• Research in Community and Public Health Nursing
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• v.27 no.4
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• pp.327-336
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• 2016

Purpose: This study was to examine the clinical characteristics and mortality risk factors of geriatric hospital patients who visited one region-wide emergency department (ED). It's basically meant to develop criteria for the patient management of geriatric hospitals and to provide related information. Methods: A retrospective research study was implemented using electronic medical records. The subjects in this study included 484 geriatric hospital patients who were selected from among 15,994 patients that visited one region-wide ED between January 1, 2014, and December 31, 2015. Results: There were significant differences in death, a change for the better and no change for the better, which were results of treatment, according to the length of stay in hospital, hospitalization in a general ward, not having an operation or surgery, the presence or absence of malignant neoplasm, the insertion of foley catheter, intubation, ventilator and the insertion of central venous catheter. Conclusion: The results of this study suggest that a patient management system is necessary in geriatric hospitals and that competent healthcare workers who can properly respond to emergencies are required as well.

• Pediatric Infection and Vaccine
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• v.18 no.1
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• pp.15-22
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• 2011

Invasive Candida infections (ICI) have become the third most common cause of late-onset infection among premature infants in the neonatal intensive care unit (NICU). Risk factors include birth weight less than 1,000 g, exposure to more than two antimicrobials, third generation cephalosporin exposure, parenteral nutrition including lipid emulsion, central venous catheter, and abdominal surgery. Candida colonization of the skin and gastrointestinal tract is an important first step in the pathogenesis of invasive disease. Strict infection control measures against the infection should be done in the NICU. The following practices are likely to contribute to reducing the rate of ICI: (1) restriction of broad-spectrum antibiotics, antacids and steroid; (2) introduction of early feeding and promoting breast milk. Fluconazole prophylaxis may be an effective control measure to prevent Candida colonization and infections in individual units with high incidence of fungal infection. In addition, there is a need of further data including the development of resistant strains and the effect on long-term neurodevelopmental outcomes of infants exposed to drugs before the initiation of routine application of antifungal prophylaxis in the NICU.

• Investigative Magnetic Resonance Imaging
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• v.23 no.1
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• pp.70-74
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• 2019

Cerebral air embolism (CAE) is a rare complication of various medical procedures. It manifests with symptoms similar to those of typical acute cerebral infarction, however the treatment is quite different. We present a case of arterial CAE that was associated with a disconnected central venous catheter and appeared as punctate dark signal intensities with aliasing artifacts on the susceptibility-weighted filtered phase magnetic resonance image. The susceptibility-weighted filtered phase image can be helpful for diagnosing CAE and the magnetic resonance imaging reflects the pathophysiology of CAE.

• Journal of Korean Biological Nursing Science
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• v.16 no.3
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• pp.182-191
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• 2014

Purpose: The aim of this study was to identify necessary emergency treatment and nursing activities for severe trauma patients according to elapsed time and vital signs. Methods: A survey was conducted with 121 patients over 15 points ISS on EMR from June 1, 2011 to May 31, 2012. Collected data were analyzed with descriptive statistics, applying McNemar's test using SPSS 12.0. Results: Almost all of the subjects were men and the mean age was 46.9. Run-time for primary diagnosis, treatment decision, and leaving for the hospital room was 0.19, 4.36, and 4.21 hours, respectively, and stayover time was 9 hours. Regardless of vital signs, emergency treatments involving ambu-bagging, intubation, ventilator, and central vein catheterization insertion were offered within an hour. Central venous pressure, Foley catheter/Levin tube preparation and maintenance were performed in cases of unstable vital sign patients within an hour. Unrelated to vital signs, nursing activities for consciousness assessment, skin assesment and wound care, bed sore/fall down assesment and care, intravenous injection insertion and maintenance were conducted for all severe trauma patients within an hour. Foley catheter/Levin tube drainage care was performed for patients who had unstable vital signs within an hour. Conclusion: Emergency treatment and nursing activities for severe trauma patients were specific according to elapsed time and vital signs.

