Author Of 3 Presentations
HEPARINISED SALINE - A SERVICE EVALUATION OF ARTERIAL LINE LONGEVITY AND COAGULATION PROFILE ACCURACY IN PAEDIATRIC INTENSIVE CARE
Abstract
Background
Traditionally in PICUs, heparinised saline (HS) is used to maintain arterial line patency. At University Hospital Southampton (UHS), PICU uses 1 unit/ml of HS, continuously infused at 1.5ml/hour. Some PICUs have converted to using 0.9% saline. HS is more expensive and it is unclear whether it is superior to normal saline (NS) for this purpose.
Objectives
Establish the longevity of heparinised arterial lines at UHS PICU, the reasons for line removal, and survey the current practice in all UK PICUs regarding the use of HS.
Methods
This 8-week study at UHS involved 61 PICU patients with an arterial line in situ, collecting data from individual patient notes. UK PICUs were surveyed using an internet and telephone questionnaire.
Results
83 arterial lines were inserted, with patency duration ranging from 1.50 hours to 527.42 hours. 34 lines became non-patent (41.0%), with average patency duration of 73.81 hours. 14 of the non-patent lines were lost in the first day of use (41.2%). UK PICU practices vary widely, with 22 units using only HS, 3 using either HS or NS (age or weight dependent) and 2 using only NS. Concentrations used range from 0.5Uml/ to 10U/ml.
Conclusion
Observed arterial line longevity was much longer than historical data, so current literature may be a poor guide to longevity. Non-patency was frequently an early phenomenon and thus, such line loss may be related to insertion rather than infusion. There is variation in Heparin infusion use and a randomised study is warranted.
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THE INCREASING BURDEN OF OBESITY AND RELATED CONDITIONS ON PAEDIATRIC INTENSIVE CARE SERVICES IN ENGLAND
Abstract
Background
Childhood obesity is an increasingly significant public health issue, but its burden on paediatric intensive care units (PICUs) is unclear.
Objectives
To identify the burden of obesity and obesity-related conditions on PICUs in England.
Methods
Anonymised admission data were obtained from the Paediatric Intensive Care Audit Network database for school-aged children admitted to English PICUs between 2003 and 2015, with a recorded admission diagnosis or co-morbidity of obesity or a condition known to be associated with obesity. The data were used to identify trends in the incidence of obesity and related conditions, and associated length of stay and mortality rates.
Results
The incidence of obesity and related conditions per 1000 PICU admissions has increased by 333% (11.26 to 37.52) during the study period. Poisson regression modelling shows a 7.7% annual increase (95% CI 6.3% to 9.0%) in obesity-related admissions, even when offset against increasing overall PICU admissions (p value <0.0001). Annual PICU bed day use has substantially increased during the study period, with an increase of 712%. Poisson regression analysis shows a 1.3% annual increase in median length of stay (95% CI 0.6% to 2.0%) when offset against the increase in obesity-related admissions (p value = 0.0003).
Conclusion
Childhood obesity and obesity-related conditions are placing an increasing burden on paediatric intensive care services in England. Our study supports the growing body of evidence that the childhood obesity epidemic is leading to an increased utilisation of health services and highlights the importance of public health initiatives to try to curb the increase in obesity-related admissions.