[Visibility of patients and respect for their privacy: reconciling apparently contrary imperatives in the intensive care unit]. / Visibilité des patients et respect de leur intimité : concilier des impératifs apparemment contraires en service de réanimation.

Rigorous monitoring of vital functions in intensive care requires optimal visibility of patients and their environment. Conversely, respect for privacy is an ethical imperative to respect. Liquid crystal electrical film is a device that can be applied to windows and can take opaque or transparent form on demand. Its use could satisfy the visibility of patients and respect for their privacy.

Preterm infant mental health in the neonatal intensive care unit: A review of research on NICU parent-infant interactions and maternal sensitivity.

Caregiving relationships in the postnatal period are critical to an infant's development. Preterm infants and their parents face unique challenges in this regard, with infants experiencing separation from parents, uncomfortable procedures, and increased biologic vulnerability, and parents facing difficulties assuming caregiver roles and increased risk for psychological distress. To better understand the NICU parent-infant relationship, we conducted a review of the literature and identified 52 studies comparing observed maternal, infant, and dyadic interaction behavior in preterm dyads with full-term dyads. Eighteen of 40 studies on maternal behavior found less favorable behavior, including decreased sensitivity and more intrusiveness in mothers of preterm infants, seven studies found the opposite, four studies found mixed results, and 11 studies found no differences. Seventeen of 25 studies on infant behavior found less responsiveness in preterm infants, two studies found the opposite, and the remainder found no difference. Eighteen out of 14 studies on dyad-specific behavior reported less synchrony in preterm dyads and the remainder found no differences. We identify confounding factors that may explain variations in results, present an approach to interpret existing data by framing differences in maternal behavior as potentially adaptive in the context of prematurity, and suggest future areas for exploration.

Las relaciones de prestación de cuidados en el período postnatal son críticas para el desarrollo del infante. Los infantes nacidos prematuramente y sus progenitores enfrentan retos únicos a este respecto, con los infantes que experimentan la separación de sus progenitores, procedimientos incómodos, así como un aumento en la vulnerabilidad biológica; y los progenitores enfrentando dificultades al asumir el papel de cuidadores y el aumento de riesgo de angustia sicológica. Para comprender mejor la relación progenitor-infante en la Unidad Neonatal de Cuidados Intensivos (NICU), llevamos a cabo una revisión de la literatura e identificamos 52 estudios que comparan la observada conducta de interacción materna, del infante y de la díada en díadas de infantes prematuros con díadas de infantes de gestación completa. Dieciocho de 40 estudios sobre la conducta materna encontraron una menos favorable conducta, incluyendo una baja en la sensibilidad y más intrusión en el caso de madres de infantes prematuros; 7 estudios encontraron que se daba la situación opuesta; 4 estudios presentaron resultados mixtos; y 11 estudios no encontraron diferencias. Diecisiete de 25 estudios sobre el comportamiento del infante encontraron una menor capacidad de respuesta en infantes prematuros; dos estudios encontraron que se daba la situación opuesta; y el resto de los estudios no encontró ninguna diferencia. Ocho de 14 estudios sobre el comportamiento específico de la díada reportaron menos sincronía en las díadas con infantes prematuros y el resto de los estudios no encontró ninguna diferencia. Identificamos factores confusos que pudieran explicar las variaciones en los resultados, presentamos un acercamiento para interpretar la información existente por medio de enmarcar las diferencias en la conducta materna como potencialmente adaptable en el contexto del nacimiento prematuro, y sugerimos futuras áreas para ser exploradas.

