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Case Report: Epidermolysis Bullosa Using a PICC Line
to fully understand how to access a vein successfully, within a timely manner, and with as little pain to the patient as possible. In fact, “routine venous access procedures are among the most frequently reported painful events in hospitalized children.” There are several products that use local anesthetic to alleviate unnecessary pain prior to an IV procedure, however some can limit visibility of the vein or take upwards of 60 minutes to have an effect. Innovative products including needle-free injectors have been developed to solve these issues by decreasing wait time, vasoconstriction, and pain that can be associated with other methods. Purpose: To evaluate whether a needle-free jet injector is more effective at delivering local anesthetic before pediatric IV starts compared to existing methods. Project/Case Description: Children aged 1 to 6 years old were randomized into three groups: an intervention group (needle-free injector), a control group (vapocoolant) and a sham group. Each group was evaluated based on FLACC scores as well as venipuncture success rates. Results: Although there was no difference in success rates of venipuncture access between groups, there was a significant increase in pain recorded from both the control (2.82; 95% CI 1.91 to 3.74) and sham group (1.68; 95% CI 0.83 to 2.52) compared to the intervention group (0.26; 95% CI -0.31 to 0.82). Implications: While pain characteristics vary based on several factors such as each patient’s anxiety levels and relationship with the treatment administrator, the needle-free injector was able to reduce venipuncture pain compared to both the vapocoolant spray and sham treatments. Conclusions: Overall, the needle-free injector is an effective tool used to reduce pain during a venipuncture treatment in young children.
AVA/MAVAN to Mentoring: The Building of the arc4k Maggie McLaughlin, Paula Lamagna, Dawn Salina, Janet Coates, Tricia Blaine Marchetti By definition, structured collaboration means to work together to achieve shared goals by encouraging problem solving and objectivity. Both the pediatric and neonatal populations pose difficult challenges in vascular access. In an effort to promote best practice amongst Boston’s leading pediatric/ neonatal institutions, a working collaborative was formed to provide immediate and current information. The ARC4K was developed after discovering that all the leading institutions were providing parallel cutting edge vascular access techniques. Through this collaborative best practice policies and education opportunities have been shared and supported. Techniques that require expert guidance have been launched due to the immediate support when faced with an unusual challenge. Both successes and failures are shared amongst the group to provide transparency and an open discussion forum on how to make positive improvements. The group has embraced the advances within social media with the formation of an objective blog and Facebook group. Our vision is to provide real, practical and proven answers to
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questions that are truly unique to the pediatric and neonatal vascular worlds.
Case Report: Epidermolysis Bullosa Using a PICC Line Telma Silva, Marcelo Teixiera Epidermolysis bullosa is a rare, serious, non-contagious inherited disease. It features blistering through the body accompanied by a very high sensitivity of the body. It may appear spontaneously through trauma, or even change in temperature. The disease is classified according to the level shows. The diagnosis is made by biopsy. We searched in major databases and there no reports in literature of PICC use of associated with Epidermolysis Bullosa. This study is a case report of a 31-year old patient diagnosed with epidermolysis bullosa and skin cancer, requiring a safe route for administration of chemotherapy and sedation during radiotherapy. The patient was sedated and a 6 Fr double lumen power injectable tip catheter was inserted in the right arm; however, these patients cannot have adhesives used in direct contact to the skin , therefore, the catheter was sutured and a medicated dressing, a sterile sponge cover, catheter stabilizer and local bandaging were used (Annex 1). After ten days of patient’s catheter was stable, without bleeding in catheter and the dressing was intact. (Annex 2). The power injectable peripherally inserted central catheter is a safe route for chemotherapy administration in patients with epidermolysis bullosa, it reduced discomfort and pain patients in chemotherapy. It is a safe alternative for patients in critical care.
