RESUMEN
OBJECTIVE: This study aims to assess differences in clinical and surgical outcomes associated with the surgical treatment of midshaft clavicle fractures of different complexities based on fragment number. Additionally, the investigation seeks to present the outcomes of a series of patients who underwent surgery at our institution. MATERIALS AND METHODS: A retrospective analysis was conducted on the medical records of patients aged over 18 who underwent midshaft clavicle fracture surgery at our center from November 2009 to May 2021. Patients were categorized based on the number of fracture fragments into groups of two, three, or more than three fragments. Consolidation, implant removal, complications, surgical duration, and functional outcomes (assessed through VAS, ASES, and Constant-Murley scale) were evaluated for each specific group and for the overall cohort. RESULTS: In total, 260 patients were analyzed. There were no significant differences in any of the parameters between the three groups except for surgical time, which was shorter in simple fractures than in those with more than three fragments (68.2 min vs. 75.3 min; p = 0.01). Pseudoarthrosis rate was 2.69%, implant removal rate was 9.61%, and 4.23% of patients presented with complications other than the previous ones. Functional results were excellent, with averages of 97.3 (72.7-100) for the ASES score, 97.5 (75-100) for the Constant score, and 0.6 (0-8) on the VAS. CONCLUSION: According to our results, there were no differences in postoperative results between simple and multifragmentary midshaft clavicle fractures. Patients across all groups reported satisfactory results.
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Clavícula , Fijación Interna de Fracturas , Fracturas Óseas , Humanos , Clavícula/lesiones , Clavícula/cirugía , Masculino , Femenino , Estudios Retrospectivos , Fracturas Óseas/cirugía , Adulto , Persona de Mediana Edad , Fijación Interna de Fracturas/efectos adversos , Fijación Interna de Fracturas/métodos , Resultado del Tratamiento , Tempo Operativo , Complicaciones Posoperatorias/etiología , Remoción de Dispositivos/estadística & datos numéricos , Seudoartrosis/cirugía , Seudoartrosis/etiología , Curación de FracturaRESUMEN
STUDY OBJECTIVE: To identify why adolescents with polycystic ovary syndrome (PCOS) chose the etonogestrel (ENG) contraceptive implant, to determine the 12-month continuation rate, and to characterize factors related to discontinuation. DESIGN, SETTING, AND PARTICIPANTS: Retrospective chart review of adolescents seen at a tertiary care children's hospital between July 1, 2008, and August 30, 2019, with PCOS diagnosis confirmed per National Institutes of Health criteria and ≥12-month ENG follow-up. INTERVENTIONS AND MAIN OUTCOME MEASURES: Demographic characteristics, reasons for ENG insertion and removal, and information on other hormonal/contraceptive therapies were collected. Patients were categorized as ENG continuers (use ≥12 months) or discontinuers (removal at <12 months), and groups were compared. RESULTS: A total of 96 patients met inclusion criteria (age 17.7 ± 2.2 years, body mass index 34.8 ± 8 kg/m2). Reasons for ENG were documented in 74% (51% contraception, 32% ease of use, 15% other, 13% estrogen avoidance). In all, 27% had never been sexually active, and 67% had had prior sexual activity. Treatments prior to ENG placement included 74% combined hormonal contraception, 20% medroxyprogesterone acetate withdrawal, and 17% depot medroxyprogesterone. A total of 77% continued ENG at 12 months. The main reasons for discontinuation were bleeding (41%), concern about weight gain (23%), and mood changes (18%). No preimplantation characteristics were independently predictive of continuation, although 100% of patients with type 2 diabetes (n = 11) continued. Patients who sought additional care, including telephone calls (41% vs 12%, P = .006) and clinic visits (64% vs 20%, P < .001) were more likely to discontinue. CONCLUSIONS: The ENG implant was well tolerated in adolescents with PCOS and similar to published 12-month continuation rates.