• Journal of Chest Surgery
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• v.29 no.12
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• pp.1401-1404
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• 1996

Central venous line insertion is an essential procedure in a cardiac operation. For this, percuteneous Insertion is usually done in the internal jugular vein or the subclavian vein. However, this method can create such complications as pneumothorax and hemothorax, and repeated failure in inserting the cathet r, especially in infant and child patients, can waste excessive time. Consequently, in our hospital, catheterization of the innominate vein was done after the completion of sternotomy in the cardiac operation of infant and child patients weighing under 1 Okg. During operation, the catheter was placed in the left atrium through the foramen ovate or pulmonary artery to be used for pressure monitoring. When the patient's hemodynamic became stabilized, the catheter was withdrawn to either the right atrium or superior vena casa to be used as the channel for fluid replacement or drug administration. In our hospital, this procedure has been used in 96 cases since 1989. No complications such as pneumothorax and hemothorax occilrred, and neither bleeding after the removal of the catheter was seen.

• Journal of Hospice and Palliative Care
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• v.17 no.3
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• pp.179-184
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• 2014

Purpose: We investigated the safety and efficacy of peripherally inserted central catheters (PICCs) in terminally ill cancer patients. Methods: A retrospective review was conducted on patients who underwent PICC at the hospice-palliative division of KEPCO (Korea Electric Power Corporation) Medical Center between January 2013 and December 2013. All PICCs were inserted by an interventional radiologist. Results: A total of 30 terminally ill cancer patients received the PICC procedure during the study period. Including one patient who had had two PICC insertions during the period, we analyzed a total of 31 episodes of catheterization and 571 PICC days. The median catheter life span was 14.0 days (range, 1~90 days). In 25 cases, catheters were maintained until the intended time (discharge, transfer, or death), while they were removed prematurely in six other cases (19%; 10.5/1000 PICC days). Thus, the catheter maintenance success rate was 81%. Of those six premature PICC removal cases, self-removal due to delirium occurred in four cases (13%; 7.0/1000 PICC days), and catheter-related blood stream infection and thrombosis were reported in one case, each (3%; 1.8/1000 PICC days). Complication cases totaled eight (26%; 14.1/1000 PICC days). The time to complication development ranged from two to 14 days and the median was seven days. There was no PICC complication-related death. Conclusion: Considering characteristics of terminally ill cancer patients, such as a poor general condition, vulnerability to trivial damage, and a limited period of survival, PICC could be a safe intravenous procedure.

• Clinical and Experimental Pediatrics
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• v.48 no.9
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• pp.953-959
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• 2005

Purpose : The administration of total parenteral nutrition(TPN) has become a standard procedure in the management of nutritionally deprived and critically low birth weight neonates. Sepsis remains the most frequent serious complication during TPN, resulting in increased morbidity, mortality and health care costs. This study was performed to evaluate the clinical efficacy and complications of percutaneous central venous catheterization(PCVC) in very low birth weight infants. Methods : A total of 56 very low birth weight infants below 1,500 g during the period from January 1998 to December 2003 were enrolled and their medical records reviewed. Study group(n=32) included the babies who had undergone PCVC and a control group(n=24) included babies who had not undergone PCVC. We compared the study group with the control group for factors such as subject characteristics and catheter-related complications. Results : There was no difference in subject characteristics, such as birth weight, gestational week, respiratory distress syndrome, duration of ventilator therapy, duration from tube to complete oral feeding, days at TPN and its total duration, body weight at discontinuation of TPN and the days taken to reach to 2,000 g. However, the morbidity rate due to patent ductus arterious, chronic lung disease, necrotizing enterocolitis, osteopenia, cholestasis, and sepsis showed no difference. The study group with infants below 1,000 g showed a higher incidence of sepsis compared to the control group of the same weight group. The study group with infants between 1,000 to 1,500 g showed significantly higher incidences of intraventricular hemorrhage and took longer reach the a body weight of 2,000 g. Conclusion : Considering the high incidence of sepsis in the PCVC group, every attempt should be made to minimize the length of TPN therapy and encourage early enteral feeding. We also recommend the use of PCVC carefully in patients requiring prolonged nutritional support.

