Reduction in the incidence of infusion-related phlebitis in a pediatric critical care unit of Eastern India: A quality improvement initiative.

Background: Phlebitis is one of the most common complications of the peripheral venous catheter (PVC) and adversely impacts future venous access, and bacterial phlebitis may lead to bloodstream infection. The objective of the study was to reduce the to reduce the incidence of infusion-related phlebitis in children admitted to the pediatric critical care unit. Methods: This Quality Initiative was implemented in the pediatric critical care unit of a tertiary care hospital between November 2019 and April 2020. Five interventions were identified (hand hygiene, use of transparent dressing, use of extension lines with PVCs, use of hard cardboard splints for joint immobilization, use of heparinized flush after medication administration) and were introduced sequentially. Over the next five weeks, a new intervention was introduced weekly while continuing the previous ones, if found to be working well as per improvement parameter, the phlebitis rate. From the sixth week onwards, all five interventions were applied together as a bundle. Results: Total seven hundred eighteen PVCs were sited in 284 (Male: female 1.58:1) patients during study period and a total of 56 incidences of phlebitis were observed. Mean baseline phlebitis rate was 48.5%. In the next 5 weeks when interventions were implemented as planned, phlebitis rate was 35.7% (n = 10), 16.6% (n = 03), 21.6% (n = 8), 10% (n = 05), and 13.3% (n = 2) respectively. Implementation of all five interventions together as a bundle led to reduction in phlebitis rate below 5 % consistently over the next 18 weeks (n = 8). Conclusion: A consistent reduction in PVC-related phlebitis can be achieved by the implementation of evidence-based interventions for the prevention of phlebitis, as a bundle.

Efficacy of paracetamol in the management of hemodynamically significant patent ductus arteriosus in preterm newborns.

OBJECTIVE: The objective is to determine the efficacy and safety of paracetamol in preterm babies with hemodynamically significant patent ductus arteriosus (hsPDA). BACKGROUND: In preterm babies, patent ductus arteriosus, when hemodynamically significant, causes considerable morbidity and mortality and also affects 20% of very low birth weight infants. Medical therapy is the mainstay of treatment. Currently used drug cyclooxygenase inhibitor has multiple serious adverse effects, including gastrointestinal perforation, bleeding, and renal failure. Hence, an alternative drug like paracetamol has been proposed for the treatment of hsPDA for fewer side effects. Hence, we used paracetamol in our neonatal intensive care unit in preterm neonates with hsPDA. METHODS: A total of 14 preterm babies diagnosed to have hsPDA on clinical and echocardiographic evaluation in neonatal ICU on days 3-14 of life during 13 months were included. Birth weight was between 1000 g and 1650 g and gestation was between 28 weeks and 33 weeks. Paracetamol in a dose of 15 mg/kg/dose every six hourly given to all the included babies for 3 days and re-evaluated echocardiographically after 3 days of treatment. RESULTS: In 12 (86%) out of 14 cases, PDA was closed, whereas in 2 (14%) hemodynamic closure with insignificant residual flow was achieved. Paracetamol was effective in 100% of cases. No adverse event was observed during treatment. CONCLUSIONS: Paracetamol is a very safe and efficacious drug for treating hemodynamically significant patent ductus arteriosus in premature babies.

Effectiveness of Botulinum Toxin Injection With Casting in Children With Spastic Cerebral Palsy: A Randomized Controlled Trial.

BACKGROUND: The most common form of movement disorder presented in children with cerebral palsy is spasticity, and dynamic equinus is the most common spastic ankle deformity. Botulinum toxin (BT) injection is now an established first-line treatment for focal spasticity. AIM: To assess the effects of BT injection with casting in the treatment of dynamic equinus in children diagnosed with cerebral palsy with spastic diplegia. SETTING AND DESIGN: A prospective randomized controlled trial was conducted among patients aged 2-12 years with cerebral palsy and spastic diplegia, attending the general outpatient department and admitted to the indoor facility of the Department of Physical Medicine and Rehabilitation and the Department of Pediatric Orthopedics at King George's Medical University, Lucknow. MATERIAL AND METHODS: Two groups of 19 patients each were formed. Group A received BT injection with casting, whereas in group B, only a cast was applied. Outcome measures including spasticity by Modified Ashworth Scale (MAS), Modified Tardieu Scale (MTS), range of motion (ROM), passive ankle dorsiflexion, and Gross Motor Function Measure (GMFM-66) (dimensions D and E) were assessed before and after the intervention. RESULTS: The participants in groups A and B were age-matched. A statistically significant difference was seen within group A and group B for MAS, passive ROM-dorsiflexion (PROM-DF), and passive ROM-plantarflexion (PROM-PF) at various follow-ups. In the 3rd week, MAS in each group was statistically insignificant (p-value> 0.05). CONCLUSION: There was a significant improvement in tone and a significant increase in the passive range of motion in both groups.

Psychological adjustments among lower limb amputees in North Indian population: A cross-sectional study.

Introduction: Limb amputation is an extremely stressful event for an individual, following which the amputee develops inferior body image, anxiety, and changes in self-concept and identity. For holistic rehabilitation, understanding the psychosocial status of the amputee and its' predictors is of utmost importance. Objective: The aim of the article is to assess the psychological adjustments in patients with lower limb amputation and determine its clinical and sociodemographic correlates. Material and Methods: A observational cross-sectional study was conducted from 2020 to 2022 among lower limb amputees of a tertiary care hospital in Lucknow which serves as the only rehabilitation and artificial limb center for the whole state of Uttar Pradesh. Baseline sociodemographic and clinical data were collected. The Hospital Anxiety and Depression Scale was used to determine underlying depression and anxiety, while the Trinity Amputation and Prosthesis Experience Scale was used for understanding the psychological adjustment. Results: The mean age of the amputee was 39.47 ± 16.99 years. The mean general, social adjustment, and adjustment to limitation score was 16.3 ± 3.34, 15.19 ± 3.59, and 12.76 ± 3.15, respectively. Male amputees, aged >40 years, and pensioners had significantly higher scores for general adjustment (P < 0.05). Those aged >40 years were pensioners and had no underlying depression and anxiety and had better social adjustment (P < 0.05). Those with transfemoral amputation had a significantly lesser adjustment to limitation (P = 0.003). Conclusion: Young age amputees had poor general and social adjustments and more activity restriction but high prosthesis satisfaction as compared to the elderly. Those with transfemoral amputation had a poor adjustment to limitation while those wearing above-knee prosthesis had more activity restriction.