Pokhylko V. I., Kovalova O. M., Tsvirenko S. M., Chernyavskaya U. I., Buhay D. A.

CONTENTS

Scentific article

The monitoring of the frequency of medication errors and adverse medical events (AME) in intensive care patients associated with central venous catheterization, analyzes the causes that contribute to their occurrence and developed preventive measures are constantly conducted in developed countries. Unfortunately, there aren’t many researches of this kind in Ukraine. The purpose of the study was to analyze the frequency of AME associated with central venous catheterization in patients Children’s Department of Anesthesiology and Critical Care (DACC) before and after the introduction of standards for diagnostic and treatment process. The study was conducted on the basis of a retrospective analysis of 6242 inpatient patients’ medical records (DACC) City Children’s Hospital in Poltava for years 2003-2013 and the study of frequency of rise adverse medical events such as catheter- associated infection of the circulatory system and local infection in the course of catheter before and after the introduction of the WHO standards for treatment of hands of medical personnel, the establishment of a local protocol catheterization and care of venous catheters. Study showed that over the period from 2003-2013 years DACC catheterization v. subclavia was made to 950 (15. 2%) children, catheterization v. femoralis – 23 (0. 37%) children, catheterization v. saphena magna an open way – 11 (0. 18%) children and catheterization v. subclavia by implanting portsystemy – 2 (0. 03%) children. Also central vein catheterization via the venous line was made to 28 (0. 45%) children. During 2003-2013 years in patient amounted DACC observed a significant reduction in subclavian vein catheterization from 17,58% to 4,11% in 2013, p <0. 05. As evidenced by the results obtained in newborns AME were significantly more often observed during the subclavian vein catheterization in Seldynheru than during central vein catheterization using a venous line (accordingly 37. 8% vs. 4. 35%, p <0. 01). The analysis of the AME in children who had catheters in the subclavian vein revealed a significant decrease in the frequency, accordingly 9. 0% (15 of 167) to 3. 3% (1 of 30), p <0. 01, at sufficiently low average duration of central venous catheter in a vein (4,98 ± 2,42 days). The obtained results we associate with an introduction to the practice of the department since 2006 Standards of medical diagnostic process, including the creation of a local protocol of catheterization and care of venous catheters; implementation of the standards of WHO about treatment arms of medical staff. A more detailed analysis of AME associated with subclavian vein catheterization showed that the development of children catheter associated infections of the circulatory system and local infection of subclavian area occurred accordingly in 1. 47% and 0. 74% of cases. Bacteriological study of remote venous catheters that were in the subclavian vein, revealed the presence of gram-positive flora in 71. 5% of cases and Gram-negative organisms in 18. 5%. The obtained results of epidemiological monitoring of flora removed venous catheters conditioned by the introduction of algorithms and local protocol of venous catheter care. Therefore, the inclusion to the work DACC standards of medical diagnostic process, the transition to new technologies through the use of central venous catheterization by using central venous lines, enables to minimize complications in the form of nosocomial infections and septic conditions in newborns and children.

children, central veins, catheterization, adverse medical events, microflora

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«Bulletin of problems biology and medicine» Issue 3 part 1 (110), 2014 year, 284-288 pages, index UDK 616-053. 31-0227-084:614. 2