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Accessing the veins for blood delivery, sampling or nutrition is a critical factor in the process of care and management of pediatric patients. In this regard, the peripherally inserted central catheter (PICC) is one of the main alternatives which could be applied effectively as traditional central venous devices in neonates and adults. Due to their essential role in providing safe central venous entry, PICCs could be applied extensively in patients who are critically ill. The main aims of the present study are to review approximately all relevant publications concerning PICC procedures, any possible complications, and the most appropriate decision for preventing these complications due to their high mortality rate. We carried out a comprehensive search on PubMed, HubMed, EMBASE, MEDLINE, Science Direct, Scopus, MEDLINE, and EMBASE databases for identifying the most relevant publications related to potential complications following the application and insertion of PICCs in hospitalized children and infants. Through appropriate care of catheters, the rate of possible infectious, mechanical and thrombotic complications would decrease considerably compared to those patients who received traditional central venous catheters. However, the process of vascular access in neonatal and children is very challenging. Any delay or denying treatment due to the lack of vascular access is intolerable. In this regard, anesthesiologists must achieve extra knowledge of various vascular devices. [ABSTRACT FROM AUTHOR]

Background: The increase in the spread of the novel coronavirus (SARS-CoV-2) has put many children at risk around the world. Some of these patients are in critical condition and present with shock symptoms and cardiac system problems. The ultrasonic cardiac output monitor (USCOM) is a non-invasive device that determines a person's cardiac output using continuous wave Doppler ultrasound. Objectives: The current study aims to present the clinical and laboratory manifestations of children with coronavirus disease (COVID-19) and to use a USCOM device for hemodynamic assessment to record and review their clinical information. Patients and Methods: We introduce 22 cases of children infected with coronavirus admitted to a public hospital in Iran. We examined the hemodynamics of these patients using USCOM and reported our experience with pediatric patients presenting with shock. This was a retrospective study, and data were collected using medical records. Results: In this study, 22 pediatric cases (10 girls and 12 boys) infected with coronavirus were reported. The youngest was 3 months old and the oldest was 14 years old. The most commonly observed symptoms were low back pain (N = 15), fever (N = 12), and seizures (N = 10). We found that the hemodynamics of the patients, including systemic vascular resistance (SVR), were abnormal and were associated with hypotension and unstable hemodynamics. The children responded well to the administration of an intravenous norepinephrine drip. Conclusion: This study presents detailed clinical and laboratory results of 22 children with COVID-19. Additionally, their hemodynamic status was measured and presented using the USCOM device. This information can provide physicians with a comprehensive understanding of the clinical history of patients referred with COVID-19, thereby improving their knowledge and care delivery. [ABSTRACT FROM AUTHOR]

Introduction: Many causes of admission to the pediatric intensive care unit (PICU) may potentially induce hyponatremia. This study was aimed at evaluating the incidence of admission dysnatremia in the PICU and its relationship with the underlying disease and demographic factors. Materials and Methods: This observational prospective study was conducted in a 12-bed medical PICU in a tertiary governmental teaching hospital for six months. The study group comprised patients aged 1 month to 18 years. Patients who received intravenous fluid within 24 hours before admission were excluded. Serum sodium was checked on admission and concentrations below 135 and above 145 mEq/L were considered hyponatremia and hypernatremia, respectively. Results: One hundred and ninety-five patients (117 males, 60%) were included in the study. The mean serum sodium level was 137.8 mEq/L ± 5.2. Forty-two patients (20.5%) were hyponatremic and 10 (5.1%) were hypernatremic. The most prevalent diagnosis in hyponatremic patients was pulmonary diseases followed by renal diseases, central nervous system (CNS) diseases, diabetic ketoacidosis (DKA), gastrointestinal (GI) diseases, and cardiovascular and hematologic-oncologic diseases. Fifty percent of nephrologic patients were hyponatremic. Hyponatremia was found in 26.5%, 23.5%, 20%, 16.6%, and 14.2%of the children with lung diseases, DKA, hematologic-oncologic diseases, cardiovascular diseases, and CNS and GI diseases, respectively. Moreover, 20%, 16.6%, 11.7%, 7.1%, and 2.9%of the patients with infectious diseases, cardiovascular diseases, DKA, CNS diseases, and pulmonary diseases had hypernatremia, respectively. Conclusions: Hyponatremia is frequent in our PICU. Patients suffering from renal diseases, pulmonary problems, DKA, and hematologic- oncologic diseases have a higher chance of hyponatremia (≥20%). [ABSTRACT FROM AUTHOR]