Search

Percutaneous central venous catheter (PCVC) placement can be used to provide the nutritional needs for premature infants while eliminating access difficulties. However, safely delivering nutrition through a PCVC requires preventing infection and mechanical complications. Establishing a program to ensure PCVC quality will produce long-term benefits for patients and staff.

Percutaneous central venous catheterization (PCVC) is the insertion of a tube-like structure called a catheter through the skin into a peripheral vein and on into a central vein, for monitoring blood pressure in the vein or for obtaining blood samples for analysis. This procedure is now being used in infants with very low birth weights, who would otherwise require frequent venipuncture (puncture of a vein) for blood tests. The effects of PCVC on 317 infants who received a total of 478 percutaneous catheters during a three-year period were assessed. Two hundred and forty-one catheters were placed in infants weighing one kilogram (2.2 pounds) or less. The average length of time that an infant was catheterized was 13 days. Almost half of the catheters placed in the central and thoracic veins were removed, because of leakage or clotting in 43 percent of cases, and because of sepsis (infection) or blockage of a vein in 6 percent of cases. Of 23 cases of suspected sepsis, six resulted from the catheter and 12 were associated with another site of infection. Sepsis due to PCVC was associated with increased duration of catheterization, infection with Staphylococcus epidermidis, and infant weight of one kilogram or less. Sepsis due to infection unrelated to the catheter was associated with the presence of another infection site, previous infection, extremely low birth weight, and persistent clinical problems. PCVC decreased the stress associated with repeated venipuncture, reduced the incidence of complications to less than the rate associated with surgically-inserted central venous catheters, and helped in identifying factors that increase the risk of sepsis. (Consumer Summary produced by Reliance Medical Information, Inc.)

The importance of communicating with parents who experience a perinatal loss has been documented repeatedly in the research. Yet, parents do not consistently receive adequate information when they experience a loss. Effective communication with parents who have experienced a loss requires ongoing dialogue throughout all phases of care, starting well before the loss of an infant. To communicate effectively, clinicians need to know the type of information to give, how and when to give the information, and how to assess parents' understanding of the information. Professionals who are skilled at communicating with and caring for parents who experience a loss should serve as mentors for their colleagues to ensure the ongoing availability of competent clinicians. [ABSTRACT FROM AUTHOR]