Systematic application of SICA-PED protocol for central venous catheterization in neonates: A prospective clinical study on 104 cases
Systematic application of SICA-PED protocol for central venous catheterization i 3.pdf
Background: Catheterization of central vessels can be associated with early and late, potentially
fatal complications. A proactive approach is imperative to reduce the frequency and magnitude
of adverse events. Recently, the GAVeCeLT has proposed a protocol called SICA-PED (i.e. Safe
Insertion of Central Access in Pediatric patients) and includes seven evidence-based strategies.
Methods: Through a single-center prospective observational study, the authors wanted to
consolidate the efficacy and safety of these protocol in newborns. In a series of 104 newborns,
the seven steps of the protocol were applied (1) pre-procedural ultrasound study of the RaCeVA
veins, (2) correct aseptic technique, (3) ultrasound-guided venipuncture, (4) intraprocedural
localization of the tip of the catheter with TTE (ECHO TIP) and (iECG) intracavitary
electrocardiogram, (5) reasoned choice of the implant exit site with the RAVESTO Tunneling
technique, (6) anchoring without stitches, and (7) exit point protection with the use of glue and
transparent semipermeable membrane. The authors have included a further precaution in point
(6) the subcutaneous anchoring system has added the counter-fixation of the catheter wings that
we will call 6Plus Point.
Results: All infants requiring implantation of elective us-guided central venous access were
enrolled in the study. None of the 104 implanted central venous catheters experienced early
complications (accidental arterial puncture, PNX, primary malposition); rare late complications
such as ecchymosis, CRBSI, exit site infection or dislodgement were observed, No catheterrelated thrombotic phenomena were observed. The CRBSI catheter-related infection rate was
2.47 × 1000 days catheter cases.
Conclusion: The results of this prospective study strengthen the feasibility and efficacy of the
SICA-Ped Protocol. Demonstrating that the systematic application of the evidence-based sevenstep implantation strategy increases the success rate, minimizes early and late complications,
which result in increased patient safety.
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