Les relations de soin dans la période postnatale sont critiques pour le développement du nourrisson. Les bébés nés avant terme et leurs parents font face à des défis uniques à cet égard, avec les bébés faisant l'expérience de la séparation des parents, des procédures désagréables et difficiles, et une vulnérabilité biologique accrue, et les parents faisant face aux difficultés assumant des rôles de soignants et étant à risque plus élevé de détresse psychologique. Afin de comprendre la relation parent-nourrisson USIN nous avons passé en revue toutes les recherches et identifié 52 études comparant le comportement d'interaction dyadique, maternel et du nourrisson chez des dyades prématurées avec des dyades à plein terme. 18 des 40 études sur le comportement maternel ont trouvé un comportement moins que favorable, y compris une sensibilité décrue et plus d'intrusion chez les mères de nourrissons prématurés, 7 études ont trouvé le contraire, 4 études ont trouvé des résultats mélangés, et 11 études n'ont trouvé aucune différence. 17 études sur 25 sur le comportement du nourrisson ont trouvé une réaction moindre chez les nourrissons prématurés deux études ont trouvé le contraire, et le reste n'a trouvé aucune différence. 8 études sur 14 sur le comportement spécifique à la dyade ont fait état de moins de synchronie chez les dyades avant terme et les autres études n'ont trouvé aucune différence. Nous identifions des facteurs confondants qui pourraient expliquer des variations dans les résultats et nous présentons une approche pour interpréter les données existantes en cadrant des différences dans le comportement maternel comme étant potentiellement adaptatives dans le contexte de la prématurité et nous suggérons des domaines futurs d'exploration.

[Child psychiatry in pediatric intensive care unit]. / Pédopsychiatrie en unité de soins intensifs pédiatriques.

A study was conducted in the pediatric intensive care and resuscitation unit of the Nice pediatric hospitals, University Hospital Center Lenval (06) from January to March 2015. Its objective was to describe the events and child psychiatric interventions experienced by young patients. Of the 181 individuals managed during the research, 63 met the inclusion criteria.

The risk of low risk: First time motherhood, prematurity and dyadic well-being.

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth-relatively unexplored in the literature-is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers' meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.

El nacimiento prematuro tiene un impacto bien documentado en los infantes, madres y sus interacciones diádicas. La maternidad primeriza dentro del contexto de nacimiento prematuro de bajo riesgo -relativamente no explorado en la literatura- es una experiencia específica que se asienta en la coyuntura entre infancia prematura, maternidad y los procesos que respaldan la conexión diádica. Este estudio cualitativo analizó entrevistas semiestructuradas con madres primerizas de bebés prematuros de bajo riesgo. Los resultados fueron generados como respuesta a las preguntas de la investigación relativas a los procesos de dar sentido, establecer conexión de afectividad, así como de identidad de las madres. Los resultados demostraron que el proceso materno de dar sentido surgió de un marco diádico. Cuando las madres o sus infantes fueron considerados fuera de un contexto diádico, ocurrió por inadvertencia un sufrimiento en exceso. Los resultados tienen implicaciones importantes para la práctica de salud mental infantil en escenarios médicos, para el apoyo en el período que sigue al nacimiento prematuro, así como para la comprensión del significado de riesgo.

La naissance prématurée a un impact bien documenté sur les nourrissons, les mères et leurs interactions dyadiques. Le fait d'être mère pour la première fois dans le contexte d'une naissance prématurée à faible risque - relativement peu exploré dans les recherches - est une expérience spécifique qui se situe au coeur de la petite enfance prématurée, de la maternité et des processus qui soutiennent la connexion dyadique. Cette analyse qualitative a analysé des entretiens semi-structurés avec des mères étant mères pour la première fois et ayant eu des bébés prématurés à faible risque. Les résultats ont été générés en réponse à des questions de recherches concernant la quête de signification des mères, leur lien et leur identité. Les résultats démontrent que la quête de signification maternelle émergeait d'une structure dyadique. Lorsque les mères ou leurs bébés étaient considérés au dehors de ce contexte dyadique une souffrance excédentaire s'est produite par inadvertance. Les résultats ont des implications importantes pour la pratique de santé mentale du nourrisson dans des contextes médicaux, à la fois pour le soutien postnatal après une naissance prématurée et pour la compréhension de la signification du risque.

[Coercive stress in psychiatric intensive care unit: What link with insight?] / Stress coercitif en unité de soins intensifs psychiatrique : quel lien avec l'insight ?

The aim of this work was to study the correlations between the coercive experience level in patients in a psychiatric intensive care unit and clinical insight. We included 40 patients without specific diagnosis criteria at the end of their hospitalization in the intensive care unit. We assessed patients with the Coercion Experience Scale (CES) to measure their coercive stress level, and the Scale to Assess Unawareness of Mental Disorder (SUMD) which measures clinical insight. A total of 42.5 % of our sample suffered from mood disorders, 50 % suffered from psychotic disorders and 7.5 % from other disorders. On the one hand, we found that patients' coercive stress level was neither correlated with the awareness of their mental disorder nor with the awareness of social consequences of their mental disorder. On the other hand, we found that coercive stress level was significantly correlated with patients' awareness of treatment efficacy and that the specific CES factor measuring coercion showed a strong trend to significantly correlate with patients' awareness of treatment efficacy. These results seem to show that education about benefits of treatment is a key point to improve patients' coercive stress in a psychiatric intensive care unit, more than an education about awareness of the mental disorder itself.