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Agentes Anticonceptivos Hormonales/administración & dosificación , Toma de Decisiones , Desogestrel/administración & dosificación , Adolescente , Adulto , Estudios de Casos y Controles , Agentes Anticonceptivos Hormonales/efectos adversos , Dispositivos Anticonceptivos Femeninos/efectos adversos , Desogestrel/efectos adversos , Remoción de Dispositivos/psicología , Remoción de Dispositivos/estadística & datos numéricos , Implantes de Medicamentos/administración & dosificación , Implantes de Medicamentos/efectos adversos , Femenino , Humanos , Síndrome del Ovario Poliquístico/psicología , Estudios Retrospectivos , Adulto JovenRESUMEN
OBJECTIVE: To describe characteristics of the full population of women who participated in the Zika Contraception Access Network program in Puerto Rico during the virus outbreak and to examine factors associated with removal of a long-acting reversible contraception (LARC) method by a Zika Contraception Access Network provider during the program's duration (May 2016-September 2017). METHODS: We conducted an observational cohort study. The Zika Contraception Access Network program was designed to increase access to contraception services in Puerto Rico for women who chose to prevent pregnancy during the Zika virus outbreak as a primary strategy to reduce adverse Zika virus-related pregnancy and birth outcomes. Among program participants, an observational cohort of women served by the Zika Contraception Access Network Program, we describe their demographic and program-specific characteristics, including contraceptive method mix before and after the program. We also report on LARC removals by Zika Contraception Access Network providers during the program. We examined factors associated with LARC removal using multivariable logistic regression. RESULTS: A total of 29,221 women received an initial Zika Contraception Access Network visit during the program. Ninety-six percent (27,985) of women received same-day provision of a contraceptive method and 70% (20,381) chose a LARC method. While the program was active, 719 (4%) women who chose a LARC at the initial visit had it removed. Women with a college degree or higher were more likely to have their LARC removed (adjusted prevalence ratio [aPR] 1.24); breastfeeding women (aPR 0.67) and those using a LARC method before Zika Contraception Access Network (aPR 0.55) were less likely to have their LARC removed. CONCLUSION: The Zika Contraception Access Network program was designed as a short-term response for rapid implementation of contraceptive services in a complex emergency setting in Puerto Rico and served more than 29,000 women. The Zika Contraception Access Network program had high LARC uptake and a low proportion of removals by a Zika Contraception Access Network provider during the program. A removal-inclusive design, with access to removals well beyond the program period, maximizes women's reproductive autonomy to access LARC removal when desired. This model could be replicated in other settings where the goal is to increase contraception access.
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Remoción de Dispositivos/estadística & datos numéricos , Servicios de Planificación Familiar/estadística & datos numéricos , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/prevención & control , Infección por el Virus Zika/prevención & control , Adolescente , Adulto , Brotes de Enfermedades , Servicios de Planificación Familiar/métodos , Femenino , Humanos , Anticoncepción Reversible de Larga Duración/métodos , Embarazo , Complicaciones Infecciosas del Embarazo/virología , Evaluación de Programas y Proyectos de Salud , Puerto Rico/epidemiología , Adulto Joven , Virus Zika , Infección por el Virus Zika/epidemiologíaRESUMEN
BACKGROUND: In the event of a surgical site infection, management includes surgical debridement in an attempt to treat the infection and retain the implant; however they are often unsuccessful in this regard. Although studies have described the incidence of complications, current literature does not have sufficient evidence to provide clear recommendations regarding retention versus removal of implants. This study aims to identify predictive factors associated with the need for implant removal to decrease unnecessary attempts at implant retention. METHODS: A retrospective review of early-onset scoliosis patients at a single institution treated with rib-based vertical expandable prosthetic titanium rib implants who developed infection requiring irrigation and debridement (I&D) due to wound problems including surgical site infection, skin slough, and wound dehiscence. All patients had a minimum of a 2-year follow-up. Univariate and multivariate logistic regression analyses were conducted to determine the odds of implant removal. RESULTS: Fifty-nine of 181 patients (32%) required an I&D due to a wound problem. These patients underwent the initial implant procedure at a mean age of 4.6±3.8 years. In total, 29 patients ultimately underwent implant removal. Significant predictive factors for removal included total number of wound problems, total number of I&Ds, days from identification of wound problem to I&D procedure, days on antibiotics, total number of surgeries, presence of gastrostomy tube, and nonambulatory status (P<0.0001, 0.001, 0.095, 0.093, 0.082, 0.054, and 0.026, respectively). Multiple logistic regression results indicated a total number of wound problems [odds ratio (OR): 6.00, P=0.001], average days from identification of wound problem to I&D (OR: 1.03, P=0.039), and presence of a gastrostomy tube (OR: 5.7, P=0.07) as independent predictors for implant removal. CONCLUSIONS: Data suggests that time from the onset of signs of infection until debridement surgery inversely correlates with the ability to retain the implants. In addition, gastrostomy tube and history of previous wound infections may be predictive clinical factors for implant removal in patients with a rib-based vertical expandable prosthetic titanium rib instrumentation. Such information can be useful for clinicians in deciding on whom to attempt implant retention versus removal when a wound problem presents itself. LEVEL OF EVIDENCE: Level III.
