dispositivo de fácil instalación, el cual fue ideado para la administración de insulinas en pacientes diabéticos, especialmente en pediatría, con el fin de disminuir el número de punciones, el dolor y la ansiedad de los pacientes y sus padres. Objetivo: Describir la experiencia del uso del catéter subcutáneo para la administración de heparina de bajo peso molecular (HBPM) en pacientes pediátricos hospitalizados. Pacientes y Método: Estudio descriptivo prospectivo en 28 pacientes que utilizaron 87 catéteres subcutáneos instalados para la administración de HBPM, en el Servicio de Pediatría de la Pontificia Universidad Católica de Chile en el período comprendido entre los meses de julio de 2010 y noviembre de 2011. Resultados: Las complicaciones asociadas al catéter presentaron una incidencia de 33 por ciento en el total de catéteres evaluados, siendo la más frecuente la presencia de hematoma en el sitio de inserción (26 por ciento). Estas complicaciones se presentaron con mayor frecuencia en pacientes de sexo masculino (38 por ciento versus 31 por ciento en sexo femenino) de menor edad (9 meses versus 12 meses), con indicación de dalteparina (54 por ciento versus 30 por ciento con otros tipos de heparina) administrada cada 24 h (41 por ciento versus 30 por ciento cuando fue administrada cada 12 h), y cuando el catéter estuvo ubicado en ambos muslos (36 por ciento versus 32 por ciento en ambos brazos); sin embargo, estas diferencias no fueron confirmadas estadísticamente. Conclusión: El catéter subcutáneo es una buena técnica a considerar para la administración de HBPM en la edad pediátrica, ya que permite la administración del medicamento con complicaciones leves asociadas a su uso.

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The caregivers of children with congenital heart disease undergoing cardiac surgery are under stress due to the uncertainty of the surgical outcome and the stressful experience of being admitted in an intensive care unit. The current review describes the factors associated with parental stress in patients with congenital heart disease undergoing cardiac surgery. These factors can be grouped into factors related to the patient, the parents, the environment and the clinical team. The loss of the parental role, the physical appearance and the childs behavior during their stay in the intensive care unit are identified as the most powerful sources of stress. An information program to be given to the caregivers before cardiac surgery should include all these factors as a central part of its contents, should significantly reduce the levels of parental stress and must be included in the process of admitting a patient for congenital heart surgery.

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Antecedentes: las necesidades de confort más relevantes para los cuidadores tienen relación con mejorar las condiciones de permanencia, a través de salas de espera más cómodas, un lugar donde dormir, un baño con ducha, alimentación para el acompañante y un lugar seguro para guardar sus pertenencias. Objetivo: implementar un modelo de cuidado a través de un espacio de acogida, para satisfacer las necesidades de confort de los padres que no cuentan con alojamiento durante la hospitalización de sus hijos. Metodología: estrategia innovadora en la entrega de cuidados avanzados en enfermería, basados en el modelo teórico de Kolcaba el que nos permite llevar la disciplina de enfermería a la práctica asistencial en directo beneficio de los pacientes. Resultados: con la implementación de un espacio de acogida, se espera un aumento en la percepción de confort de los padres durante hospitalización, lo que conllevará a un incremento en el estado de alerta de los padres, participación efectiva en los cuidados de su hijo, mejoría en la respuesta frente a las intervenciones educativas y vinculación efectiva con el equipo de salud. Conclusiones: un espacio de acogida para padres de niños hospitalizados, diseñada para satisfacer las necesidades de confort más relevantes identificadas en la literatura y contextualizadas en la teoría de Kolcaba, contribuiría a implementar el cuidado avanzado en enfermería, rescatando la esencia de la enfermería en el Servicio de Pediatría del Hospital Clínico de la Universidad Católica.

Background: The most important comfort needs for caregivers are related to improving their hospital stay conditions, with more comfortable waiting rooms, a place to sleep, a toilette with shower, food and a safe place where to leave their belongings. Objective: To implement a hosting area that meets the comfort needs of parents who do not have their own accommodations during the hospitalization of their children. Methodology: Innovative strategies in providing advanced nursing care based on the theoretical model of Kolcaba, which allows us to bring the discipline of nursing care into practice, in direct benefit of patients. Results: We expect an increase in comfort perception of parents during hospitalization, which will lead to increased alertness of parents, effective participation in child care, improved response to educational interventions and effective linkages with the caring team. Conclusions: A hosting area for parents of hospitalized children, designed to meet the most important comfort needs reported in the literature and contextualized according to Kolcaba’s theory, can contribute to implement advanced nursing care, recovering the essence of nursing at the Pediatrics Service of the UC Hospital.

