Audit of acute limb ischaemia in a paediatric intensive care unit

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dc.contributor.advisorHodges, Owenen_ZA
dc.contributor.advisorThomas, Jennyen_ZA
dc.contributor.authorMumba, Jesse Musokotaen_ZA
dc.date.accessioned2016-07-27T10:15:23Z
dc.date.available2016-07-27T10:15:23Z
dc.date.issued2016en_ZA
dc.description.abstractObjective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population.en_ZA
dc.identifier.apacitationMumba, J. M. (2016). <i>Audit of acute limb ischaemia in a paediatric intensive care unit</i>. (Thesis). University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia. Retrieved from http://hdl.handle.net/11427/20838en_ZA
dc.identifier.chicagocitationMumba, Jesse Musokota. <i>"Audit of acute limb ischaemia in a paediatric intensive care unit."</i> Thesis., University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2016. http://hdl.handle.net/11427/20838en_ZA
dc.identifier.citationMumba, J. 2016. Audit of acute limb ischaemia in a paediatric intensive care unit. University of Cape Town.en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Mumba, Jesse Musokota AB - Objective:Iatrogenic acute limb ischaemia in paediatric patients is a well-recognised complication of vascular access. This retrospective review of a paediatric intensive care unit identified patients who developed iatrogenic acute limb ischaemia between January 2008 and July 2013. Methods: The medical records of inpatients diagnosed with acute limb ischaemia during the study period were reviewed. Patients with other causes of acute limb ischaemia were excluded. A descriptive analysis of demographics, primary diagnosis, type of vascular access used, affected anatomical region, clinical presentation, type of therapy, type of block, response to intervention used and outcomes was conducted. Results:A total of 28 patients presented with signs of acute limb ischaemia, of whom 28.6% were aged <30 days, 46.4 % were between one and 12 months and 25% were between one and five years old; 78.6% of the affected limbs were lower limbs. Four patients had resolution of ischaemia upon removal of the vascular access devices. 23 patients received various forms of pharmacological sympathectomy, in addition to conservative therapy. One patient had missing data on the type of sympathectomy that was done. The response to the sympathectomies was: 60.9% good, 8.7% moderate, 8.7% poor and in 21.7% no responses. Documented tissue loss related to the ischaemia occurred in six (21.4%) of the 28 patients. Conclusions: Iatrogenic acute limb ischaemia in children are usually managed without surgical intervention. Pharmacological sympathectomies lead to increased blood flow to the affected limb via vasodilatation of collateral vessels, with an added advantage of reducing ischemic pain. The improved blood flow is postulated to avoid and/or minimise the amount of tissue loss. Pharmacological sympathectomies may, thus, have a role to play in th e management of iatrogenic acute limb ischaemia in the paediatric population. DA - 2016 DB - OpenUCT DP - University of Cape Town LK - https://open.uct.ac.za PB - University of Cape Town PY - 2016 T1 - Audit of acute limb ischaemia in a paediatric intensive care unit TI - Audit of acute limb ischaemia in a paediatric intensive care unit UR - http://hdl.handle.net/11427/20838 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/20838
dc.identifier.vancouvercitationMumba JM. Audit of acute limb ischaemia in a paediatric intensive care unit. [Thesis]. University of Cape Town ,Faculty of Health Sciences ,Department of Anaesthesia, 2016 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/20838en_ZA
dc.language.isoengen_ZA
dc.publisher.departmentDepartment of Anaesthesiaen_ZA
dc.publisher.facultyFaculty of Health Sciencesen_ZA
dc.publisher.institutionUniversity of Cape Town
dc.subject.otherAnaesthesiologyen_ZA
dc.subject.otherPaediatricen_ZA
dc.subject.otheracute limb ischaemiaen_ZA
dc.subject.othercomplications of arterial cannulationen_ZA
dc.subject.othertreatment algorithmsen_ZA
dc.subject.otherumbilical artery catheter complicationen_ZA
dc.titleAudit of acute limb ischaemia in a paediatric intensive care uniten_ZA
dc.typeMaster Thesis
dc.type.qualificationlevelMasters
dc.type.qualificationnameMMeden_ZA
uct.type.filetypeText
uct.type.filetypeImage
uct.type.publicationResearchen_ZA
uct.type.resourceThesisen_ZA
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