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Remoción de Dispositivos/estadística & datos numéricos , Prótesis e Implantes/efectos adversos , Escoliosis/cirugía , Infección de la Herida Quirúrgica/epidemiología , Adolescente , Antibacterianos/uso terapéutico , Niño , Preescolar , Desbridamiento , Femenino , Humanos , Incidencia , Lactante , Masculino , Análisis Multivariante , Estudios Retrospectivos , Costillas/cirugía , Factores de Riesgo , TitanioRESUMEN
BACKGROUND: Sacral neuromodulation (SNM) is a widely used therapeutic option for fecal incontinence (FI). Larger series are mainly from Western countries, while few reports address the results of SNM in less developed or less wealthy countries. The aim of the present study was to evaluate the efficacy of SNM in patients with FI in Latin America. METHODS: A retrospective study was conducted on patients with FI who had SNM between 2009 and 2016 at 15 specialized colorectal surgery centers in Latin America. Main outcomes measures were functional outcomes, postoperative complications, requirement of revisional surgery, and requirement of device removal. All patients had failed conservative management and had clinical assessment including recording of the validated Cleveland Clinic Florida Fecal Incontinence Score (CCF-FIS) and, when available, anal manometry and endoanal ultrasound. Patients were followed up for a median of 36.7 (1-84) months. RESULTS: One hundred and thirty-one patients [119 females, median age of 62.2 (range 19-87) years] were included. The most common etiology of FI was obstetric injury (n = 60; 45.8%). After successful test lead implantation, the stimulator was permanently placed in 129 patients (98.5%). One patient failed to respond in the test phase and one patient did not proceed to permanent implantation for insurance reasons. Nineteen patients (14.7%) had 19 complications including infection (n = 5, 3.8%), persistent implant site pain (n = 5, 3.8%), generator/lead dislodgment (n = 5, 3.8%), malfunctioning device (n = 3, 2.3%), and hematoma (n = 1, 0.7%). Reimplantation after the first and second stages was necessary in 2 (1.5%) and 3 patients (2.3%), respectively. The device removal rate was 2.2%. At a median follow-up of 36.7 (range 1-84) months, the CCF-FIS significantly improved from a preoperative baseline of 15.9 ± 2.98 to 5.2 ± 3.92 (95%CI: 15.46 vs 4.43; p < 0.0001). Overall, 90% of patients rated their improvement as "significant". CONCLUSIONS: Sacral nerve stimulation for FI is safe and efficient, even in less wealthy or less developed countries.
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Terapia por Estimulación Eléctrica/métodos , Incontinencia Fecal/terapia , Sacro/inervación , Adulto , Anciano , Anciano de 80 o más Años , Remoción de Dispositivos/estadística & datos numéricos , Electrodos Implantados , Femenino , Humanos , América Latina/epidemiología , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Sacro/cirugía , Resultado del Tratamiento , Adulto JovenRESUMEN
Abstract Introduction: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. Objective: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Methods: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. Results: 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77 ± 0.84 vs. 1.7 ± 1.00 comorbidities; p < 0.001). Conclusion: Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
Resumo Introdução: As crianças podem necessitar de traqueostomia devido a diferentes problemas de saúde. Ao longo dos últimos 40 anos, as indicações de traqueostomia passaram por mudanças substanciais. Objetivo: Avaliar pacientes pediátricos com traqueostomia no nosso hospital, no que diz respeito às suas indicações, comorbidades associadas, complicações e taxas de decanulação. Método: Estudo retrospectivo de pacientes com menos de 18 anos submetidos a traqueostomia em um centro de saúde terciário, de janeiro de 2006 a novembro de 2015. Resultados: 123 crianças precisaram de uma traqueostomia após avaliação otorrinolaringológica durante o período do estudo. Do total, 63% eram do sexo masculino e 56% menores de um ano. Glossoptose foi a indicação mais comum (30%), seguida por estenose subglótica (16%) e faringomalácia (11%). A taxa de mortalidade foi de 31%. Até o fim deste artigo, 35 crianças (28,4%) haviam sido decanuladas e quanto menor o número de comorbidades, maior foi a taxa de decanulação (0,77 ± 0,84 vs. 1,7 ± 1,00 comorbidades; p < 0,001). Conclusão: A traqueostomia em crianças é um procedimento relativamente frequente em nosso hospital. As indicações mais comuns são glossoptose e estenose subglótica. Uma alta taxa de mortalidade foi encontrada, potencialmente comprovada pelo elevado número de pacientes críticos com condições neurológicas crônicas nessa coorte. Nossa taxa de decanulação está ligeiramente abaixo de outras séries, provavelmente por causa da maior quantidade de pacientes com comorbidades.
