Difficult intravenous access in a paediatric intensive care unit.

INTRODUCTION: Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES: The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD: A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS: A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS: We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.

Vía venosa difícil en una unidad de cuidados intensivos pediátricos / Difficult intravenous access in a paediatric intensive care unit

Introducción: Los múltiples intentos durante la canalización periférica pueden producir importantes consecuencias que afectan a pacientes, familiares y profesionales, por ello se planteó la necesidad de conocer la dimensión de este problema en una unidad de cuidados intensivos pediátricos (UCIP).Objetivos: El objetivo principal fue describir la canalización de catéter venoso periférico y catéter central de inserción periférica en niños de UCIP. Como objetivos secundarios se propuso determinar la proporción de éxito en el primer intento de canalización, cuantificar los pacientes que presentan vía venosa difícil (VVD), así como explorar la asociación entre la aparición de la VVD y las características sociodemográficas, las relativas a la técnica y a las enfermeras.Método: Estudio descriptivo transversal. Mediante muestreo consecutivo se reclutaron pacientes entre 0 y 18 años ingresados en UCIP que precisaron canalización de acceso venoso periférico. Para ello se utilizó un cuestionario ad hoc incluyendo la presencia de VVD como variable independiente.Resultados: Se recogieron 163 canalizaciones venosas. El 55,8% (91) se realizaron en pacientes menores de 1 año. El 38,7% (63) acertó en el primer intento y el 36,8% (60) presentaron VVD. Cuando aparecía VVD el 85% (51) de los pacientes tuvieron complicaciones, la mediana de tiempo para la canalización mediante catéter venoso periférico corto fue de 30minutos [15-53] y se precisaron 2 o más enfermeras en el 80% (48) de las ocasiones.Conclusiones: Se encontró un bajo porcentaje de acierto al primer intento y una proporción elevada de VVD. Aparecía un mayor número de enfermeras y de tiempo empleado durante la canalización y un aumento de las complicaciones si el paciente presentaba VVD. Se encontró asociación estadísticamente significativa entre VVD y edad, peso, mala perfusión, vena no visible ni palpable, puntuación en la escala DIVA≥4, historia de VVD, complicaciones, número de enfermeras y tiempo empleado.

Introduction: Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU).Objectives: The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics.Method: A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable.Results: A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions.Conclusions: We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.

Difficult intravenous access in a paediatric intensive care unit. / Vía venosa difícil en una unidad de cuidados intensivos pediátricos.

INTRODUCTION: Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU). OBJECTIVES: The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics. METHOD: A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable. RESULTS: A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions. CONCLUSIONS: We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score≥4, history of difficult intravenous access, complications, number of nurses and time spent.

Rehabilitación tras reconstrucción del LCA con plastia H-T-H / Rehabilitation after-tendon-bone ACL plastia

Los protocolos de rehabilitación tras reconstrucción del LCA han sufrido notables transformaciones en las últimas décadas, desde los protocolos clásicos y conservadores de Paulos hasta los actuales y más agresivos de Beynnon. El proceso de reeducación ha de sustentarse en la evidencia científica en cada uno de los diferentes elementos que lo componen. Los protocolos acelerados actuales se basan en una período de enfriamiento y rehabilitación preoperatoria con el objetivo de conseguir un balance articular y muscular adecuados. La reeducación postoperatoria se iniciará de forma precoz, con un buen control del dolor, buscando la rápida recuperación del balance articular, la carga completa y un refuerzo muscular intensivo inicialmente en cadena cerrada y a partir de la sexta semana en cadena cinética abierta, junto con un programa de reeducación neuromuscular propioceptiva. La utilización de técnicas de electromioestimulación ayudará en las fases iniciales en la recuperación de los desequilibrios del balance muscular. Las ortesis desempeñan todavía un papel discutido durante el proceso de rehabilitación, pudiendo ser utilizadas en las primeras fases de rehabilitación para el mayor confort del paciente. Es fundamental la valoración y monitorización mediante los tests funcionales, las escalas de valoración funcional y los tests instrumentados isocinéticos. El cumplimiento de estas premisas minimizará las complicaciones(artrofibrosis, síndromes rotulianos y algodistrofia) permitiendo el retorno a la práctica deportiva al mismo nivel prelesional (AU)

