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    "titulo" => "Estudio prospectivo sobre catéteres epicutáneos en neonatos. Grupo de Hospitales Castrillo"
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        "titulo" => "Prospective Evaluation of Percutaneous Central Venous Silastic Catheters in Newborn Infants&#34;Castrillo&#34; Hospital Group"
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            1 => "Silicona"
            2 => "Neonato"
            3 => "Facto-res de riesgo"
            4 => "Sepsis"
            5 => "Staphylococcus epidermidis"
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            1 => "Silicone elastomers"
            2 => "Newborn infant"
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            4 => "Sepsis"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objetivos</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Conocer la situaci&#243;n actual en nuestro pa&#237;s sobre el empleo de cat&#233;teres epicut&#225;neos en neonatos&#44; analizando ca-racter&#237;sticas t&#233;cnicas y complicaciones infecciosas&#44; mec&#225;nicas y locales&#46;</p> <span class="elsevierStyleSectionTitle">M&#233;todos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Entre el 15&#47;7&#47;97 y el 31&#47;12&#47;98&#44; en los servicios de neonatolog&#237;a de los hospitales integrantes del Grupo de Hospitales Castrillo se recogieron de forma prospectiva para su an&#225;lisis los cat&#233;teres epicut&#225;neos colocados en reci&#233;n nacidos &#40;RN&#41;&#46; Cada hospital escog&#237;a la duraci&#243;n del per&#237;odo durante el cual se recog&#237;an los cat&#233;teres&#44; pero se impuso la condici&#243;n de que durante este tiempo se deb&#237;an estudiar todos los cat&#233;teres colocados&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se han analizado 939 cat&#233;teres epicut&#225;neocava&#44; colocados en 787 RN&#44; totalizando 8&#46;073 d&#237;as-cat&#233;ter&#46; De ellos&#44; 826 &#40;88&#37;&#41; se colocaron a trav&#233;s de venas de extremidad superior&#44; 82 &#40;8&#44;7&#37;&#41; a trav&#233;s de venas de extremidad infe-rior y 31 &#40;3&#44;3&#37;&#41; a trav&#233;s de venas del cuero cabelludo&#46; Fueron colocados en neonatos con amplia variedad de pesos y edades gestacionales&#44; insert&#225;ndose la mayor&#237;a en la primera semana de vida y permaneciendo una media de 7 d&#237;as &#40;m&#225;ximo 55 d&#237;as&#41;&#46; Se utilizaron principalmente cat&#233;teres de silicona &#40;96&#44;8&#37;&#41; siendo su colocaci&#243;n poco dificultosa &#40;un 58&#44;7&#37; al primer intento&#41;&#46; La mayor&#237;a se re-tiraron electivamente &#40;61&#44;5&#37;&#41;&#46; Se realiz&#243; cultivo de lapunta en 872 cat&#233;teres &#40;92&#44;8&#37;&#41; y de ellos&#44; 219 &#40;25&#44;1&#37;&#41; es-taban colonizados&#46; Entre los colonizados&#44; 178 presenta-ban contaminaci&#243;n del cat&#233;ter y en 41 se confirm&#243; sep-sis relacionada con cat&#233;ter &#40;SRC&#41;&#46; La incidencia de con-taminaci&#243;n fue del 20&#44;4&#37; &#40;178&#47;872&#41; y de sepsis cierta relacionada con cat&#233;ter del 4&#44;7&#37; &#40;41&#47;872&#41;&#46; Para los 7&#46;744d&#237;as-cat&#233;ter de estos 872&#44; la densidad de incidencia fue de 23 y 5&#44;3 por 1&#46;000 d&#237;as-cat&#233;ter para contaminaci&#243;n y sep-sis&#44; respectivamente&#46; En la etiolog&#237;a de contaminaci&#243;n y SRC predominaron g&#233;rmenes grampositivos&#44; destacando S&#46; epidermidis&#40;71&#44;7 y 50&#37;&#44; respectivamente&#41;&#46; En 205 ca-t&#233;teres aparecieron complicaciones locales o mec&#225;nicas&#44; siendo la m&#225;s frecuente la flebitis &#40;9&#44;5&#37;&#41;&#44; sobre todo en cat&#233;teres colocados en extremidad inferior&#46; La obstruc-ci&#243;n&#44; la extravasaci&#243;n y la rotura fueron complicaciones infrecuentes&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La utilizaci&#243;n de cat&#233;teres epicut&#225;neos es una pr&#225;ctica habitual en las UCIN de nuestro pa&#237;s&#46; Es una t&#233;cnica de ac-ceso venoso&#44; f&#225;cil&#44; segura y eficaz para la administraci&#243;n prolongada de soluciones intravenosas&#44; siendo el princi-pal problema derivado de su uso las infecciones&#44; sobre to-do las SRC originadas por S&#46; epidermidis&#46;</p>"
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        "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To evaluate the current use of percutaneous central ve-nous silastic catheters in newborn infants in Spain by analysing technical characteristics and infections&#44; as well as mechanical and local complications&#46;</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Percutaneous central venous catheters inserted in new-borns in the neonatal units of the hospitals in the &#34;Cas-trillo Hospital Group&#34; from July 15&#44; 1998 to December 31&#44; 1998 were collected for prospective analysis&#46; Each hospi-tal was able to chose the length of the period of catheter data collection on condition that all inserted catheters were studied during the period&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">A total of 939 percutaneous venous catheters&#44; inserted in 787 newborn infants&#44; and representing a total of 8073 cathe-ter-days&#44; were analysed&#46; Of these&#44; 823 &#40;88&#37;&#41; were inserted in upper extremity veins&#44; 82 &#40;8&#46;7&#37;&#41; in lower extremity veins&#44; and 31 &#40;3&#46;3&#37;&#41; in scalp veins&#46; Catheterizations were perfor-med in newborn infants with a wide range of weights and gestational ages&#44; in most cases during the first week of life and with an average indwelling time of 7 days &#40;55 days maxi-mum&#41;&#46; Silicone elastomer catheters were mainly used &#40;96&#46;8&#37;&#41;&#44; because of the ease of their placement &#40;58&#46;7&#37; at the first attempt&#41;&#46; Most were electively removed &#40;61&#46;5&#37;&#41;&#46; A total of 872 &#40;92&#46;8&#37;&#41; catheter tips were sent for microbiological exa-mination and 219 &#40;25&#46;1&#37;&#41; yielded positives cultures &#40;catheter colonization&#41;&#46; Of these&#44; 178 had catheter contamination and in 41 catheter-related sepsis &#40;CRS&#41; was confirmed&#46; The inci-dence of catheter contamination was 20&#46;4&#37; &#40;178&#47;872&#41; and was 4&#46;7&#37; for CRS &#40;41&#47;872&#41;&#46; The density of incidence was 23 and 5&#46;3 for each 1000 catheter-days respectively&#46; The most common organisms isolated were Gram-positive&#44; especially Staphylococcus epidermidisorganisms &#40;71&#46;1&#37; and 50&#37; for contamination and CRS respectively&#41;&#46; Local or mechanical complications were documented in 205 catheters&#44; phlebitis being the most common &#40;9&#46;5&#37;&#41;&#44; especially after inserting cat-heters through low extremity veins&#59; occlusion&#44; extravasation of fluid and catheter breakage were rare complications&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">The placement of percutaneous venous catheters is common in Spanish neonatal units&#46; This is an easy&#44; safe and effective technique for prolonged intravenous the-rapy&#46; The main problem is infection&#44; particularly CRS caused by Staphylococcus epidermidis&#46;</p>"
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Vol. 53. Núm. 2.
Páginas 138-147 (agosto 2000)
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Vol. 53. Núm. 2.
Páginas 138-147 (agosto 2000)
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Estudio prospectivo sobre catéteres epicutáneos en neonatos. Grupo de Hospitales Castrillo
Prospective Evaluation of Percutaneous Central Venous Silastic Catheters in Newborn Infants"Castrillo" Hospital Group
Visitas
11950
J.B. López Sastre
Autor para correspondencia
jsastre@hca.es