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Humanos , Masculino , Femenino , Recién Nacido , Lactante , Preescolar , Niño , Adolescente , Traqueostomía/estadística & datos numéricos , Complicaciones Posoperatorias/epidemiología , Brasil/epidemiología , Traqueostomía/efectos adversos , Comorbilidad , Laringoestenosis/cirugía , Estudios Retrospectivos , Resultado del Tratamiento , Distribución por Edad , Remoción de Dispositivos/estadística & datos numéricos , Centros de Atención Terciaria , Glosoptosis/cirugía , Complicaciones Intraoperatorias/epidemiologíaRESUMEN
Resumen: Introducción: En pediatría se reportan complicaciones del catéter central de inserción periférica (CCIP) del 30 al 40% de los casos, siendo los factores de riesgo más frecuentes la edad del paciente y la localización del CCIP. El objetivo de este trabajo fue describir las características de los CCIP e identificar los factores relacionados con su retiro debido a complicaciones. Métodos: Estudio de cohorte prospectiva. Se incluyeron pacientes de 2 meses a 18 años de edad. Se les dio seguimiento hasta el retiro del CCIP. Se registró la edad, sexo, medicamentos administrados, localización del CCIP, calibre, número de lúmenes, días que estuvo colocado y el motivo del retiro. Se realizó análisis univariado y multivariado. Resultados: Se incluyeron 225 pacientes. En 33.02%, el CCIP fue retirado por alguna complicación. En el análisis bivariado, la edad y la localización fueron los factores asociados con las complicaciones. Se realizó un modelo de riesgos proporcionales de Cox y se identificó que solamente el grosor del calibre se asoció con cualquier complicación (razón de tasas (RT): 0.5, intervalo de confianza (IC)95%: 0.35-0.99), y la edad (RT: 1.02, IC95%: 1-1.04) solamente con el retiro del CCIP por sospecha de flebitis. Conclusiones: El 33% de los pacientes presentaron retiro del CIPP por complicaciones; solamente el calibre del CIPP y la edad de los pacientes estuvieron relacionados con este evento.
Abstract: Background: In pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30% to 40% of cases, with the most frequent risk factors being the age of the patient and the location of PICC. The aim of this study was to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications. Methods: Prospective cohort study. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed. Results: Two hundred and twenty-five patients were included. In 33.02%, PICC were withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. It was identified that only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI)95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) only to the withdrawal of PICC due to suspected phlebitis. Conclusions: PICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.
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Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Masculino , Cateterismo Venoso Central/efectos adversos , Remoción de Dispositivos/estadística & datos numéricos , Catéteres Venosos Centrales/efectos adversos , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/métodos , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Estudios de Cohortes , Estudios de Seguimiento , Factores de Edad , Centros de Atención Terciaria , Hospitales PediátricosRESUMEN
INTRODUCTION: Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. OBJECTIVE: To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. METHODS: Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. RESULTS: 123 children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). CONCLUSION: Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities.
Asunto(s)
Traqueostomía/estadística & datos numéricos , Adolescente , Distribución por Edad , Brasil/epidemiología , Niño , Preescolar , Comorbilidad , Remoción de Dispositivos/estadística & datos numéricos , Femenino , Glosoptosis/cirugía , Humanos , Lactante , Recién Nacido , Complicaciones Intraoperatorias/epidemiología , Laringoestenosis/cirugía , Masculino , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Centros de Atención Terciaria , Traqueostomía/efectos adversos , Resultado del TratamientoRESUMEN
BACKGROUND: In pediatrics, complications of the peripherally inserted central venous catheters (PICC) are reported in 30% to 40% of cases, with the most frequent risk factors being the age of the patient and the location of PICC. The aim of this study was to describe the characteristics of PICCs and to identify factors related to their withdrawal due to complications. METHODS: Prospective cohort study. Patients from 2 months to 18 years of age were included and followed-up until PICC was withdrawn. Age, sex, medications administered, PICC location, caliber, the number of lumens, days PICC was on the patient, and the reason for withdrawal was recorded. Univariate and multivariate analyses were performed. RESULTS: Two hundred and twenty-five patients were included. In 33.02%, PICC were withdrawn due to complications. In the bivariate analysis, age and location were factors associated with complications. A Cox proportional hazards model was performed. It was identified that only the caliber thickness (hazard ratio (HR): 0.5, confidence interval (CI)95%: 0.35-0.99) was associated with any complication, and age (HR: 1.02, CI95%: 1-1.04) only to the withdrawal of PICC due to suspected phlebitis. CONCLUSIONS: PICC withdrawal due to complications was performed in 33% of the patients. Risk factors related to complications were PICC caliber thickness and age.
