GKD Anest Yoð Bak Dern Derg. 2019; 25(2): 96-101 | DOI: 10.5222/GKDAD.2019.03880

Çocuklarda Anatomik Ýþaret ve Ultrasonografi Eþliðinde Perkutan Kateter Takýlmasý Yöntemlerinin Hastane Maliyeti Üzerine Etkisinin Karþýlaþtýrýlmasý

Yahya Yýldýz
Medipol Üniversitesi, Týp Fakültesi, Anesteziyoloji Ana Bilim Dalý, Ýstanbul, Türkiye

GÝRÝÞ ve AMAÇ: Giriþ: Çocuklarda santral venöz kateter ve arter kateteri takýlmasý damar çapý küçük olduðundan güçlükler içerir. Ultrasonografi ile kateterizasyon zaman ve malzeme tasarrufu ile birlikte giriþim baþarýsý artmýþ, komplikasyonlarda da azalma olmuþtur. Bu çalýþmanýn amacý çocuklara anatomik iþaret ve ultrasonografi eþliðinde santral venöz kateter ve arter takýlmasý yöntemlerini; zaman, malzeme, cerrahi, atriyal kateter takma yönlerinden karþýlaþtýlmasýdýr.
YÖNTEM ve GEREÇLER: Hastane etik komite onayý alýndýktan sonra, prospektif, vaka kontrollü, ard arda 1’er yýllýk sürelerde, 1.yýl anatomik iþaret (Grup A, n=151) ve ikinci yýl ultrasonografi (Grup B, n=151) yöntemleri kullanýlarak, 10 kg'ýn altý, santral venöz kateter ve/veya arter takýlan vakalar çalýþmaya dahil edildi.
BULGULAR: Grup A ve Grup B’de sýrasý ile tüm vakalarýn toplam santral venöz kateter takma süresi 78 saat, 37 saat, fark 41 saat idi (p<0,005). Grup A ve Grup B’de sýrasý ile tüm vakalarýn toplam arter kateteri takma süresi 96 saat, 63 saat, fark ise 33 saat idi (p<0,005). Kullanýlan toplam kateter sayýsý Grup A’da 203, Grup B’de 167 ve aradaki fark 36 bulundu. Kateterizasyon için cerrahi set kullanýmý 9 adet (Grup A: 8 set, Grup B: 1 set) idi (p<0.05). Toplam kateterizasyon süreleri (ameliyathane saatlik kullaným fiyatý olan 3.200 TL), kullanýlan kateter ve cerrahi set dikkate alýndýðýnda iki gruptaki ayný sayýdaki vakalar için 241.620 TL net iyileþtirme saðlandýðý görüldü.
TARTIÞMA ve SONUÇ: Ultrasonografi kýlavuzluðunda yapýlan santral venöz kateter ve arter kateteri yerleþtirilmesi, anatomik iþaret ile karþýlaþtýrýldýðýnda anlamlý derecede daha kýsa zamanda yapýldý. Ultrasonografi ile yapýlan kanülasyonlarda daha az malzeme kullanýldý. Hastane maliyetlerinde azalma saðlamasý nedeniyle özellikle düþük aðýrlýklý çocuk hastalarda ultrasonografi kullanýlmasý akla getirilmelidir.

Anahtar Kelimeler: Santral venöz kateter, anatomik iþaret, ultrasonugrafi, yenidoðan, perioperatif komplikasyonlar, maliyet.

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Comparison of The Effects of Percutaneous Catheter Insertion with Anatomic Landmark or Ultrasonography Guided Techniques on Hospital Cost in Children

Yahya Yýldýz
Medipol University, Medical Faculty, Department Of Anesthesiology, Istanbul, Turkey

INTRODUCTION: Insertion of a central venous catheter and an arterial catheter in children involves difficulties because the vessel diameter is small. With catheterization time and material saving by ultrasonography, the success of the procedure increased and the complications decreased. The aim of this study was to investigate the methods of insertion of central venous catheter and artery in the presence of anatomical signs and ultrasonography; time, material, surgery, atrial catheter insertion aspects of comparison.
METHODS: After obtaining hospital ethics committee approval, using prospective, case-controlled, first year anatomical signs (Group A, n = 151) and second year ultrasonography (Group B, n = 151) guidance methods in 1-year period catheter insertion into the superior vena cava and / or arteries in patients less than 10 kg, were included in the study.
RESULTS: In Group A and Group B, the total time of insertion of central venous catheter was 78 hours, 37 hours and 41 hours, respectively (p <0.005). In Group A and Group B, total arterial catheter insertion time was 96 hours, 63 hours and the difference was 33 hours, respectively (p <0.005). The total number of catheters used was 203 in Group A, 167 in Group B and 36 in Group B. The use of surgical set for catheterization was 9 (Group A: 8 sets, Group B: 1 set) (p <0.05). Total catheterization times (operating room hourly usage price is 3.200 TL), the catheter and surgical set used in the same number of cases in the two groups taken into account a net improvement of TL 241.620 was achieved.
DISCUSSION AND CONCLUSION: Ultrasonography guided central venous catheter and arterial catheter placement were performed in a significantly shorter time compared to the anatomical sign. Less material was used in the cannulations performed by ultrasonography. Due to the reduction in hospital costs, the use of ultrasonography should be considered in especially low-weighted children.

Keywords: Central venous catheter, anatomic landmark, ultrasonography, newborn, perioperative complications, cost.

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