[Neuropsychopathology of stroke victims]. / Neuropsychopathologie des personnes victimes d'AVC.

A stroke is a medical emergency with potentially fatal consequences. The speed of the initial treatment has a direct impact on the person's outcome. Rehabilitation and the support provided to the patient and their families is long-term. There may be sequelae on a cognitive, emotional, professional or social level which require very specific care.

University of Alberta Hospital Acute and Convalescent Polio Care and the Reintegration of Polio Patients into Albertan Communities, 1953-80.

Following Canada's largest polio epidemic in 1953, Station 67 at the University of Alberta Hospital (UAH) in Edmonton became home to patients who contracted the virus. As young as nine years old, some of these patients lived at the UAH for more than three decades. Akin to wartime services, the epidemic banded together families, patients, doctors, nurses, community members, and later respiratory, physical, and occupational therapists. The nature of the disease, the government response, and the social and economic climate dramatically affected the lived experiences of patients in Alberta's fight against polio. Drawing on archival research and oral interviews, this article argues that it was the agency and resilience of patients, the contributions of healthcare providers to rapid developments in acute and convalescent care, and the dedication of families that were primarily responsible for the recovery and reintegration of polio patients back into the community.

Monitoring of near-infrared spectrum values during packed red blood cell transfusion in pediatric intensive care unit.

OBJECTIVES: Packed red blood cell (PRBC) transfusion is one of the most common treatment options in pediatric intensive care unit (PICU) which targets a better cerebral oxygenation. This study aimed to show the cerebral near-infrared spectroscopy (cNIRS) changes during PRBC transfusions in PICU. MATERIAL AND METHODS: In this prospective observational study, changes in regional cerebral tissue oxygen saturation (rSO2) in pediatric patients, who required PRBC transfusion were monitored. All the cNIRS and related values were classified as baseline values. The same values were measured and calculated at the end of transfusion and named as 4th-hour values. Further measurements and calculations were made three hours later and named as 7th-hour values. Changes in cNIRS, cerebral tissue fractional oxygen extraction (CTFOE), cNIRS variability index (cNIRS-VI) were compared using Friedman test. RESULTS: A total of 53 PRBC transfusions were monitored. Baseline haemoglobin increased from 6.3 (5.9, 6.7) gr/dL to 8.6 (8.4, 9) gr/dL at the 7th-hour. cNIRS values improved during transfusion (P=0.012), with a concomitant decrease in cNIRS-VI and CTFOE values (P<0.001 and P=0.017 consecutively) CONCLUSION: Our study revealed that there is an increase in cNIRS and related values after transfusion compared to baseline values in critically ill children admitted to a PICU. Age of PRBC did not have an effect on delta-cNIRS or post-transfusion hemoglobin values. There is a moderate correlation between the baseline cNIRS values and delta-cNIRS value after the transfusion.

One train may hide another: Acute cardiovascular diseases could be neglected because of the COVID-19 pandemic.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is likely to have significant implications for the cardiovascular care of patients. In most countries, containment has already started (on 17 March 2020 in France), and self-quarantine and social distancing are reducing viral contamination and saving lives. However, these considerations may only be the tip of the iceberg; most resources are dedicated to the struggle against COVID-19, and this unprecedented situation may compromise the management of patients admitted with cardiovascular conditions. AIM: We aimed to assess the effect of COVID-19 containment measures on cardiovascular admissions in France. METHODS: We asked nine major cardiology centres to give us an overview of admissions to their nine intensive cardiac care units for acute myocardial infarction or acute heart failure, before and after containment measures. RESULTS: Before containment (02-16 March 2020), the nine participating intensive cardiac care units admitted 4.8±1.6 patients per day, versus 2.6±1.5 after containment (17-22 March 2020) (rank-sum test P=0.0006). CONCLUSIONS: We confirm here, for the first time, a dramatic drop in the number of cardiovascular admissions after the establishment of containment. Many hypotheses might explain this phenomenon, but we feel it is time raise the alarm about the risk for patients presenting with acute cardiovascular disease, who may suffer from lack of attention, leading to severe consequences (an increase in the number of ambulatory myocardial infarctions, mechanical complications of myocardial infarction leading to an increase in the number of cardiac arrests, unexplained deaths, heart failure, etc.). Similar consequences can be feared for all acute situations, beyond the cardiovascular disease setting.

