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Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; > 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P < 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P < 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.

Effective family management can improve the ability of children's families to cope with the disease. However, the family management styles of children with leukemia are unknown.This study used a family management style framework and structural equation model to determine the direct and indirect predictors of family management of children with leukemia.A total of 496 parents of children with leukemia completed the Family Management Measure, the Feetham Family Functioning Survey, the Social Support Rating Scale, and a demographic family information form. We used structural equation modeling to explore the direct and indirect effects of the study variables on family management styles.Family functioning, family income, parental education level, and geographic location affect family management directly, among which family functioning has the most significant coefficient in the model (0.53). Siblings and social support can affect family management through the mediating effect of family functioning. Employment change can directly affect family management (-0.27) and indirectly affect family functioning (-0.08).Our results support the family management style framework. Individual and family factors such as family income, parental education level, geographic location, employment change, siblings, and social support contribute to the ease or difficulty of family management. In addition, family functioning can also mediate between contextual influences and family management styles.Family functioning plays a vital role in relationships between contextual influences and family management. We can construct family management interventions according to family management influencing factors.

Background: Acute respiratory distress syndrome (ARDS) is one of the common causes of death in children hospitalized in the pediatric intensive care unit (PICU). The overall case fatality rate is as high as 25%, and the case fatality rate is higher in severe cases. Objectives: This study aimed to analyze the clinical outcomes of extracorporeal membrane oxygenation (ECMO) supportive therapy in children with ARDS. Methods: Sixteen ARDS children (8 boys and 8 girls aged 0.17 to 10 years old, with an average age of 3.25 years) were enrolled in this retrospective observational study. They were admitted to the PICU of a tertiary children’s hospital in China between January 2017 and March 2020. All patients received venous-arterial ECMO (veno-arterial, V-A ECMO) mode and were treated with heparin-coated ECMO-specific intravenous 8 - 19 Fr. catheter. Data were collected from medical records. General characteristics included gender, age, body weight, ventilator use before ECMO establishment, ECMO operation mode, ECMO operation hours, number of fiberoptic bronchoscopy assisted treatments, days on the ventilator after ECMO evacuation, total days on the ventilator, days of hospitalization, pathogen infection, primary disease/underlying disease, complications during ECMO therapy, comparison of monitored values of children 1 hour before and after ECMO establishment, analysis of the causes of complications during ECMO treatment in ARDS children. Results: The time in 16 cases of ECMO support ranged from 92 to 759 hours, with an average time of 255.13 hours. All patients survived the ECMO treatment, except for 1 case who died due to intracranial bleeding. Monitoring values, such as FiO2, mean airway pressure (MAP), blood pH, partial pressure of carbon dioxide (PCo2), etc., were statistically significantly different before and after ECMO establishment. There were 34 person-time complications during ECMO operation, among which hypertension was the most common. At follow-up (1 month to 3 years, until February 2020), 15 children were found to have good lung function. Conclusions: Early ECMO-assisted treatment in children with ARDS can improve their survival rate.