Characteristics of Common Infusates Jill Nolte Background: Much attention has been given to the characteristics of infusates with relation to site and device selection for vascular access placement. Purpose: This poster provides guidance on the chemical nature of many common infusates to help clinicians choose the best site and device. Project or Case Description: The poster is a graph revealing generalized pH range, high osmolarity infusates, and known irritants and vesicants. Precise characteristics of the infusates would be difficult if not impossible to provide as much variance is present across facilities and pharmacies. The information on the graph is intended to provide generalized guidance only. Results: The graph is easy to use and covers most common infusates. Implications: With this information readily available, clinicians can rapidly determine when central access would be a best choice for their patient, and know to more closely monitor infusions in the periphery. In the event of an infiltration/extravsation, this graph can also help guide the best treatment option. Conclusions: The infusate graph is a useful tool for clinicians involved in infusion therapy to appropriately insert, manage, and minimize risk.
2016
AVA/MAVAN to Mentoring: The Building of the arc4k Maggie McLaughlin, Paula Lamagna, Dawn Salina, Janet Coates, Tricia Blaine Marchetti By definition, structured collaboration means to work together to achieve shared goals by encouraging problem solving and objectivity. Both the pediatric and neonatal populations pose difficult challenges in vascular access. In an effort to promote best practice amongst Boston’s leading pediatric/ neonatal institutions, a working collaborative was formed to provide immediate and current information. The ARC4K was developed after discovering that all the leading institutions were providing parallel cutting edge vascular access techniques. Through this collaborative best practice policies and education opportunities have been shared and supported. Techniques that require expert guidance have been launched due to the immediate support when faced with an unusual challenge. Both successes and failures are shared amongst the group to provide transparency and an open discussion forum on how to make positive improvements. The group has embraced the advances within social media with the formation of an objective blog and Facebook group. Our vision is to provide real, practical and proven answers to
248
j
JAVA
j
Vol 21 No 4
j
questions that are truly unique to the pediatric and neonatal vascular worlds.
Case Report: Epidermolysis Bullosa Using a PICC Line Telma Silva, Marcelo Teixiera Epidermolysis bullosa is a rare, serious, non-contagious inherited disease. It features blistering through the body accompanied by a very high sensitivity of the body. It may appear spontaneously through trauma, or even change in temperature. The disease is classified according to the level shows. The diagnosis is made by biopsy. We searched in major databases and there no reports in literature of PICC use of associated with Epidermolysis Bullosa. This study is a case report of a 31-year old patient diagnosed with epidermolysis bullosa and skin cancer, requiring a safe route for administration of chemotherapy and sedation during radiotherapy. The patient was sedated and a 6 Fr double lumen power injectable tip catheter was inserted in the right arm; however, these patients cannot have adhesives used in direct contact to the skin , therefore, the catheter was sutured and a medicated dressing, a sterile sponge cover, catheter stabilizer and local bandaging were used (Annex 1). After ten days of patient’s catheter was stable, without bleeding in catheter and the dressing was intact. (Annex 2). The power injectable peripherally inserted central catheter is a safe route for chemotherapy administration in patients with epidermolysis bullosa, it reduced discomfort and pain patients in chemotherapy. It is a safe alternative for patients in critical care.
Characteristics of Common Infusates Jill Nolte Background: Much attention has been given to the characteristics of infusates with relation to site and device selection for vascular access placement. Purpose: This poster provides guidance on the chemical nature of many common infusates to help clinicians choose the best site and device. Project or Case Description: The poster is a graph revealing generalized pH range, high osmolarity infusates, and known irritants and vesicants. Precise characteristics of the infusates would be difficult if not impossible to provide as much variance is present across facilities and pharmacies. The information on the graph is intended to provide generalized guidance only. Results: The graph is easy to use and covers most common infusates. Implications: With this information readily available, clinicians can rapidly determine when central access would be a best choice for their patient, and know to more closely monitor infusions in the periphery. In the event of an infiltration/extravsation, this graph can also help guide the best treatment option. Conclusions: The infusate graph is a useful tool for clinicians involved in infusion therapy to appropriately insert, manage, and minimize risk.
2016