Sheikh Ahmed

Catheter-associated bloodstream infection in the pediatric intensive care unit: a multidisciplinary approach.

Background: Catheter-associated bloodstream infections have been reported to occur in 3% to 8% of all central venous catheters inserted and are the predominant cause of hospital-acquired infection in intensive care units. Objective: Decreasing the pediatric intensive care unit rate of catheter-associated bloodstream infections became a high priority in 2008 for all members of the intensive care unit team affiliated with central venous catheter insertion and maintenance. Interventions: Through a series of multidisciplinary initiatives, the annual average catheter-associated bloodstream infection rate in the pediatric intensive care unit fell from 7.9 infections per 1000 central catheter days in 2007 to 1.3 infections per 1000 central catheter days in 2009, a decrease of 83%. We attribute this success to the implementation of several key interventions, adherence to published insertion and maintenance bundles, and collaboration among pediatric intensive care unit physicians and nurses in all aspects of central catheter care. Measurements and Main Results: Statistically significant interventions included improvements to central venous catheter insertion practices, the development of a dedicated central catheter team, and regular collaborative discussion of central venous catheter necessity. In this 24-month period, this equates to 50 catheter-associated infections avoided, six potential deaths prevented, and an estimated cost savings of

Alteplase use for malfunctioning central venous catheters correlates with catheter-associated bloodstream infections.

1.45 million (based on

Implementation of a diuretic stewardship program in a pediatric cardiovascular intensive care unit to reduce medication expenditures.

29,000 per infection). Conclusion: While implementation of these and other interventions has shown a positive impact, this project will continue into the future to assure sustainable successes and continued best practice improvements.

Corrigendum to "High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI".

Objectives: A catheter thrombosis and the presence of a catheter-associated bloodstream infection (CBSI) often occur simultaneously, but it is unclear if or to what degree the two complications relate. Several animal and adult studies indicate a relationship between fibrin sheaths and thrombi in the development of CBSIs. To date, there has been limited human investigation in the pediatric population to determine a clear link between the presence of a thrombus and bacteremia. The use of alteplase for malfunctioning central venous catheter may indicate the formation of intraluminal thrombus or fibrin sheath. A catheter that requires alteplase is at higher risk of a CBSI. Design: A retrospective chart review from July 2008 to December 2010. Setting: PICU. Patients: All patients with central catheters admitted to the PICU. Interventions: No interventions performed with the retrospective study. Measurements: Number of total central venous catheters, number of central venous catheters that received treatment with alteplase, and number of CBSIs. Main Results: Preliminary data during the study period identified 3,289 central venous catheters. Twelve percent of these catheters required at least one dose of alteplase. There were 40 CBSIs during this same time period of which 28% received alteplase during the 5 days preceding the positive blood culture. The odds ratio for getting a CBSI when alteplase is administered is 2.87 (confidence interval 1.42–5.80; p = 0.002). The average age of the central venous catheters at time of infection was not statistically different, 16.1 days in the alteplase catheters compared with 25.6 days for the catheters that did not receive alteplase (p = 0.6). Conclusions: There is a positive correlation between the use of alteplase for malfunctioning central venous catheters and the development of a CASBI. This is likely associated with the presence of an intraluminal fibrin sheath or thrombus. This study adds evidence linking thrombus formation to CBSI.

Profound hypoxemia and pulmonary hypertension in a 7-month-old infant: late presentation of alveolar capillary dysplasia.

PURPOSE The implementation of a diuretic stewardship program in a pediatric cardiovascular intensive care unit (ICU) is described. METHODS This retrospective study compared the use of i.v. chlorothiazide and i.v. ethacrynic acid in pediatric cardiovascular surgery patients before and after implementation of a diuretic stewardship program. All pediatric patients admitted to the pediatric cardiovascular service were included. The cardiovascular surgery service was educated on formal indications for specific diuretic agents, and the diuretic stewardship program was implemented on January 1, 2013. Under the stewardship program, i.v. ethacrynic acid was indicated in patients with a sulfonamide allergy, and i.v. chlorothiazide was considered appropriate in patients receiving maximized i.v. loop diuretic doses. A detailed review of the pharmacy database and medical records was performed for each patient to determine i.v. chlorothiazide and i.v. ethacrynic acid use and expenditures, appropriateness of use, days using a ventilator, and cardiovascular ICU length of stay. RESULTS After implementation of diuretic stewardship, the use of i.v. chlorothiazide decreased by 74% (531 fewer doses) while i.v. ethacrynic acid use decreased by 92% (47 fewer doses), resulting in a total reduction of

Dexmedetomidine versus Propofol: Is One Better Than the Other for MRI Sedation in Children?

91,398 in expenditures on these diuretics over the six-month study period and an estimated annual saving of over

590: Dexmedetomidine Vs Propofol

182,000. The median number of days using a ventilator and the length of ICU stay did not differ significantly during the study period. CONCLUSION Implementation of a diuretic stewardship program reduced the use of i.v. chlorothiazide and i.v. ethacrynic acid without adversely affecting clinical outcomes such as ventilator days and length of stay in a pediatric cardiovascular ICU.

328: PEDIATRIC INFLUENZA MYOCARDITIS POST-CARDIAC ARREST AND CPR REQUIRING ECMO BENEFIT FROM PERAMIVIR

[This corrects the article DOI: 10.1155/2015/397372.].