Abstracts

Arch Dis Child: first published as 10.1136/archdischild-2022-rcpch.300 on 17 August 2022. Downloaded from http://adc.bmj.com/ on September 13, 2023 at UNICEUMA - Universidade
their choice of agent on findings from neonatal 1226 PARENTAL EXPERIENCE INTERVIEWS: PART OF A
echocardiography. DIRECT NICU TO PCCU TRANSFER SERVICE
IMPROVEMENT PROJECT
Shil Patel, Catarina Silvestre, Phoebe Kigozi. Nottingham University Hospitals NHS Trust

1203 LUNG ULTRASOUND COULD BE USED AS A SCREENING 10.1136/archdischild-2022-rcpch.300

FOR HEMODYNAMICALLY SIGNIFICANT PATENT
DUCTUS ARTERIOSUS (HPDA) – PROSPECTIVE STUDY Aims As part of a service improvement project, we aimed to
ascertain parental experiences when transitioning between the
1
Amelie Cyr, 2Prosanta Mondal, 1Veronica Samedi, 1Sibasis Daspal. 1Royal University Neonatal Intensive Care Unit (NICU) and the Paediatric Crit-
Hospital; 2University of Saskatchewan, Saskatoon ical Care Unit (PCCU).
10.1136/archdischild-2022-rcpch.299
Methods In this study, parents of infants hospitalised at the
Nottingham University Hospitals (NUH) tertiary NICU and
Aims Determining whether a PDA is hemodynamically signifi- directly transferred to PCCU were enrolled.
cant or not (non-hsPDA) is clinically relevant to evaluate the Parents were invited for an interview by a family care team
risk of associated morbidities and to determine subsequent administrator who also plays a key role in the NICU parental
management courses such as the need for intervention. A support group.
known consequence of hsPDA is pulmonary edema. Parents who agreed to an interview were then contacted at
The aim of the study is to evaluate whether the assessment their convenience and verbally consented by Dr Shil Patel.
of pulmonary edema by lung ultrasound is a reliable sono- The interviews were performed using a semi-structured for-
graphic indicator of hsPDA. Lung ultrasound could then be an mat to establish the background summary of their case, infor-
accessible bedside tool used to evaluate if a PDA is hemody- mation received about the transfer and opinions on some
namically significant and to assist with decision-making regard- suggested interventions. Open questions were used to elicit
ing its management along with other clinical and their personal experiences.
echocardiographic indicators. The interviews were not recorded but indirect quotations
Methods We conducted a prospective study of 20 infants in were recorded with key themes noted.

Ceuma. Protected by copyright.

the Neonatal Intensive Care Unit at the Jim Pattison Child- Results Four parent interviews were undertaken, representing
ren’s Hospital, Canada, between July 2019 to October 2020. 10% of NICU to PCCU transfers at NUH over the last 10
Inclusion criteria were very preterm infants (gestational age years. Two were ex-preterm current PCCU patients, with one
less than 32 weeks) with low birth weight (less than 2500 awaiting a tracheostomy and one weaning tracheostomy venti-
grams) who had an echocardiogram and a bedside lung ultra- lation. Two were children who had surgical airways and were
sound assessment within their first two weeks of life. two years post discharge.
The infants were divided into two groups based on their 6 key themes emerged including clarity/amount of informa-
echocardiogram findings: infants with a non-hsPDA (no PDA tion received, differences in care approaches, expectations
or non-hsPDA) and infants with a hsPDA. Differences in clini- around parental involvement and outcomes, pre-transfer tours,
cal characteristics, echocardiogram findings, and lung ultra- available support for parents and finally the perceptions
sound scores were evaluated. around transfer. Figure 1.
A bedside lung ultrasound was done on the same day as Key quotes outlined in table 1.
the echocardiogram to assess for the presence of pulmonary Parents wanted more information, seeking information else-
edema. Lung ultrasound scoring was used to evaluate oxygena- where, and felt that it was ‘empowering when more informa-
tion needs. tion is given’.
Results The echocardiographic and lung ultrasound scores of They noticed the ‘culture’ difference between the two units,
infants included in this study are summarized in table 1. Six even minor aspects like the number of bedside toys. They
patients (6/20) did not have a PDA (2/6) or had a non- also struggled to understand why the approach to management
HsPDA (4/6) while 14 patients (14/20) had an HsPDA based was so different ‘when the child is the same’.
on echocardiogram findings. The expectation of the plan prior to transfer was also a
LUS score was significantly higher (10.6) in the HsPDA key talking point, with all parents having the expectation
group compared to the non-HsPDA group ( 6.0), and these of going to PCCU to wean respiratory support and go
indices correlated with echocardiographic parameters. home.
Perception of the transfer was also key as many felt the
day of transfer was rushed and due to ‘bed pressure’.
Abstract 1203 Table 1 The parents who received tours before transfer greatly
appreciated them. One stating that they still remember the
doctor and nurse who conducted them.
Parents overall felt more supported on NICU. They found
it difficult to relate to other parents on PCCU and got much
Conclusion • This study demonstrates that LUS scoring can be of their support outside of the units, through social media
used as a sonographic indicator of hsPDA.However, given sig- and groups.
nificant limitations – further studies with a larger population
size are required.