• Pediatric Infection and Vaccine
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• v.28 no.3
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• pp.133-143
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• 2021

Purpose: This study aimed to determine the incidence of central line-associated bloodstream infection (CLABSI) in the neonatal intensive care unit (NICU), evaluate the patients' clinical characteristics, and identify the etiologic agents for guidance in prevention and treatment. Methods: A retrospective chart review study of infants classified as having CLABSI was conducted at the NICU of Seoul National University Bundang Hospital from January 2016 to December 2020. Results: Of the 45 infants, 53 had CLABSIs within a follow-up period of 18,622 catheter days. The incidence of CLABSIs was 2.85 per 1,000 catheter days. The most common catheter type was a peripherally inserted central catheter (n=47, 81%). A total of 57 pathogens were isolated, of which 57.9% (n=33) were Gram-positive bacteria, 36.8% (n=21) were Gram-negative bacteria, and 5.3% (n=3) were Candida spp. The most common pathogens were Staphylococcus aureus (n=12, 21%) and coagulase-negative staphylococci (n=12, 21%), followed by Klebsiella aerogenes (n=8, 14%). The median duration of bacteremia was 2 days, and 19 episodes showed bacteremia for 3 days or more. The mortality rate of infants within 14 days of CLABSI was 13.3% (n=6). Conclusions: This study analyzed the incidence of CLABSI and the distribution of pathogens in the NICU. Continuous monitoring of CLABSI based on active surveillance serves as guidance for empiric antibiotic use and also serves as a tool to assess the necessity for implementation of prevention strategies and their impact.

• Journal of Chest Surgery
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• v.23 no.1
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• pp.32-40
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• 1990

Surgical correction of congenital cardiac defects in infants and children with an elevated pulmonary arterial pressure or pulmonary vascular resistance carries a significant early postoperative mortality. And accurate assessments of cardiac output is critically important in these patients. From April 1988 through September 1989, serial measurements of cardiac index, ratio of pulmonary-systemic systolic pressure, ratio of pulmonary-systemic resistance, central venous pressure, left atrial pressure, and urine output during the first 48 hours after the cardiac operation were made in 30 congenital cardiac defects associated with pulmonary hypertension. Cardiac index showed significant increase only after 24 hour postoperatively and this low cardiac performance in the early postoperative period should be considered when postoperative management is being planned in the risky patients. There were no variables which showed any significant correlation with cardiac index. In 12 cases[40%], pulmonary hypertensive crisis developed during the 48 hours postoperatively, and they were treated with full sedation, hyperventilation with 100 % 0y and pulmonary vasodilator infusion. In all patient with preoperative pulmonary hypertension, surgical placement of a pulmonary artery catheter is desirable to allow prompt diagnosis of pulmonary hypertensive crisis and to monitor subsequent therapy.

• Korean Journal of Adult Nursing
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• v.24 no.3
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• pp.232-243
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• 2012

Purpose: This study was to identify the level of knowledge and performances on evidence-based infection control and influencing factors on performance among nurses in intensive care unit. Methods: A descriptive cross-sectional survey design was used. Two hundred thirty-nine nurses at intensive care units were conveniently recruited from seven hospitals located in Seoul and Kyounggi province. Data were collected with a questionnaire survey about evidence-based infection control. Data were analyzed using SPSS/WIN 17.0 program. Results: Both level of knowledge (mean 9.15 out of 19) on preventing ventilator-associated pneumonia and central venous catheter induced bloodstream infection, and performance on evidence-based infection control (1.94 out of 4) were moderate. Performance of evidence-based practice for infection control was related to reading research articles regularly, professional satisfaction, and taken education course. Conclusion: These results indicate that systematic and organizational strategies for enhancing evidence-based infection control are needed to improve quality of intensive nursing care.