[Nursing support during thrombolysis in the neurovascular ICU]. / Accompagnement par l'infirmière lors d'une thrombolyse en unité de soins intensifs neurovasculaires.

Intravenous thrombolysis is one of two emergency procedures for ischaemic stroke. Its implementation requires fine coordination of the healthcare team and must be adapted to the local context of each hospital and sector. International good clinical practice guidelines are available to support team organisation.

Mechanical circulatory support in patients with cardiogenic shock in intensive care units: A position paper of the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology, endorsed by the "Groupe Athérome et Cardiologie Interventionnelle" of the French Society of Cardiology.

Cardiogenic shock (CS) is a major challenge in contemporary cardiology. Despite a better understanding of the pathophysiology of CS, its management has only improved slightly. The prevalence of CS has remained stable over the past decade, but its outcome has seen few improvements, with the 1-month mortality rate still in the range of 40-60%. Inotropes and vasopressors are the first-line therapies for CS, but they are associated with significant hazards, and have well-known deleterious effects. Furthermore, a significant number of patients develop refractory CS with haemodynamic instability, causing critical organ hypoperfusion and/or pulmonary congestion, despite increasing doses of catecholamines. A major change has resulted from the recent advent and availability of potent mechanical circulatory support (MCS) devices. These devices, which ensure sustained blood flow, provide a great and long-awaited opportunity to improve the prognosis of CS. Several efficient MCS devices are now available, including left ventricle-to-aorta circulatory support devices and full pulmonary and circulatory support with venoarterial extracorporeal membrane oxygenation. However, evidence to support their indications, the timing of implantation and the selection of patients and devices is scarce. Because these devices are gaining momentum and are becoming readily available, the "Unité de Soins Intensifs de Cardiologie" group of the French Society of Cardiology aims to propose practical algorithms for the use of these devices, to help intensive care unit and cardiac care unit physicians in this complex area, where evidence is limited.

[Nursing care after thrombectomy]. / Prise en charge infirmière au décours d'une thrombectomie.

Since its inception in 2015, thrombectomy has revolutionised the emergency management of ischaemic stroke with large vessel occlusion. Indeed, early endovascular extraction of the thrombus considerably improves the prognosis. Different medical teams are involved in the critically urgent management of these very fragile patients.

Fungemia due to Saprochaete capitata in a non-neutropenic patient hospitalized in an intensive care unit after cardiac surgery.

The majority of invasive fungal infections observed in non-neutropenic patients hospitalized in an intensive care unit are caused by Candida spp and current guidelines recommend echinocandins as the first-line treatment. Fungemias caused by filamentous or arthrosporic fungi such as Saprochaete capitata (previously named Geotrichum capitatum) are extremely rare. In fact, invasive infections due to S. capitata have been reported almost exclusively in neutropenic oncohematological patients. In this report, we describe a case of fungemia caused by S. capitata in a non-neutropenic patient hospitalized in an intensive care unit after aortic valve replacement. The prompt identification of S. capitata is extremely important because of its intrinsic resistance to echinocandins.

Easily applicable SEP-monitoring of the N20 wave in the intensive care unit.

In this technical note, a conveniently sized, single-channel somatosensory evoked potentials (SEP)-stimulation-recording unit for bedside use in the intensive care unit is presented. The validation of the SEP N20 wave in intensive care guidelines as initial parameter for the prognostic evaluation of cardiac arrest has increased the demand for a more widespread availability of SEP, outside the electrophysiological domain. A device with a simplified interface that safely guides the user through a complete examination and that includes artifact removal is a prerequisite for such more widespread use, in which expert interpretation can be reduced to a necessary minimum.