Arch Dis Child 2022;107(Suppl 2):A1–A537 A187

 Abstracts

Arch Dis Child: first published as 10.1136/archdischild-2022-rcpch.300 on 17 August 2022. Downloaded from http://adc.bmj.com/ on September 13, 2023 at UNICEUMA - Universidade
Documentation should include indication for insertion, site,
number of attempts, batch number, expiry date, length of use
& reason for removal.
Review any complications after insertion e.g., infection,
thrombosis, extravasation.
Methods A total of 33 cases identified over 6 months period.
Review of cases included gestational age, birth weight and
indication for long line insertion. Other areas reviewed
included, grade of clinician performing procedure, type of line
inserted, grade of assistant, x-ray confirmation of line position
and any complications following the procedure.
Type of line inserted included Premicath, UVC/UAC, Vygon,
Temena
Results In most cases, infant’s weight was < 2kg (28/33 cases)
and gestational age was equal to or less than 32 weeks‘ gesta-
tion (23/33 cases) i.e., long line insertion was required more
for the low birth weight or small gestational age infants.
TPN was the main indication for long line insertion (in 27/
33 cases) with other indications including IV fluids, medica-
tions, monitoring (figure 1).
Abstract 1226 Figure 1 Majority of lines were inserted by middle grade paediatri-
cian (21/33 cases). Check lists were completed in 16/33 cases.
Documentation in the case notes was recorded in 31 cases.
Type of line inserted; 12 cases had Premicath, in 8 cases
Abstract 1226 Table 1
Vygon was used, 9 had an umbilical line, Temena was used in
one case (figure 2). In 3 cases, not clearly documented. All

Ceuma. Protected by copyright.

cases had an x-ray to confirm long line placement.

Conclusion In a limited number of parent interviews, we

observed that families struggle with transition periods, whether
that is admission, step downs or transfers.
Children transferred directly from NICU to PCCU make
up a very low number of patients. However, they occupy dis-
proportionate resources. They frequently go on to require fur-
ther support in the community. The parents need to be
supported to look after their children who have complex
needs in hospital and perhaps beyond.
These results are informing our local improvement plan for Abstract 1228 Figure 1 Indications for long or central line insertion
the transition of care pathways between NICU and PCCU;
and should be considered by other units with similar patients.

1228 A REVIEW OF LONG LINE INSERTION AT A LEVEL TWO

NICU IN A DGH, ENGLAND, UK: FOLLOWING BEST
PRACTICE IN PERFORMING PROCEDURE, AFTERCARE
AND DOCUMENTATION
1
Khairy Gad, 2Maged Amin. 1Consultant Paediatrician, Health and Social Care, UK;
2
Paediatrician, UK

10.1136/archdischild-2022-rcpch.301

Aims Long line insertion is aseptic procedure.

A checklist should be completed after the Long Line is Abstract 1228 Figure 2 Type of long or central line
inserted.

A188 Arch Dis Child 2022;107(Suppl 2):A1–A537