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Introducción: La nutrición enteral (NE) es la entrega de nutrientes al tracto gastrointestinal mediante una sonda nasogástrica (SNG), nasoyeyunal (SNY) o de gastrostomía (GTT); siendo la ruta preferida para satisfacer las necesidades nutricionales cuando la vía oral está contraindicada o es insuficiente. Objetivo: Describir el perfil de pacientes pediátricos que requirieron NE domiciliaria y su efecto en el estado nutritivo. Sujetos y Método: Estudio analítico retrospectivo, en 37niños hospitalizados en el Servicio de Pediatría del Hospital Clínico Universidad Católica (UC) que fueron dados de alta con soporte nutricional enteral durante el período de Abril 2010 a Abril 2011. Resultados: La indicación principal para iniciar soporte nutricional fue trastorno de deglución (n=27), siendo la mayoría de los pacientes menores de 1 año al momento de recibir la indicación (n=27). El tipo de dispositivo más utilizado fue GTT (n=20). No hubo complicaciones asociadas al uso de SNG. Las complicaciones asociadas al uso de GTT fueron: granuloma periostomal (n=7), neumonía por aspiración (n=3) y retiro accidental (n=1). Del total de pacientes evaluados, un 62% presentaba desnutrición calórico-proteica al inicio de la NE versus 30% al último control (p<0,001). Conclusión: El uso de soporte nutricional enteral permite recuperar y/o mantener el estado nutricional de losniños con trastornos de la deglución y alteraciones en la curva del crecimiento, mejora la calidad de vida, y presenta una tasa baja de complicaciones mayores.

Enteral nutrition (EN) is the delivery ofnutrients to the gastrointestinal tract by nasogastric (SNG), nasojejunal (SNY) or gastrostomy (GTT), being the preferred route to fulfill nutritional needs when the oral route is contraindicated or inadequate. Objective: To describe the clinical profile of pediatric patients with home EN and to assess their nutritional status. Subjects and methods: A retrospective analytic study in 37 children from the Pediatric Service Hospital Clinico UC, discharged with enteral nutrition support from April 2010 to April 2011. Results: The main indication to use EN was swallowing disorder (n=27). 73% began EN before one year of life. GTT was the principal route to EN (n=20). There were no complications associated to NGT or OGT. The reported complications associated with GTT were periosteal granuloma (n=7), aspiration pneumonia (n=3) and accidental removal (n=1). 62% ofpatients had protein-calorie malnutrition (z-score W/H) at baseline vs. 30% at the last control (p<0,001). Conclusion: The use of enteral nutrition allows to restore and/ or to maintain nutritional status in children with swallowing disorder or undernutrition. This feeding procedure also improves the quality of life and promotes a proper development without major complications.

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INTRODUCTION: As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. OBJECTIVE: To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. POPULATION AND METHODS: All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. RESULTS: A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). CONCLUSIONS: In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.

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Introduction. As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.(AU)

Introducción. Producto del aumento de los procedimientos pediátricos, tanto diagnósticos como terapéuticos fuera del quirófano, la sedación y analgesia en este contexto ha cobrado importancia. Objetivo. Caracterizar el tipo de sedoanalgesia utilizada por un equipo de sedación pediátrico en procedimientos fuera del quirófano, así como sus resultados y su seguridad. Pacientes y métodos. Se analizaron todos los procedimientos realizados bajo sedación intravenosa con midazolam, ketamina, propofol o lidocaína, en pacientes de entre 1 mes y 5 años, en un período de 14 meses. Para determinar la respuesta a la sedoanalgesia administrada, se aplicó la escala de sedación de Ramsay y la escala de dolor de CHEOPS. Resultados. Se analizaron 186 procedimientos. Al evaluar la respuesta a la sedoanalgesia, se obtuvo una sedación profunda adecuada en un 98% de los casos y una analgesia adecuada en un 92% de los pacientes. Un 12% de los procedimientos se asociaron a efectos adversos, todos relacionados con la vía aérea, ninguno grave. La única variable vinculada de forma estadísticamente significativa a la ocurrencia de eventos adversos fue el procedimiento con intervención de la vía aérea, es decir, fibrobroncoscopia, endoscopia digestiva alta o ecocardiograma transesofágico, con un OR de 6,27 (IC 95% 1,28 a 30,63; p= 0,023). Conclusiones. En este grupo de pacientes la sedación y analgesia intravenosa para procedimientos fuera del quirófano, otorgada por un equipo especializado, resultó segura y eficaz.(AU)

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Introduction. As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. Objective. To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. Population and Methods. All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. Results. A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98% of cases, and that an adequate analgesia was achieved in 92% of patients. Around 12% of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95% CI: 1.28-30.63; p = 0.023). Conclusions. In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.