Correspondencia: Servicio de Neonatología.Hospital Central de Asturias.Celestino Villamil,s/n.33006 Ovied.Asturias.
, B. Fernández Colomer, G.D. Coto Cotallo, A. Ramos Aparicio
Coordinadores. Hospital Central de Asturias. Oviedo
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Objetivos

Conocer la situación actual en nuestro país sobre el empleo de catéteres epicutáneos en neonatos, analizando ca-racterísticas técnicas y complicaciones infecciosas, mecánicas y locales.

Métodos

Entre el 15/7/97 y el 31/12/98, en los servicios de neonatología de los hospitales integrantes del Grupo de Hospitales Castrillo se recogieron de forma prospectiva para su análisis los catéteres epicutáneos colocados en recién nacidos (RN). Cada hospital escogía la duración del período durante el cual se recogían los catéteres, pero se impuso la condición de que durante este tiempo se debían estudiar todos los catéteres colocados.

Resultados

Se han analizado 939 catéteres epicutáneocava, colocados en 787 RN, totalizando 8.073 días-catéter. De ellos, 826 (88%) se colocaron a través de venas de extremidad superior, 82 (8,7%) a través de venas de extremidad infe-rior y 31 (3,3%) a través de venas del cuero cabelludo. Fueron colocados en neonatos con amplia variedad de pesos y edades gestacionales, insertándose la mayoría en la primera semana de vida y permaneciendo una media de 7 días (máximo 55 días). Se utilizaron principalmente catéteres de silicona (96,8%) siendo su colocación poco dificultosa (un 58,7% al primer intento). La mayoría se re-tiraron electivamente (61,5%). Se realizó cultivo de lapunta en 872 catéteres (92,8%) y de ellos, 219 (25,1%) es-taban colonizados. Entre los colonizados, 178 presenta-ban contaminación del catéter y en 41 se confirmó sep-sis relacionada con catéter (SRC). La incidencia de con-taminación fue del 20,4% (178/872) y de sepsis cierta relacionada con catéter del 4,7% (41/872). Para los 7.744días-catéter de estos 872, la densidad de incidencia fue de 23 y 5,3 por 1.000 días-catéter para contaminación y sep-sis, respectivamente. En la etiología de contaminación y SRC predominaron gérmenes grampositivos, destacando S. epidermidis(71,7 y 50%, respectivamente). En 205 ca-téteres aparecieron complicaciones locales o mecánicas, siendo la más frecuente la flebitis (9,5%), sobre todo en catéteres colocados en extremidad inferior. La obstruc-ción, la extravasación y la rotura fueron complicaciones infrecuentes.