Rehabilitation protocols after ACL reconstruction has undergone remarkable transformations in recent decades, from the classic and conservative Paulos’ protocols to the current most aggressive of Beynnon. The rehabilitation process must be supported by scientific evidence in each of the different elements that compose it. The current accelerated protocols are based on a period of cooling and pre-operative rehabilitation in order to achieve a suitable joint and muscle balance. The postoperative rehabilitation starts early, with good pain control, for the speedy recovery of the joint stock, the full load and intensive muscle strengthening initially using closed chain and from the sixth week open kinetic chain, along with a proprioceptive neuromuscular re-education program. The electromios estimulation techniques helps in the initial stages in the recovery of muscle imbalances. Orthoses still play a discussed role during the rehabilitation process and can be used in the early stages of rehabilitation for greater patient comfort. It is essential to the assessment and monitoring by the functional tests, functional assessment scales and isokinetic instrumented test. The fulfillment of these assumptions will minimize complications (Arthrofibrosis, patellar syndrome and reflex sympathetic dystrophy) allowing the return to sports at the same level before de injury (AU)

[Elimination of measles plan in the Valencia community: epidemiological surveillance in 2003]. / Plan de eliminación del sarampión en la Comunidad Valenciana: vigilancia epidemiológica en el año 2003.

AIMS: Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. DESIGN: Cross-sectional, descriptive study. SETTING: Community of Valencia (CV), Spain. PARTICIPANTS: Cases of suspected measles notified in 2003. MAIN MEASUREMENTS: Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. RESULTS: From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). CONCLUSIONS: In year 2003 no case of measles has taken place from autochthonous virus in the CV.

Plan de eliminación del sarampión en la Comunidad Valenciana: vigilancia epidemiológica en el año 2003 / Elimination of measles plan in the Valencia Community: epidemiological surveillance in 2003

Objetivo. Describir las características clínicas y epidemiológicas de los casos de sospecha de sarampión notificados en la Comunidad Valenciana durante el año 2003 y evaluar el sistema de vigilancia. Diseño. Estudio descriptivo, transversal. Emplazamiento. Comunidad Valenciana (CV). Participantes. Casos de sospecha de sarampión notificadas en 2003. Mediciones principales. Descripción de los datos recogidos en las encuestas nominales del Plan de Eliminación del Sarampión de la CV y obtención de indicadores de calidad de éste y los propuestos desde el plan de acción a escala nacional. Resultados. De 43 sospechas notificadas, se confirmó el 25,6%, se descartó el 67,4% y fue compatible el 7%. La tasa de incidencia fue de 0,33 por 105 habitantes. De los 11 casos confirmados, 10 correspondían a 2 brotes (uno familiar y otro comunitario) y uno fue un caso aislado e importado. El 80% de las áreas de salud notificó sospechas de sarampión. La mayoría de sospechas y casos se dio en la primera mitad del año. Cinco casos pertenecían a grupos de edad no incluidos en el programa de vacunación (menores de 15 meses y mayores de 20 años) y 2 casos podrían haberse evitado (niños de 6 y 12 años no vacunados). Se recogieron 40 muestras de suero y 33 de orina. La mayoría de los indicadores de calidad se cumplió por encima de los valores recomendados (80%). Conclusiones. Durante 2003 no se declaró ningún caso de sarampión por virus autóctonos en la CV

Aims. Describing the clinical and epidemiological characteristics of the suspicions of measles notified in the CV during the year 2003 and evaluating the system of surveillance. Design. Cross-sectional, descriptive study. Setting. Community of Valencia (CV), Spain. Participants. Cases of suspected measles notified in 2003. Main measurements. Description of the data collected in the questionnaires (including names) of the Plan to Eliminate Measles of the CV, and obtaining of quality indicators for this plan and those proposed in the national action plan. Results. From 43 notified suspicions, 11 (25.6%) were confirmed, 29 (67.4%) discarded, and 3 (7%) compatible. The rate of effect was 0.33 of 105. From 11 confirmed cases, 10 belonged to two outbreaks (one familiar and an other one communitary) and one was an isolated and imported case. 80% of areas of health were declared. The majority of the suspicions and all the cases were given in the first half of the year. Five cases were given in cohorts of age not submitted to the program of vaccination (minors of 15 months and major of 20 years), and 2 cases might have been avoidable in agreement with the program (6 and 12-year-old children not vaccinated). 40 samples of whey and 33 of urine were collect within the recommended periods. The majority of quality indicators were over the recommended ones (80%). Conclusions. In year 2003 no case of measles has taken place from autochthonous virus in the CV