[Severe pulmonary tuberculosis in the ICU, diagnosis and treatment]. / Diagnostic et traitement d'une pneumonie tuberculeuse grave en réanimation.

INTRODUCTION: Pulmonary tuberculosis can rarely lead to acute respiratory distress syndrome and anti-tuberculous therapy initiation depends on this difficult diagnosis in ICU. CASE REPORT: A 50-year-old man presented a septic shock and acute respiratory distress syndrome with bilateral infiltrates mainly in the upper lobes on chest radiography. Diagnosis of pulmonary tuberculosis was made 10days after admission on examination of cavitary and diffuse infiltrates on a second CT scan, in addition to presence of acid-fast bacilli on smear examination of bronchial aspirates. Amikacin, with four first-line anti-tuberculous drugs, was started in the case of a resistant strain and seriousness of the illness. After 14weeks, he left on rifampicin and isoniazid treatment. CONCLUSIONS: There are no specific recommendations concerning pulmonary tuberculosis in ICU but a delay in initiation of anti-tuberculous therapy is a factor of poor prognosis. Using a second-line anti-tuberculous drug, like amikacin or/and fluoroquinolones, within initial treatment may accelerate improvement of sepsis and immediately treat resistant strains, when genomic methods for detection of resistance are not available in routine.

French recommendations on electroencephalography.

Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows repeat testing when follow-up is necessary, even at the patient's bedside. Faced with advances in knowledge, techniques and indications, the Société de neurophysiologie clinique de langue française (SNCLF) and the Ligue française contre l'épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and highlight proposals for writing an EEG report. Some questions could not be answered by review of the literature; in such cases, in addition to the guidelines the working and reading groups provided their expert opinion.

[French guidelines on electroencephalogram]. / Recommandations françaises sur l'électroencéphalogramme.

Electroencephalography allows the functional analysis of electrical brain cortical activity and is the gold standard for analyzing electrophysiological processes involved in epilepsy but also in several other dysfunctions of the central nervous system. Morphological imaging yields complementary data, yet it cannot replace the essential functional analysis tool that is EEG. Furthermore, EEG has the great advantage of being non-invasive, easy to perform and allows control tests when follow-up is necessary, even at the patient's bedside. Faced with the advances in knowledge, techniques and indications, the Société de Neurophysiologie Clinique de Langue Française (SNCLF) and the Ligue Française Contre l'Épilepsie (LFCE) found it necessary to provide an update on EEG recommendations. This article will review the methodology applied to this work, refine the various topics detailed in the following chapters. It will go over the summary of recommendations for each of these chapters and underline proposals for writing an EEG report. Some questions could not be answered by the review of the literature; in those cases, an expert advice was given by the working and reading groups in addition to the guidelines.

Costo de recolocación de catéter central inserción periférica en neonatos de un hospital de tercer nivel / Relocation cost peripherally inserted central catheter in neonates of a tertiary hospital / Custo da recolação do cateter central de inserção periférica em neonatos de um hospital de terceiro nivel / Coüt du repositionnement du cathéter central á insertion périphérique chez les nouveau-nés d'un hopital tertiaire

Resumen Objetivo: Determinar los costos por recolocación de catéter central de inserción periférica (PICC) por complicaciones mecánicas en neonatos de un hospital de tercer nivel. Material y métodos: Estudio de análisis de costos de recolocación de catéter central de inserción periférica en el área de cuidados intensivos neonatales de un hospital de tercer nivel de Tabasco durante el año 2016. Para el cálculo de costos se elaboró un modelo de costeo adaptado del sistema ABC para ser aplicable en un hospital; se diseñó la fórmula: a + b + c + d + e. Para obtener el costo total de recolocación de PICC; donde a= Costo servicio personal por procedimiento para reparación del Evento Adverso X número de trabajadores participantes, b = Insumo requerido para reparar el Evento Adverso, c = Costo por auxiliar diagnóstico (USG, Tomografia, Rayos X, Labs.), d = Costo medicamento y material de curación utilizado por Evento Adverso, e = Número dia estancia en UCIN X costo D-C-O en UCIN. Resultados: Se revisaron 43 expedientes clínicos obtenidos de la base de datos del programa SICALIDAD del hospital; se identificaron 22 casos de ruptura de PICC, 20 casos por obstrucción, 1 caso por retiro accidental. Conclusiones: El costo derivado de las 22 recolocaciones fue de $1,512,248.56 afectando los recursos financieros del hospital. Se observó una cadena de procedimientos e intervenciones altamente generadores de costos.