Introducción. Producto del aumento de los procedimientos pediátricos, tanto diagnósticos como terapéuticos fuera del quirófano, la sedación y analgesia en este contexto ha cobrado importancia. Objetivo. Caracterizar el tipo de sedoanalgesia utilizada por un equipo de sedación pediátrico en procedimientos fuera del quirófano, así como sus resultados y su seguridad. Pacientes y métodos. Se analizaron todos los procedimientos realizados bajo sedación intravenosa con midazolam, ketamina, propofol o lidocaína, en pacientes de entre 1 mes y 5 años, en un período de 14 meses. Para determinar la respuesta a la sedoanalgesia administrada, se aplicó la escala de sedación de Ramsay y la escala de dolor de CHEOPS. Resultados. Se analizaron 186 procedimientos. Al evaluar la respuesta a la sedoanalgesia, se obtuvo una sedación profunda adecuada en un 98% de los casos y una analgesia adecuada en un 92% de los pacientes. Un 12% de los procedimientos se asociaron a efectos adversos, todos relacionados con la vía aérea, ninguno grave. La única variable vinculada de forma estadísticamente significativa a la ocurrencia de eventos adversos fue el procedimiento con intervención de la vía aérea, es decir, fibrobroncoscopia, endoscopia digestiva alta o ecocardiograma transesofágico, con un OR de 6,27 (IC 95% 1,28 a 30,63; p= 0,023). Conclusiones. En este grupo de pacientes la sedación y analgesia intravenosa para procedimientos fuera del quirófano, otorgada por un equipo especializado, resultó segura y eficaz.

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INTRODUCTION: As a result of the increased number of both diagnostic and therapeutic procedures in pediatric outpatients, sedation and analgesia have gained relevance in this context. OBJECTIVE: To characterize the type of sedation and analgesia used by pediatric sedation teams in procedures done outside the operating room, as well as its safety and outcome. POPULATION AND METHODS: All procedures performed in 1 month to 5 year old patients under intravenous sedation with midazolam, ketamine, propofol or lidocaine were analyzed over a 14-month period. The Ramsay sedation scale and the CHEOPS pain scale were used to determine the response to the sedation and analgesia administered. RESULTS: A total of 186 procedures were analyzed. The results of the evaluation of response to sedation and analgesia indicated that an adequate deep sedation was obtained in 98

of cases, and that an adequate analgesia was achieved in 92

of patients. Around 12

of the procedures were associated with adverse events, all related to the airways, and none was serious. The only statistically significant endpoint associated with adverse events were procedures which involved airway interventions, i.e., fibrobronchoscopy, upper gastrointestinal endoscopy or transesophageal echocardiogram, with an OR of 6.27 (95

CI: 1.28-30.63; p = 0.023). CONCLUSIONS: In this group of patients, intravenous outpatient sedation and analgesia administered by a specialized team were safe and effective.

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Introduction: Central venous catheter of peripheral insertion (PICC) can stay installed from several days up to months without removal. It allows the administration of extreme pH and osmolarity solutions, irritating and/or vesicant drugs, parenteral nutrition and other medications for prolonged periods in patients with complicated peripheral venous access. Objective: To describe the experience with PICCs in hospitalized pediatric. Patients and Methods: Observational and descriptive study on 337 patients hospitalized in the Pediatrics Service of the Clinical Hospital of Catholic University of Chile between 2001 and 2011, who fulfilled the inclusion criteria and had a PICCs installed by trained nurses. Results: The patients' average age was of 36 months. Main indication for installing PICC was prolonged antibiotic therapy, in 67.1 percent of cases. The most widely used venous route was the upper limb, in 52.2 percent. The mean average time in which the PICC remained in the body was of 9 days, ranging between 1 and 90 days. The main cause for PICC withdrawal was the end of therapy in 75.3 percent. The observed complications were: occlusion and catheter associated infection in 8.9 percent and 2.9 percent respectively. Conclusion: PICC is an excellent alternative for prolonged intravenous therapy; but, it is very important to keep on a team of well-trained nurses, both in the insertion as well in the maintenance of the PICC during the time it remains in the body.

