The Utility of Paired Upper and Lower COVID-19 Sampling in Patients with Artificial Airways.

2021

1-8

2021 May 10

1559-6834

<p>Early in the COVID-19 pandemic, CDC recommended collection of a lower respiratory tract (LRT) specimen for SARS-CoV-2 testing in addition to the routinely recommended upper respiratory tract (URT) testing in mechanically ventilated patients. Significant operational challenges were noted at our institution using this approach. In this report, we describe our experience with routine collection of paired URT and LRT sample testing. Our results revealed a high concordance between the two sources, and that all children tested for SARS-CoV-2 were appropriately diagnosed with URT testing alone. There was no added benefit to LRT testing. Based on these findings, our institutional approach was therefore adjusted to sample the URT alone for most patients, with LRT sampling reserved for patients with ongoing clinical suspicion for SARS-CoV-2 after a negative URT test.</p>

10.1017/ice.2021.222

Infect Control Hosp Epidemiol

33966664

Development and Implementation of a Bedside Peripherally Inserted Central Catheter Service in a PICU.

2019

71-78

2019 01

1529-7535

<p><strong>OBJECTIVES: </strong>To create a bedside peripherally inserted central catheter service to increase placement of bedside peripherally inserted central catheter in PICU patients.</p>

<p><strong>DESIGN: </strong>Two-phase observational, pre-post design.</p>

<p><strong>SETTING: </strong>Single-center quaternary noncardiac PICU.</p>

<p><strong>PATIENTS: </strong>All patients admitted to the PICU.</p>

<p><strong>INTERVENTIONS: </strong>From June 1, 2015, to May 31, 2017, a bedside peripherally inserted central catheter service team was created (phase I) and expanded (phase II) as part of a quality improvement initiative. A multidisciplinary team developed a PICU peripherally inserted central catheter evaluation tool to identify amenable patients and to suggest location and provider for procedure performance. Outcome, process, and balancing metrics were evaluated.</p>

<p><strong>MEASUREMENTS AND MAIN RESULTS: </strong>Bedside peripherally inserted central catheter service placed 130 of 493 peripherally inserted central catheter (26%) resulting in 2,447 hospital central catheter days. A shift in bedside peripherally inserted central catheter centerline proportion occurred during both phases. Median time from order to catheter placement was reduced for peripherally inserted central catheters placed by bedside peripherally inserted central catheter service compared with placement in interventional radiology (6 hr [interquartile range, 2-23 hr] vs 34 hr [interquartile range, 19-61 hr]; p &lt; 0.001). Successful access was achieved by bedside peripherally inserted central catheter service providers in 96% of patients with central tip position in 97%. Bedside peripherally inserted central catheter service central line-associated bloodstream infection and venous thromboembolism rates were similar to rates for peripherally inserted central catheters placed in interventional radiology (all central line-associated bloodstream infection, 1.23 vs 2.18; p = 0.37 and venous thromboembolism, 1.63 vs 1.57; p = 0.91). Peripherally inserted central catheters in PICU patients had reduced in-hospital venous thromboembolism rate compared with PICU temporary catheter in PICU rate (1.59 vs 5.36; p &lt; 0.001).</p>

<p><strong>CONCLUSIONS: </strong>Bedside peripherally inserted central catheter service implementation increased bedside peripherally inserted central catheter placement and employed a patient-centered and timely process. Balancing metrics including central line-associated bloodstream infection and venous thromboembolism rates were not significantly different between peripherally inserted central catheters placed by bedside peripherally inserted central catheter service and those placed in interventional radiology.</p>

10.1097/PCC.0000000000001739

Pediatr Crit Care Med

30234675