Abstract Introduction Accidental dislocation or removal are well-known complications of external CSF drainage in daily clinical practice, although no data about the incidence of such complications ...are available across the scientific literature so far. SecurAcath® (Interrad Medical) is a subcutaneously anchored device recently adopted for securement of central venous catheters, known to be highly effective (and cost-effective) in reducing the risk of catheter dislodgement and/or accidental removal. Methods We report our preliminary experience with the use of SecurAcath® to secure CSF drainage, either ventricular or spinal, to the skin. Results SecurAcath® was used in 29 consecutive patients (age 3 weeks-16 years). In particular, the device was used for 25 ventricular catheters (a patient received two catheters in the same procedure for bilateral brain abscess) and 5 spinal drainages. Period in place ranged from 1 to 4 weeks. No complication related to the use of the device was observed, in particular there was no case of dislocation or accidental removal of the catheter. The removal procedure was extremely easy. The device has proven its utility also in three cases requiring an adjustment of the length of the catheter. Conclusions In our experience, SecurAcath® is a safe and effective device to secure CSF external catheters to the skin, with several relevant advantages: its placement and maintenance are easy; it may stay in place for the whole duration of the catheter; it allows a more complete antisepsis of the exit site, thus reducing local skin complications; it eliminates the risk of suture-related needlestick injuries.
Abstract Study Objective To describe our 10 years of experience with childhood choroid plexus tumors (CPTs). Design Retrospective chart analysis. Setting Operating room and pediatric intensive care ...unit (PICU) of a university hospital. Patients 18 infants and children undergoing CPT surgery from 1995 to 2004, 11 of whom were younger than 12 months. Measurements Perioperative hematologic and coagulation data were measured as well as estimated red cell volume variations (as a reliable index of blood loss) in the perioperative period, together with coagulation parameters. Results Greater blood loss was recorded in the infant group vs older children (percentage of estimated red cell volume loss, 1.31 ± 1.79% vs 0.20 ± 0.17% P < 0.01 and 1.50 ± 1.86% vs 0.29 ± 0.21% P < 0.01 on PICU admission and after 72 hours, respectively). Platelet count decrease was similarly noted (51.60 ± 28.06 vs 27.57 ± 11.98, P < 0.05, as percentage of preoperative count). Patients operated on in the neonatal period showed the highest blood loss and related coagulation impairment. Conclusion Younger CPT surgery patients present an increased risk versus their older counterparts of massive bleeding resulting in hemodynamic instability and coagulative impairment.