Introducción: El catéter venoso central de inserción periférica (PICC) puede permanecer desde días hasta meses instalado sin necesidad de recambio; permitiendo la administración de soluciones con pH y osmolari-dad extremas, medicamentos irritantes y/o vesicantes, nutrición parenteral u otros medicamentos por tiempo prolongado en pacientes con accesos venosos periféricos difíciles. Objetivo: Describir la experiencia del uso de PICCs en pacientes pediátricos hospitalizados. Pacientes y Método: Estudio observacional y descriptivo, donde se hizo un seguimiento a 337 pacientes con PICCs instalados por enfermeras capacitadas, en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile entre los años 2001 y 2011, que cumplieron con los criterios de inclusión. Resultados: La edad de los pacientes presentó una mediana de 36 meses. La principal indicación para la instalación del PICC fue la terapia antibiótica prolongada en el 67,1 por ciento. El acceso venoso más utilizado fue la extremidad superior en un 52,2 por ciento. El promedio de días de permanencia del catéter presentó una mediana de 9 días con un rango entre 1 y 90 días. El principal motivo para el retiro del PICC fue la finalización del tratamiento en el 75,3 por ciento. Las complicaciones presentadas fueron: oclusión e infección asociada al catéter con un 8,9 por ciento y 2,9 por ciento, respectivamente. Conclusión: El PICC es una excelente alternativa para la terapia endovenosa por períodos prolongados; sin embargo, es muy importante mantener un equipo de enfermería capacitado, tanto en la inserción como en la mantención del PICC durante su permanencia.

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Background: Most pediatric cardiac arrest episodes are the result from extra cardiac events. They occur at home, while children are under the supervision of their parents or caregivers. Therefore pediatric health care providers should promote the education of basic pediatric cardiopulmonary resuscitation (CPR) to parents. objective: To describe the outcome of an educational program of basic pediatric CPR to parents of admitted children. Patients and Method: 108 parents of 89 patients admitted to the pediatric Service of the Clinical Center Universidad Catolica were provided with CPR training. Acquired knowledge was assessed through a phone survey, consistent in 6 questions with a maximum score of 14 points, applied 1 month after the training session. Results: Median score obtained was 12 points. Five participants achieved a score of 14 points. Least retained knowledge related to: steps of CPR (31.5 percent), number of cycles before activating an emergency system (55.6 percent), and steps followed when removing foreign body airway obstruction in conscious children (14.8 percent). Conclusions: in this study, only a few participants were able to answer all six questions without mistakes. However, hard-to-remember concepts were identified, for emphasis in future educational programs.

Antecedentes: En pediatría, la mayoría de los paros cardiorrespiratorios son de origen extra cardíaco y se producen en el hogar, donde los niños se encuentran bajo la supervisión de sus padres o cuidadores. Por lo anterior, los profesionales de la salud infantil deberían promover la capacitación a los padres en reanimación cardiopulmonar (RCP) básica pediátrica. objetivo: Evaluar los conocimientos adquiridos por los padres de niños hospitalizados luego de un programa educativo de RCP básica pediátrica. Pacientes y Método: Se realizó un estudio descriptivo para identificar los conocimientos adquiridos por 108 padres de 89 pacientes hospitalizados, en un programa educativo implementado en el Servicio de Pediatría del Hospital Clínico UC. El instrumento utilizado fue una encuesta de 6 preguntas con un puntaje máximo de 14 puntos, aplicada telefónicamente un mes después del taller. Resultados: El puntaje obtenido presentó una mediana de 12 puntos. Cinco participantes obtuvieron el puntaje total. Las preguntas con menos porcentaje de cumplimiento fueron las referentes a los pasos para realizar RCP (31,5 por ciento), al número de ciclos antes de activar el sistema de emergencias (55,6 por ciento) y a los pasos para aliviar la asfixia por cuerpo extraño en niños conscientes (14,8 por ciento). Conclusión: En este estudio, un bajo porcentaje de los participantes estudiados fue capaz de responder las 6 preguntas sin errores. Por otro lado, se logró identificar los conceptos que fueron más difíciles de recordar para los participantes; los cuales deben ser abordados con más énfasis en futuros programas educativos.

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