Intervención en un caso con trastorno específico del lenguaje / Intervention in a case of specific language impairment

La finalidad de este artículo es presentar la intervención realizada durante 2 cursos en un niño de 4 años que inicialmente presentaba un retraso específico del lenguaje, comparándola con otra ya presentada en un artículo anterior de esta misma revista. Se pretende mostrar cómo la evolución y el resultado final son diferentes a pesar de que ambas intervenciones responden a los mismos principios sobre qué intervenir (resultados del perfil) y cómo intervenir (marco teórico, estrategias utilizadas y soportes para la intervención). La valoración psicolingüística inicial, los objetivos de la intervención y la valoración final se establecieron a partir de la realización de su perfil. Se describe el curso de la evolución en 6 momentos en cada uno de los cuales se presentan lo objetivos, las estrategias utilizadas y los soportes para la reeducación, con ejemplos de la producción infantil. La intervención realizada se enmarca en un enfoque sociocognitivo del cual se presentan sus fundamentos y cómo estos inciden en la intervención. Se concluye en la necesidad de disponer de más trabajos teóricos sobre el TEL (trastorno específico del lenguaje) que nos ayuden en nuestra actividad asistencial cotidiana (AU)

The aim of this article is to present the intervention for two school terms that was made to a 4-6 year-old boy that showed a specific retard, comparing the intervention with another one that was presented in a previous article from this magazine. It pretends to show how different the evolution and the final result are, despite the interventions respond to the same principles on which intervention we have to take part (results in profile) and how we have to do the intervention (theorical framework, skills used and help for the intervention). The initial psycholinguistic profile, the aims of the intervention and the final profile were established from the achievement of the profile. The course of the evolution has been described in 6 parts in which in each aim, the skills used and the help for the reeducation with example of the children’s production are presented. The intervention that has been made forms part of the socio-cognitive approach which presents its fundamentals and how these fundamentals influence in the intervention. It concludes in the need to make use of more theorical works about the TEL which can help us in our daily social activity (AU)

Intervención en un caso con dificultades del lenguaje (4-6 años) / No disponible

En este artículo se resume la intervención logopédica realizada durante dos cursos escolares a un niño que a los 3 años presentaba un retraso del lenguaje. La reeducación programada, que enfatiza las dimensiones social y cognitiva de la adquisición del lenguaje, se inició con la elaboración del perfil psicolingüístico que determinó tanto la situación lingüística inicial del niño como los objetivos a trabajar, en este caso, referidos a la comunicación y el lenguaje. La presentación de la intervención se ha estructurado en 6 momentos, en cada uno de los cuales se citan los objetivos planteados para ese momento (el qué trabajar), la metodología y las estrategias utilizadas (el cómo trabajar), los avances logrados por el niño y ejemplos de su producción. La evolución queda reflejada en el artículo con la presentación del perfil final de comunicación y lenguaje. Del artículo se concluye la necesidad de realizar un diagnóstico y una intervención precoz para que dificultades iniciales no se consoliden en un trastorno, de disponer de perfiles para su evaluación y de tener un marco teórico que guíe nuestra intervención (AU)

In this paper it is explained the evolution of the intervention during two years of a Language Delayed child of 3 years old. The theoretical frame of the interventions emphasieces the social and cognitive dimensions in the langauge acquisition. At the beginng a psycholinguistic profile of the child competence was established and accordig to it were defined the goals of his rehabilitation in communication and language. The presentation of the evolution of the intervention has been divided in 6 time points, and in each of them the language state is described and illustrated with typical exemples together with the goals, methodology and strategies for improving language production. The evolution is presented with the final profile of the child. It is concluded that early diagnosisi is a real need as well as early profiles for evaluation and intervention in order to avoid a consolidation of the early difficulties in more severe impairments (AU)

[Epidemiological profile of tuberculosis in a health area of the Valencian Community (1998-2000)]. / Perfil epidemiológico de la tuberculosis en un área de salud de la Comunidad Valenciana (1998-2000).