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Cateterismo Venoso Central/efectos adversos , Catéteres Venosos Centrales/efectos adversos , Remoción de Dispositivos/estadística & datos numéricos , Adolescente , Factores de Edad , Cateterismo Venoso Central/instrumentación , Cateterismo Venoso Central/métodos , Niño , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Hospitales Pediátricos , Humanos , Lactante , Masculino , Análisis Multivariante , Estudios Prospectivos , Factores de Riesgo , Centros de Atención TerciariaRESUMEN
BACKGROUND: Nonelective removal of peripherally inserted central catheters (PICCs) due to complications continues to be a major concern in neonatal intensive care units (NICUs) around the world. Nonelective removal results in interruption of intravenous therapy, added costs, stress, and negative impacts on infant's health. Identification of predictors of complications that lead to nonelective removal of PICCs would allow for the initiation of preventive strategies to improve the quality of care. AIM: To identify predictors of nonelective removal of PICCs in neonates. METHODS: A prospective cohort study with a sample of 524 PICC lines inserted in 436 neonates admitted to a tertiary-level NICU of a Brazilian hospital. Data were collected on all neonates between August 31, 2010, and August 30, 2012. Neonates were monitored daily from insertion of the catheter until its removal. Bivariate analysis and a logistic regression were conducted in order to identify predictors of nonelective removal. RESULTS: A diagnosis of a transitory metabolic disorder (hypoglycemia; disorders of calcium, magnesium, sodium, or potassium; or dehydration), previous PICC line insertion, insertion of dual-lumen polyurethane PICC, noncentral tip position, and multiple intravenous solutions in a single-lumen silicone PICC were predictors of nonelective removal of PICC lines. CONCLUSION: The avoidance of repeated PICC insertions, noncentral tip position, and placement of single-lumen silicone PICCs for administration of four or more intravenous solutions is suggested. Interventions should be explored that facilitate PICC insertion success and correct tip placement.
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Infecciones Relacionadas con Catéteres/etiología , Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/efectos adversos , Cateterismo Venoso Central/enfermería , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/enfermería , Remoción de Dispositivos/estadística & datos numéricos , Brasil , Cateterismo Venoso Central/estadística & datos numéricos , Cateterismo Periférico/estadística & datos numéricos , Estudios de Cohortes , Femenino , Humanos , Lactante , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Estudios Prospectivos , Factores de RiesgoRESUMEN
OBJECTIVE: To compare the incidence and reasons for nonelective removal of percutaneously inserted central catheters (PICC lines) between centrally and noncentrally placed PICC lines in neonates. DESIGN: Prospective cohort study. SETTING: A 60-bed, tertiary-level neonatal intensive care unit in a private hospital in São Paulo, Brazil. PARTICIPANTS: Neonates who were born at the hospital and underwent successful insertion of 237 PICC lines. They were divided into two groups, central and noncentral, according to tip position. METHODS: Neonates were monitored daily from insertion of the PICC until its removal. Data were collected from medical records. RESULTS: Of the 237 PICCs analyzed, 207 (87.4%) had their tip in a central position and 30 (12.6%) in a noncentral position. The incidence of nonelective PICC removal was similar between the central and noncentral groups (p = .48). The reasons for nonelective removal were significantly different between the groups (p = .007), with a higher incidence of extravasation in the noncentral group. CONCLUSION: Noncentrally placed PICCs can provide vascular access in neonates requiring venous access for the administration of intravenous solutions. Many potential catheter-related complications can be prevented by careful bedside nursing. Frequent monitoring of noncentral PICCs is necessary to detect and prevent extravasation in neonates.
