Central venous catheters

Use of central venous catheters in the acute care setting is an integral approach to deliver fluids, blood products, nutrients, medications, obtaining blood specimens, maintaining emergency vascular access, and for haemodynamic monitoring. Risk factors: Mechanical complications (malposition, occlusion, dislodgement, tamponade), infection, pneumothorax, thrombosis Insertion: Ask nurse to complete the checklist and to stop you if…

Infection

Surgical site infection (superficial/deep/organ): Prevalence 5-10% Within 10-14 days post surgery Most common: Staphylococcus aureus Risk factors: neonate, HLHS, hospitalization prior surgery, TPN, emergency procedures, long CPB Blood stream infection: Prevalence 5-10% Within 10-14 days post surgery Most common: gram negative organism (Pseudomonas, Enterobacter) Risk factors: surgical complexity, open sternum, low body weight, longer duration…

Formulae

Body surface index (BSA) = ( [Height(cm) x Weight(kg) ] / 3600 )½ Mean arterial blood pressure (MAP) = (SBP + 2 x DBP) / 3 Transpulmonary gradient (TPG) = mPAP – PCWP or in Glenn/Fontan: SVC (CVP) – LAP Cardiac output (CO) = SV x HR. normal: 2.1-3.5 l/min/m2 Cardiac index (CI) = CO / BSA. normal 3.0-5.5 l/min/m2 Systemic…

Empiric antibiotics for general infection

Age if meningitis excluded if meningitis is NOT excluded if Staphylococcus aureus suspected < 3 months Amoxicillin 50 mg/kg q6hrGentamycin 7.5 mg/kg q24hr Amoxicillin 50 mg/kg q6hrGentamycin 7.5 mg/kg q24hr Cefotaxime 50 mg/kg q6hr Consider especially in infants aciclovir 20mg/kg q8hr Amoxicillin 50 mg/kg q6hrCefotaxime 50 mg/kg q6hr Vancomycin 15 mg/kg q6hr Clindamycin 15 mg/kg…

Initial post-operative care and problems

ABDOMINAL DISTENSION Causes: Air in stomach or bowel (usually from mask ventilation at induction of anaesthesia) or tension pneumothorax Fuid in bowel or in peritoneal cavity (usually capillary leak, high RA pressure or PD fluid Rarely fluid overload or peritoneal haematoma) Exclude NEC, especially in neonates with parallel circulations or long cross-clamp time. Investigation and…