American journal of perinatology
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Review Case Reports
Unusual misplacement sites of percutaneous central venous lines in the very low birth weight neonate.
Percutaneously placed central venous lines have become an intricate part of the medical management of the very low birth weight infant. It is critically important that health care providers involved with the placement of these catheters be familiar with the possible subtle sites for catheter misplacement. We present two case reports of inadvertent ascending lumbar vein catheterization with a percutaneously placed Silastic catheter where the saphenous vein was used for venous access. The literature is reviewed with regard to the history of use, indications, placement, and associated complications of these catheters.
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Comparative Study
Increased intrapartum antibiotic administration associated with epidural analgesia in labor.
To determine whether women who receive continuous epidural analgesia for labor and delivery are more likely to receive antibiotic therapy compared to those parturients who do not use epidural analgesia, a chart review was performed for 300 women 100 in each group using narcotics alone epidural alone, or parenteral narcotics followed by epidural analgesia. While only 2% of women with narcotics alone developed an intrapartum temperature > or = 37.8 degrees C, 16% and 24% of women with epidural use alone or in addition to narcotics did so, respectively. ⋯ A probable causal relationship between maternal temperature elevation and epidural use in labor is supported. Rather than treating all women with temperature elevations and epidurals for presumed chorioamnionitis, it is reasonable to target treatment to those with fetal tachycardia, meconium stained fluid, or abnormal amniotic fluid studies.