With millions upon millions of journal articles being published every year it is impossible to keep up. Every month we ask some of our friends from PERUKI (Paediatric Emergency Research in UK and Ireland) to point out something that has caught their eye.
We were pleased that Amanda Ullman took up our offer to speak at DFTB after the great post she and the Vascular Access Management Service wrote for us on management of paediatric central access devices. This talk comes complete with trigger warnings. We’ve all been in the situation when we have been confronted with doughy armed toddlers and no sign of a vein in site. The parents, and that patient, are relying on you to get it right.
Given the prime directive of physicians of Primum Non Nocere (First Do No Harm) it is worth considering if we should be cannulating the child in the first place. In a study by Holloway et al. (2017) they found that 22% of PIVCs were unused after insertion. With a success rate of around 60% in our well children, we really to sway the odds further in our favour.
But is also worth considering the flipside – cannulation may be less painful than heel prick for blood sampling in neonates. Amanda asks us to consider if you are the right person to put in that cannula. Should you just ‘give it a go anyway’? Have you been up half the night and can barely focus? Have you just missed you last six cannulae and have something to prove?
This talk was recorded live at DFTB18 in Melbourne, Australia. With the theme of ‘Science and Story‘ we pushed our speakers to step out of their comfort zones and consider why we do what we do. Caring for children is not just about acquiring the scientific knowhow but also about taking a look beyond a diagnosis or clinical conundrum at the patient and their families.
Deitcher SR, Gajjar A, Kun L, Heideman RL. Clinically evident venous thromboembolic events in children with brain tumors. The Journal of pediatrics. 2004 Dec 1;145(6):848-50.
Hollaway W, Broeze C, Borland ML. Prospective observational study of predicted usage of intravenous cannulas inserted in a tertiary paediatric emergency department. Emergency Medicine Australasia. 2017 Dec;29(6):672-7.
Kleidon TM, Cattanach P, Mihala G, Ullman AJ. Implementation of a paediatric peripheral intravenous catheter care bundle: A quality improvement initiative. Journal of paediatrics and child health. 2019 Jan 31.
Stolz LA, Cappa AR, Minckler MR, Stolz U, Wyatt RG, Binger CW, Amini R, Adhikari S. Prospective evaluation of the learning curve for ultrasound-guided peripheral intravenous catheter placement. The journal of vascular access. 2016 Jul;17(4):366-70.
Takashima M, Schults J, Mihala G, Corley A, Ullman A. Complication and failures of central vascular access device in adult critical care settings. Critical care medicine. 2018 Dec 1;46(12):1998-2009.
Ullman AJ, Cooke M, Kleidon T, Rickard CM. Road map for improvement: point prevalence audit and survey of central venous access devices in paediatric acute care. Journal of paediatrics and child health. 2017 Feb;53(2):123-30.
Six year old Angela comes into your department with a three day history of diarrhoea and vomiting. You determine that she needs cannulation both to assess her renal function and to begin treatment. You know that cannulating children can be a painful and traumatic experience and are keen to make it as stress-free as possible. The nurses ask you what you would like them to put on the child?