![]() 39, –, 41Ī randomized controlled trial comparing the subclavian and femoral insertion sites report higher levels of catheter colonization with the femoral site ( Category A3 evidence ) equivocal findings are reported for catheter-related sepsis ( P = 0.07) ( Category C2 evidence ). ![]() 25, –, 27, 29, –, 35, 37, 38Cases of anaphylactic shock are reported after placement of a catheter coated with chlorhexidine and silver sulfadiazine ( Category B3 evidence ). 20, –, 22, 24Meta-analyses of randomized controlled trials 25, –, 36demonstrate that catheters coated with chlorhexidine and silver sulfadiazine reduce catheter colonization ( Category A1 evidence ) equivocal findings are reported for catheter-related bloodstream infection ( i.e. , catheter colonization and corresponding positive blood culture) ( Category C1 evidence ). Meta-analysis of randomized controlled trials 20, –, 24comparing silver-impregnated catheters with uncoated catheters report equivocal findings for catheter-related bloodstream infection ( Category C1 evidence ) randomized controlled trials were equivocal regarding catheter colonization ( P = 0.16–0.82) ( Category C2 evidence ). Meta-analysis of randomized controlled trials 15, –, 19comparing antibiotic-coated with uncoated catheters indicates that antibiotic-coated catheters reduce catheter colonization ( Category A1 evidence ). A summary of recommendations may be found in appendix 1. Seventh, all available information was used to build consensus within the Task Force to finalize the Guidelines. Sixth, the consultants were surveyed to assess their opinions on the feasibility of implementing the Guidelines. Fifth, the Task Force held open forums at three major national meetings†to solicit input on its draft recommendations. Opinions on selected topics related to pediatric patients were solicited from a sample of active members of the Society for Pediatric Anesthesia (SPA). Fourth, opinions about the Guideline recommendations were solicited from a sample of active members of the ASA. Third, expert consultants were asked to (1) participate in opinion surveys on the effectiveness of various central venous access recommendations and (2) review and comment on a draft of the Guidelines. Second, original published research studies from peer-reviewed journals relevant to central venous access were reviewed and evaluated. ![]() First, they reached consensus on the criteria for evidence. The Task Force developed the Guidelines by means of a seven-step process. The ASA Guidelines differ from existing guidelines because it addresses the use of bundled techniques, use of an assistant during catheter placement, and management of arterial injury Why does this statement differ from existing guidelines? The ASA Guidelines differ in areas such as insertion site selection ( e.g. , upper body site) guidance for catheter placement ( e.g. , use of real-time ultrasound) and verification of venous location of the catheter How does this statement differ from existing guidelines? This was based on a rigorous evaluation of recent scientific literature as well as findings from surveys of expert consultants and randomly selected ASA members ![]() The ASA has created this new Practice Guideline to provide updated recommendations on some issues and new recommendations on issues that have not been previously addressed by other guidelines. Several major organizations have produced practice guidelines on central venous access 128, –, 132 You will need to provide special care for your child’s central line when they are not in the hospital.What other guideline statements are available on this topic? These lumens are used to give medicines, fluids, blood products, or may be used to draw blood samples. The central line may have 1, 2, or 3 outside openings called lumens. The cuff also acts as a barrier to keep germs out of the body. It contains a “cuff” attached to it that allows your child’s tissue to grow around the cuff to anchor it and decrease the chance that it will be pulled out. The exit site is covered by a sterile (germ-free) dressing. The catheter may also have a few stitches at the exit site to hold it in place. This is called the “insertion site.” It is then tunneled under the skin and brought out at an “exit site.” Small bandage tapes, called Steri-Strips ® are placed over the insertion site. It is most commonly placed in the neck (internal jugular) but may also be placed in the groin (femoral), liver (transhepatic), chest (subclavian) or back (translumbar).Ī small incision is made where the catheter is placed into the vein. A tunneled central line (also called a tunneled central venous catheter) is a catheter (thin tube) that is placed under the skin in a vein, allowing long-term access to the vein.
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