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Öğe The effect of ultrasound-guided central venous catheterization on complications and success rate in critically ıll children: a multicenter study(T.C. Sağlık Bakanlığı Ankara Şehir Hastanesi, 24 Eylül 2024) Yaman, Ayhan; Emeksiz, Serhat; Yıldızdaş, Dinçer; Kendirli, Tanıl; Ödek, Çağlar; Boşnak, Mehmet; Bayraktar, Süleyman; Ağın, Hasan; Anıl, Ayşe Berna; Kutlu, Nurettin Onur; Arslan, Gazi; Bayrakçı, Benan; Kalkan, Gökhan; Dursun, Oğuz; Sevketoglu, Esra; Azapağası, Ebru; Perk, Oktay; Yılmaz, HayriObjective: The aims of this study were to compare the results of ultrasound (US) guidance and the landmark (LM) technique for central venous catheter (CVC) placement in pediatric intensive care units (PICUs) as performed by clinicians. Material and Methods: The patients were divided into two groups according to the technique used: an LM group (459 patients) and a US-guided group (200 patients). We evaluated the success rate, the number of attempts, and the complication rates based on each patient’s age and weight. Results: The time required for the successful placement of the CVC was significantly different between the two groups: 10.9±10.8 min in the LM group and 8.1±7.6 min in the US-guided group (p=0.012). Additionally, the average number of attempts for successful catheterization was 1.8±0.8 in the US-guided group; and 2.5 ± 1.4 in the LM group (p=0.024). A total of 115 (17.3%) complications were noted: 24 (3.6%) in the US-guided group and 91 (13.7%) in the LM group (p=0.014). The frequency of complications decreased as the age and weight of the patients increased. When the inserted catheters used by ultrasound were evaluated, 59.5% of them were placed by clinicians who had ultrasound training while 40.5% were inserted by clinicians who did not have ultrasound training. There was no significant difference in the complication rate, number of punctures, and success rates between the ultrasound-trained and untrained clinicians (p=0.476). Conclusion: This is the largest multicenter study comparing the US-guided vs. LM technique for CVC placement in children. We believe that the US-guided CVC procedure is more safe and takes less time than the LM technique. Also, point-of-care ultrasound is useful, beneficial, and easily available for pediatric intensivists.Öğe Alpha-lipoic acid intoxication in an adolescent girl(2021) D. Al-Mendalawi, Mahmood; Polat, Sinem; Kılıcaslan, Onder; Turan Sonmez, FeruzaDear Editor, Polat et al. (1) described nicely the clinical picture, management plan, and favorable outcome of a case of alpha-lipoic acid (ALA) intoxication in a 16-year-old Turkish girl. On the basis of her medical history, Polat et al. (1) mentioned that the patient took three pills, each of 600 mg ALA, approximately 2 hours before hospital admission to self-treat her headache with intervals of half an hour. I assume that the claimed self-treatment should not mask the potential suicidal attempt in the studied patient. Worldwide, suicide and suicide attempts are important health risks among adolescents with grave consequences (2). In an interesting Turkish study involving medico-legal autopsy cases, childhood and adolescent (aged 0-18 years) deaths constituted 24.4% of all cases. Suicide was the origin of death in 13.4% of cases recruiting victims aged <18 years. Females comprised the majority of the suicide cases (62.9%), and adolescents aged 16-18 years constituted the overwhelming majority (70.4%) of all childhood suicides. The mean age was 16.13 years. The most frequent method of suicide in females was poisoning (3). An in-depth psychological assessment of the studied patient would have solicited. If that assessment was to unveil potential suicide thought and intention, strict actions must be geared to prevent further incidents. Although the studied patient favorably survived that incident, fatal suicidal intoxication with ALA has been reported in a 14-year-old German girl (4)Öğe Infant death due to aluminum phosphide intoxication, an uncontrolled insecticide used : case report(DergiPark, 2019) Terece, Cem; Sagukpinar, Veysel Osman; Ozdemir, Nazim; Polat, SinemPhosphine gas is a gas that is frequently used as rodenticide and insecticide due to its high diffusion capacity and the absence of residues in agricultural products. Since this gas is highly toxic, it is found in our country as aluminum phosphite tablets impregnated with clay, these tablets emit phosphine gas when they meet with the moisture in the air or gastric hydrochloric acid. Mortality rates in aluminum phosphite intoxications are 40-80% depending on the exposure dose. There is no control mechanism in the supply of aluminum phosphide tablets which are so dangerous and no information is given about the serious conditions that may occur during the use of these tablets. A 2 month old baby, whose family practiced drying pepper-eggplant, was reported to have been exposed to phosphine gas by inhalation, admitted to hospital with vomiting and cyanosis and lost his life within 24 hours. We present our case, who lost his life due to erroneous usage of aluminum phosphite, with additional emphasis on early diagnosis, treatment and gathering sample for toxicologic analysis, with corresponding forensic and medical documents.