Conclusiones

La utilización de catéteres epicutáneos es una práctica habitual en las UCIN de nuestro país. Es una técnica de ac-ceso venoso, fácil, segura y eficaz para la administración prolongada de soluciones intravenosas, siendo el princi-pal problema derivado de su uso las infecciones, sobre to-do las SRC originadas por S. epidermidis.

Palabras clave:
Canalización venosa central
Silicona
Neonato
Facto-res de riesgo
Sepsis
Staphylococcus epidermidis
Estu-dios prospectivos
Análisis multivariante
Objective

To evaluate the current use of percutaneous central ve-nous silastic catheters in newborn infants in Spain by analysing technical characteristics and infections, as well as mechanical and local complications.

Methods

Percutaneous central venous catheters inserted in new-borns in the neonatal units of the hospitals in the "Cas-trillo Hospital Group" from July 15, 1998 to December 31, 1998 were collected for prospective analysis. Each hospi-tal was able to chose the length of the period of catheter data collection on condition that all inserted catheters were studied during the period.

Results

A total of 939 percutaneous venous catheters, inserted in 787 newborn infants, and representing a total of 8073 cathe-ter-days, were analysed. Of these, 823 (88%) were inserted in upper extremity veins, 82 (8.7%) in lower extremity veins, and 31 (3.3%) in scalp veins. Catheterizations were perfor-med in newborn infants with a wide range of weights and gestational ages, in most cases during the first week of life and with an average indwelling time of 7 days (55 days maxi-mum). Silicone elastomer catheters were mainly used (96.8%), because of the ease of their placement (58.7% at the first attempt). Most were electively removed (61.5%). A total of 872 (92.8%) catheter tips were sent for microbiological exa-mination and 219 (25.1%) yielded positives cultures (catheter colonization). Of these, 178 had catheter contamination and in 41 catheter-related sepsis (CRS) was confirmed. The inci-dence of catheter contamination was 20.4% (178/872) and was 4.7% for CRS (41/872). The density of incidence was 23 and 5.3 for each 1000 catheter-days respectively. The most common organisms isolated were Gram-positive, especially Staphylococcus epidermidisorganisms (71.1% and 50% for contamination and CRS respectively). Local or mechanical complications were documented in 205 catheters, phlebitis being the most common (9.5%), especially after inserting cat-heters through low extremity veins; occlusion, extravasation of fluid and catheter breakage were rare complications.

Conclusions

The placement of percutaneous venous catheters is common in Spanish neonatal units. This is an easy, safe and effective technique for prolonged intravenous the-rapy. The main problem is infection, particularly CRS caused by Staphylococcus epidermidis.

Key words:
Central venous catheterization
Silicone elastomers
Newborn infant
Risk factors
Sepsis
Staphylococcus epi-dermidis
Prospective studies
Multivarite analysis
Cat-heters
Iindwelling
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Hospitales participantes: Hospital General de Galicia. Santiago (J.M. Fraga Bermúdez, J.R. Fernández Lorenzo). Hospital del Bierzo. Ponferrada (I. Fidalgo). Complejo Hospitalario de León (E. Álvaro). Hospital Clínico de Valladolid (M.P. Aragón García). Hospital del Río Hortega. Valladolid (C. González Armengod). Hospital Clínico de Salamanca (M.C. Pedraz García). Hospital S.S. Segovia (A. Urbón Artero). Hospital General Yagüe. Burgos (P. Aparicio Lozano). Hospital de Cruces. Bilbao (A. Cotero Lavín). Hospital Ntra. Sra. Aránzazu. San Sebastián (L. Paisán Grisolía). Hospital Clínico de Zaragoza (J. Pérez González). Hospital Clínico San Carlos. Madrid (M. Moro Serrano). Hospital Gregorio Marañón. Madrid (M. Sánchez Luna). Hospital La Paz. Madrid (J. Quero Jiménez, S. Salas Hernández). Hospital Clínico y Casa Maternidad. Barcelona (X. Carbonell Estrany, J. Figueras Aloy). Hospital San Juan de Dios. Barcelona (X. Krauel i Vidal. M. Iriondo Sanz). Instituto Dexeus. Barcelona (R. Baraibar Castelló). Hospital La Fe. Valencia (V. Roqués Serradilla). Hospital S.S. Jerez (J. Ortiz Tardío). Hospital Materno Infantil-Clínico Universitario. Málaga (M. García del Río). Hospital Virgen de las Nieves. Granada (M. Samaniego Muñoz). Hospital Clínico de Granada (E. Narbona López). Hospital Clínico Sta. Cruz de Tenerife (E. Domenech Martínez).

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