Çocuk Yoğun Bakımda Kateter Kullanmak Güvenli mi?

Öz

Amaç: Damar içi kateter yerleştirilmesi gerek yoğun bakım üniteleri gerekse servislerde hasta çocukların yönetiminde giderek artan sıklıkta kullanılmaktadır. Çalışmada amaç, çocuk yoğun bakım hastalarında kateter yerleştirilmesi ile ilişkili komplikasyonlar ve risklerin değerlendirilmesidir. Gereç ve Yöntemler: 15 Ekim 2016 ile 15 Haziran 2017 tarihleri arasında Okmeydanı Eğitim ve Araştırma Hastanesi, Çocuk Yoğun Bakım Ünitesinde yatan 262 hastanın dosyası geriye dönük incelendi. Kateter takılan hastaların demografik bulguları, kateter takılma endikasyonları, takılma yeri ve kalış süresi, kateter takılma sırasında ve sonrasında gelişen komplikasyonlar, enfeksiyon oranları ve kateterin çekilme nedeni incelendi. Bulgular: Hastaların 123’üne toplam 148 adet kateter yerleştirildi. Kateterlerin 57’si %38,5 kız, 91’i %61,5 erkek hastaya takıldı. Hastaların yaş dağılımları 3 gün ile 17 yaş arasında olup ortalama kateter takılma yaşı 4,0±5,0 yıldı. Hastaların tartıları 2,2 ile 75 kilogram arasında idi. Hastaların 115’inde %77,7 başvuru anında enfeksiyon vardı. Takılma nedenlerinden en sık üç neden 83 %56,1 hastada damar yolu bulunamaması, 26’sında %17,6 hemodiyaliz uygulanması ve 39’unda %26,4 ilaç ve sıvı tedavisi idi. Hastalara takılan kateterlerin 94’ü %63,5 femoral ve 54’ü %36,5 jugulerdi. Kateterlerin 112’si %75,7 acil şartlarda takıldı. Hastaların 3’ünde %2,1 enfeksiyon dışı komplikasyon gözlendi. Kateter takılma sırasında ölen hastamız olmadı. Hastaların 2’sinde %1,4 kateter sepsisi gelişti. Bin kateter gününe düşen kateter enfeksiyon sıklığı ise 1,6 olarak hesaplandı. Kateterlerin 124’ü %83,8 gereksinimin ortadan kalkması nedeniyle çekildi.Sonuç: Çocuk hastalarında önem taşıyan kateterin tecrübeli kişiler tarafından yerleştirilmesi ve bakımı ile komplikasyon oranları azaltılabilmektedir

Anahtar Kelimeler

• Kateter, Çocuk, Komplikasyon

Catheterization in the Pediatric Intensive Care Unit: Is it Safe?

Abstract

Objective: Intravascular catheters are being increasingly used both in intensive care units and inpatient care for the management of children. Herein, we aimed to determine the risk factors and the complications associated with the intravascular catheter placement.Material and Methods: The medical records of 262 patients hospitalized in Okmeydanı Training and Research Hospital’s Pediatric Intensive Care Department between October 2016 and June 2017 were evaluated retrospectively. The demographic data, indications for catheterization, the location and duration of catheterization, the complications including the rate of infection, and the reasons for removing the catheters were evaluated.Results: A total of 148 intravascular catheters were placed for 123 patients. We found that 57 catheters 38.5% had been used in female and 91 61.5% in male patients. The age range was 3 days to 17 years and the weight range 2.2 to 75 kilograms. The mean age at catheter insertion was 4.0±5.0 years. Signs of infection at presentation were present in 115 patients 77.7% . The reasons for catheterization were lack of vascular access in 83 56.1% patients, hemodialysis in 26 17.6% patients and replacement of drugs and fluids in 39 26.4% patients. Access sites were the femoral vein 63.5% and jugular vein 36.5% Urgent catheterization was required for 112 75.7% catheters. Noninfectious complications developed in 3 patients 2.1% . We did not experience any death during catheterization. Catheter sepsis developed in 2 patients 1.4% . The rate of infection was 1.6 for 1000 catheter days. A total of 124 catheters 83.8% were removed as they were no longer required. Conclusion: The expertise of the doctor performing the procedure and nursing care are important factors in reducing the complication rate of catheterization.

Keywords

• Catheter, Child, Complication

Kaynakça

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