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  • ISSN: 2378-9344
    Current Issue
    Volume 4, Issue 6
    Review Article
    John P. Grant*
    This paper reviews potential complications of central venous access (excluding sepsis) and offers suggestions for their management.
    Yasmin Abou El-Ella and Suren G. Arul*
    Permanent central venous access has become one of the cornerstones of modern hospital medicine. It is of particular importance in pediatrics as many treatments cannot start without reliable central access. For this reason using the optimal technique for central venous access is crucial. The decision about approach is based both on the local expertise but also balancing the early risks associated with insertion (such as pneumothorax and cardiac tamponade) against the long term risks of venous occlusion. For patients requiring long term venous access, occlusion of the great veins can become a life limiting problem. This article discusses the evidence of the three established techniques of open cut down, landmark percutaneous and the ultrasound guided percutaneous techniques. It also discusses the benefits of organization of a venous access service to improve the patient journey and increase the efficiency of the service provided. With local expertise and a well organized service the literature confirms that the ultrasound guided percutaneous technique offers the best combination of low complications associated with insertion with a venous occlusion rate of less than 3%. This should now consider the gold standard for insertion of permanent venous access in children.
    John P. Grant*
    This paper reviews various methodologies for central line placement. For each technique, local anatomy is reviewed, necessary materials for insertion are listed, preparation of access site is described, and steps for catheter placement are detailed. The following routes for central venous access via the upper body veins are addressed: antecubital vein, cephalic vein, subclavian vein, internal jugular vein.
    Perspective
    James Bonz*, Ambrose Wong, and Leigh Evans
    Background: Central venous catheters (CVC) are routinely inserted by house staff from a broad array of specialties. CVC insertion is associated with several complications. Simulation training has been shown to increase operator efficiency, success, and reduce complications. Many hospitals have a variety of CVC training programs varying in rigor and content instituted at the discretion of the departments within.
    Objective: Our institution has instituted a mandated, centralized simulation training program for CVC insertion that must be completed, regardless of specialty, before house staff are allowed to insert CVCs in the clinical space. We discuss the content and administration of this course as well as assess cost and look toward future directions.
    Methods: A structured, rigorous CVC training course was established at the university simulation center. All new house staff is required to complete the course and become certified.
    Results: In the first year, the possible number of participants was 102; all 102 completed the training for a completion rate of 100%. Residents from 14 specialties went through the mandated CVC training course. Ten trainees failed on their first attempt at completion and required further training (10% failure rate). The total cost of administering this program was $30,938.
    Conclusions: The medical simulation center operates a mandatory hospital-wide CVC training program. We believe that with mounting scholarship as its foundation, this type of mandate is necessary for improved patient care and that other institutions can gain from our experiences in implementing simulated procedural training as policy.
    Editorial
    Marcel GJ Nederhoff*
    In daily life, immune functions keep the body healthy by protecting it from potential injury caused by threats from outside, physical forces or exhaustion. Therefore, it is involved in recognizing and fighting pathogen associated molecular patterns (PAMPs) from the external environment and damage associated molecular patterns (DAMPs) from injured tissue inside the body [1]. But it is also involved in repairing damaged tissue and restoring organ function [2,3].
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