Abstract Object: To determine the costs of repositioning peripheral central insertion catheter (PICC) due to mechanical complications in neonates of a tertiary hospital. Materials and methods: Cost analysis study of peripherally inserted central catheter in the neonatal intensive care unit of a tertiary hospital in Tabasco during 2016. To obtain the total cost of repositioning PICC; where a = Cost of personal service by procedure for repairing the Adverse Event X number of participating workers, b = Input required to repair the Adverse Event, c = Cost per diagnostic assistant (USG, Tomography, X-ray, Labs.), d = Medication cost and healing material used by Adverse Event, e = Day number stay in NICU X cost D-C-O in NICU. Results: 43 clinical files were reviewed obtained from the database of the SICALIDAD program of the hospital; we identified 22 cases of PICC rupture, 20 cases due to obstruction, 1 case due to accidental withdrawal. Conclusions: The cost derived from the 22 relocations was $ 1,512,248.56 (Mexican pesos), affecting the financial resources of the hospital. A chain of highly cost-generating procedures and interventions was observed.

Resumo Objetivo: Determinar os custos do recolocação do cateter central de inserjao periférica (PICC) devido a complicares mecânicas em neonatos de um hospital de terceiro nível. Materiais e métodos: Estudo sobre o custo do recolocação de um cateter central inserido perifericamente na área de cuidados intensivos neonatais de um hospital terciário em Tabasco durante o ano de 2016. Para o cálculo dos custos, foi desenvolvido um modelo de cálculo de custos adaptado do sistema ABC para ser aplicado num hospital; com a seguinte fórmula: a + b + c + d + e. Para obter o custo total do reposicionamento da PICC; onde a = custo com os profissionais de saúde por procedimento para reparar o evento adverso X número de trabalhadores participantes, b = entrada necessária para reparar o evento adverso, c = custo por exame auxiliar de diagnóstico (USG, tomografia, raios-X, laboratórios), d = custo do material e tratamento usado pelo Evento Adverso, e = Número de dias nas UCIN's X custam DCO em UCIN. Resultados: Revisou-se 43 registos clínicos obtidos no banco de dados do programa SICALIDAD do hospital; Identificou-se 22 casos de ruptura de PICC, 20 casos de obstrução, 1 caso de remojao acidental. Conclusões: O custo derivado das 22 recolocajoes foi de US $ 1.512.248,56, o que prejudicou os recursos financeiros do hospital. Observou-se uma série de procedimentos e de intervenções altamente geradores de custos.

Résumé Objectif: Déterminer les coüts de repositionnement du cathéter central á insertion périphérique (PICC) par des complications mécaniques chez les nouveau-nés d'un hopital tertiaire. Matériaux et méthodes: Étude de l'analyse des coüts de la relocalisation de cathéter central á insertion périphérique dans l'unité de soins intensifs néonatals dans un hopital tertiaire á Tabasco en 2016. Pour le calcul des coüts un modéle d'établissement des coüts adapté du systéme ABC a été élaboré pour étre applicable dans un hopital : la formule a été conjue: a + b + c + d + e. Pour obtenir le coüt total du repositionnement du PICC; ou a = Coüt du service personnel par procédure pour la réparation du nombre d'événements indésirables X des travailleurs participants, b = entrée nécessaire pour réparer l'événement indésirable, c = Coüt par assistant de diagnostic (USG, Tomographie, X-Ray, Labs.), d = coüt des médicaments et matériel de guérison utilisé par l'événement indésirable, e = Le nombre de jours reste dans l'USIN X coüte D-C-O dans l'USIN. Résultats: 43 dossiers cliniques ont été examinés obtenu á partir de la base de données du programme SICALIDAD de l'hopital; nous avons identifié 22 cas de rupture de PICC, 20 cas dus á une obstruction, 1 cas dü á un retrait accidentel. Conclusion: Le coüt des 22 réinstallations s'est élevé á 1 512 248,46 $, ce qui a eu une incidence sur les ressources financiéres de l'hópital. Une chame de procédures et d'interventions trés coüteuses a été observée.