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Stase PGD

Yunior

INCIDENCE AND PREDICTORS OF INDWELLING


ARTERIAL CATHETER-RELATED THROMBOSIS IN
CHILDREN
B. BROTSCHI, M. I . HUG, B. LATAL, D. NEUHAUS, C BUERKI, S . KROISS, C. SPOERRI, M. ALBISETTI

Pembimbing :
Dr. Moh. Supriatna TS, SpAK
Dr. Yusrina
Dr. Dewi Ratih, M.Si. Med, SpAK
Oleh : Roro Rukmi Windi
Perdani

INTRODUCTION
Indwelling arterial catheter (IACs) in neonatal & pediatric care
unit
Hemodynamic monitoring & blood sampling purposes
Various location : umbilical artery, ulnar, brachial, axillary,
dorsalis pedia, tibialis posterior, femoral
Different catheter types
Require a high level of technical skill
Cause important complication thrombosis

Arterial thrombosis complication:


Skin necrosis
Threatened limb/organ viability
Leg length difference
Claudication
Loss of arterial access
Cardiac patient : interventional cardiac catheter
Bleeding (caused by antithrombotic th/)

AIM
Investigate the incidence and predictors of
thrombosis resulting from IACs at different
locations i pediatric population

MATERIAL AND METHOD


Population
All consecutive children aged 018 years requiring
an IAC during hospitalization in the Pediatric
Intensive Care Unit (PICU) at the University Childrens
Hospital of Zurich from February 2008 to January
2009
Ethical approval
Research Ethics Boards of the University Childrens
Hospital of Zurich, Zurich, Switzerland

Management of IACs
2x unseccssful staff
intensivists/anesthesiolo
gists
Verified by X-ray
Not right
Felows in training
positionremoved
Staff intensivists
Different type of
Staff anesthesiologists
catheter
Management of PICU spesific
Flushed byclinical
Saline
solution
w/
1
U/mL
UHF
situationManagement of PICU
at 1-2 mL/h (< 10 kg or
spesific clinical situation > 10 kg)
Removed if no longer
needed/complication
Dysfunction : not able
to flush IAC w/ saline
solution, to aspirate
blood or providing
arterial blood pressure
curve

Femoral arteries : BP
measurment 1x/day,
extrimities palpation
3x/day
Absent pulses, BP
difference of limb > 15-20
mmhg/pale extrimities
doppler USG
Radial artery : pulse
palpation
Umbilical arteriy : skin
color on the back,
periumbilical, & lower
extrimities 6x/day
Persistent elevated BP :
doppler USG

Management of IAC-related thrombosis


Diagnosis : clinical signs :
Loss of palpable pulse
BP
Cool & pale limb
Threatened limb

Therapy : LMWH / UFH from diagnosis radiologic


resolution & maximal 3-4 weeks
In infants : if persistent : heparin change to
antiplatelet aspirin 3-6 months

Iv
milrinone
&/or
cathecola
mine

Low
cardiac
output :
cool
extrimities
,
mottled/ci
anotic
skin, low
urin
output,
lactate >
2.0
mmo/L,
central
venous
saturation
< 25%,
ejection
fraction <
55 %

Postoperat
ive
protocol :
bidirection
al Glenn
anastomo
sis, a
Fontan
proscedur
ew
extracardi
ac
conduit,
modified
BlalockTaussig
shunt, etc

Management of PICU spesific


clinical situation

Iv milrinone &/or
cathecolamine

Low cardiac
output : cool
extrimities ,
mottled/cianotic
skin, low urin
output, lactate >
2.0 mmo/L, central
venous saturation
< 25%, ejection
fraction < 55 %

LMWH or UFH antifactor Xa level


0.5-1.0 & 0.35-0.7 IU /mL

Iv milrinone &/or
cathecolamine

STATISTICAL ANALYSIS
Descriptive : frequencies, means, ,median
Differences : one-way ANOVA
Predictors : univariate logistic regression : OR
95% CI
Multiple logistic regression
Signoficance : P<0.05
SPSS version 18, Chicago, IL, USA

RESULT
Patient Population