OBJECTIVE: To find the epidemiological characteristics of cases of tuberculosis (TB) notified in Health Area 09 of the Valencian Community during 1998-2000.Design. Descriptive, observational, epidemiological study. SETTING: Unit of epidemiology in the Public Health Centre of Alzira, Area 09 of the Valencian Community.Participants. Cases of TB that met the clinical or bacteriological definitions according to the protocols of the National Network of Epidemiology Protection. MAIN MEASUREMENTS AND RESULTS: The epidemiological questionnaire for TB declaration in the Valencian Community was used. The variables included were: sex, age, town, risk factors, associated pathology, location, origin and study of contacts. A univariate statistical analysis was run, with the SPSS version 9.01. Cases numbered 118. The rate of annual occurrence ranged between 25.5 per 100 000 in 1999 and 43.5 per 100 000 in 1998, similar to that in the year 2000 (42.5 per 100 000). 64.4% were men and 26.3% were between 25 and 34 years old. 64.4% were admitted. There was a study of contacts in 73.7%. 78% of cases were declared by the referral hospital. CONCLUSIONS: TB in Area 09 was concentrated in young adults needing hospital admission. TB declaration was usually made from the hospital.

Perfil epidemiológico de la tuberculosis en un área de salud de la Comunidad Valenciana (1998-2000) / Epidemiological profile of tuberculosis in a health area of the Valencian Community (1998-2000)

Objetivo. Conocer las características epidemiológicas de los casos incidentes de tuberculosis (TB) notificados en el Área de Salud 09 de la Comunidad Valenciana durante el período 1998-2000.Diseño. Estudio epidemiológico, observacional, descriptivo. Emplazamiento. Área 09 de la Comunidad Valenciana, Unidad de Epidemiología referente en el Centro de Salud Pública de Alzira. Participantes. Casos de TB que cumplían las definiciones clínica o bacteriológica según los Protocolos de la Red Nacional de Vigilancia Epidemiológica. Mediciones y resultados principales. Se empleó la encuesta epidemiológica para declaración de TB en la Comunidad Valenciana. Las variables incluidas fueron: sexo, edad, municipio, factores de riesgo, patología asociada, localización, procedencia y estudio de contactos. Se llevó a cabo un análisis estadístico univariante a través del programa SPSS, versión 9.01.El número de casos fue de 118. La tasa de incidencia anual osciló entre 25,5 por 100.000 en 1999 y 43,5 por 100.000 en 1998, similar a la del año 2000 (42,5 por 100.000). En un 64,4 por ciento de los casos se trataba de varones, el 26,3 por ciento tenía 25-34 años. Un 64,4 por ciento fue ingresado. Se realizó estudio de contactos en el 73,7 por ciento. Un 78 por ciento de casos fue declarado por el hospital de referencia. Conclusiones. La TB en el Área 09 se concentra en adultos jóvenes que precisan ingreso hospitalario. El patrón de declaración de TB es hospitalario. (AU)

[Changes in HIV-related attitudes and knowledge of teenagers following the Aulasida intervention in 1996-1997]. / Cambios en las actitudes y conocimientos de los adolescentes sobre la infección por VIH tras la intervención escolar Aulasida, 1996-1997.

BACKGROUND: Schools being the ideal setting for carrying out Health Education activities, the aim of this study was that of pinpointing and quantifying the changes in attitudes and knowledge on the part of teenagers enrolled in school in Algemesí (Valencia) following an educational intervention regarding HIV infection. METHOD: Eleven schools at which a total of 2,599 teenagers (ages 12-19) were enrolled in eleven different years of study (Secondary Education, Secondary Ed. and School Leaving Certificate, College Preparation Course and Vocational Training) were invited to take part. The Aulasida intervention carried out during the 1996-1997 school year consisted of an informative lecture-panel discussion and student involvement activities in small groups using educational materials. The gauging instrument was a questionnaire. This questionnaire was designed in a before-and-after cross-sectional study. An analysis was made divided into age and educational level strata. The averages were compared with the Student "t" test and the percentages of change with ji square. RESULTS: A total of nine schools accepted taking part. 1575 students answered the "before" test (47.4% males and 52.1% females), the average age being 15.2 (1.96) years old. The average number of correct answers to the "before" test was 13.5 (2.8). The "after" test showed an overall increase of up to 14.7 (3.0) correct answers (p < 0.01). By educational levels, this increase was highly appreciable in the younger age group. The most common sources of information on HIV were: television (80.8%); Aulasida (76.8%), teachers (60.9%), pamphlets (58.4%) and films (53.7%9. CONCLUSIONS: Educational interventions are useful tools for increasing knowledge and improving attitudes regarding HIV infection. Secondary schools are the best environment for this purpose, it being necessary to carry out interventions among younger groups, as a greater impact is thus achieved.