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Infecciones Relacionadas con Catéteres/prevención & control , Cateterismo Venoso Central/estadística & datos numéricos , Cateterismo Periférico/estadística & datos numéricos , Catéteres/estadística & datos numéricos , Remoción de Dispositivos/estadística & datos numéricos , Enfermería Neonatal/organización & administración , Brasil , Infecciones Relacionadas con Catéteres/etiología , Cateterismo Venoso Central/enfermería , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Cateterismo Periférico/enfermería , Catéteres/efectos adversos , Estudios de Cohortes , Remoción de Dispositivos/métodos , Femenino , Humanos , Incidencia , Recién Nacido , Unidades de Cuidado Intensivo Neonatal , Masculino , Evaluación de Resultado en la Atención de Salud , Estudios ProspectivosRESUMEN
OBJETIVO: Determinar a incidência e fatores de risco para a extubação acidental (EA) em uma unidade de terapia intensiva neonatal de nível terciário. MÉTODOS: Estudo de coorte prospectivo para determinar a densidade de incidência de EA por 100 pacientes-dia, no período de 23 meses, em 222 recém-nascidos em assistência ventilatória (AV). Foram estudados os fatores de risco para a EA utilizando análise de regressão logística. A presença de padrão cíclico nas taxas de extubação, segundo variáveis de interesse, foi investigada pela análise de Cosinor. RESULTADOS: A média da taxa de EA foi de 5,34/100 pacientes-dia ventilados. As variáveis preditoras que se associaram à EA foram o uso subsequente da via oral e nasal durante a AV [risco relativo (RR) = 4,73; intervalo de confiança de 95 por cento (IC95 por cento) 1,92-11,60], a duração da AV (a cada dia RR = 1,03; IC95 por cento 1,02-1,04) e o número de pacientes-dia ventilados (RR = 1,01; IC95 por cento 1,01-1,02). Pela regressão múltipla ajustada, o tempo total de AV foi o único preditor independente para a EA nesta amostra (RR = 1,02; IC95 por cento 1,01-1,03). O tempo de AV de 10,5 dias apresentou acurácia de 0,79 (IC95 por cento 0,71-0,87) para a ocorrência de EA. A análise de Cosinor demonstrou periodicidade significativa na taxa geral de EA e no número de pacientes-dia ventilados. Houve correlação significativa entre o número de pacientes-dia e a frequência de EA. CONCLUSÃO: A densidade média de EA foi de 5,34/100 pacientes-dia. O único preditor independente para EA foi a duração da AV. A melhor acurácia para a ocorrência de EA foi obtida aos 10,5 dias de duração da AV.
OBJECTIVE: To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit. METHODS: A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis. RESULTS: The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95 percent confidence interval (95 percentCI) 1.92-11.60], AV duration (per day, RR = 1.03; 95 percentCI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95 percentCI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95 percentCI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95 percentCI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency. CONCLUSION: Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.
Asunto(s)
Humanos , Recién Nacido , Remoción de Dispositivos/estadística & datos numéricos , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Intubación Intratraqueal/estadística & datos numéricos , Incidencia , Estudios Prospectivos , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To determine the incidence and risk factors of accidental extubation (AE) in a tertiary neonatal intensive care unit. METHODS: A prospective cohort study was conducted to determine AE incidence density per 100 patient-days, during a 23-month period, in 222 newborns receiving assisted ventilation (AV). Logistic regression analysis was used to determine risk factors for AE. The presence of a cyclical pattern in extubation rates, according to the variables of interest, was investigated by Cosinor analysis. RESULTS: The mean AE rate was 5.34/100 patient-days ventilated. AE-associated predictive variables were: subsequent use of the oral and nasal routes during AV [relative risk (RR) = 4.73; 95% confidence interval (95%CI) 1.92-11.60], AV duration (per day, RR = 1.03; 95%CI 1.02-1.04), and number of patient-days ventilated (RR = 1.01; 95%CI 1.01-1.02). According to the adjusted multiple regression analysis, total AV time was the only independent predictor of AE in this sample (RR = 1.02; 95%CI 1.01-1.03). AV time of 10.5 days showed an accuracy of 0.79 (95%CI 0.71-0.87) for the occurrence of AE. Cosinor analysis showed significant periodicity in overall AE rate and in the number of patient-days ventilated. There was a significant correlation between the number of patient-days ventilated and AE frequency. CONCLUSION: Mean AE density was 5.34/100 patient-days ventilated. AV duration was the only independent predictor of AE. The best accuracy for AE occurrence was achieved at 10.5 days of AV duration.