Background: Umbilical vein Cutdown in neonates as an important method of accessing vascular is very important in cases in which peripheral vein is not available and it is not possible to cut down another vein. The umbilical vein is believed to become thrombotic and lumen is closed and unusable one week postpartum. Methods: In this cross-sectional study, all neonates who were admitted to the surgical ward of Mohammad Kermanshahi Hospital in Kermanshah, who needed emergency vein access and who were unable to have vein Cutdown elsewhere during 2012-2014 were enrolled. The participants were divided to four age groups (one week to four weeks) and the possibility of umbilical vein Cutdown was assessed in each group. Results: Of all participants, 25 infants were girls and 20 were boys. The umbilical vein Cutdown was successful in 39 patients (86. 7%), and failed in 6 patients (13. 3%). The procedure was successful in all infants younger than 3 weeks old except for one case, while the success rate rapidly decreased after 3 weeks old. Conclusions: Umbilical vein Cutdown was successful in infants under three weeks old and it was not possible afterward due to umbilical vein thrombosis. One-week age restriction for umbilical vein Cutdown is questionable and requires further randomized trials with a control group to reach definitive conclusions.

The present study aimed to evaluate the patency of the two vascu-lar access catheterization techniques including percutaneus IJV cannulation and saphenofemoral Cutdown in terms of the functional time of catheterization and the complications of these two vas-cular access methods among the neonatal and pediatric patients. This prospective interventional case series study was conducted on 88 children admitted to the intensive care unit (ICU) and needing an intravenous cannulation. The study population was randomly assigned into two groups undergoing vascu-lar catheterization by saphenous vein Cutdown (n=59) and percutaneus internal jugular vein cathe-terization (n=29). The two groups were compared regarding the rates of catheter blockage,vein thrombosis and infection. The data were analyzed using SPSS software. The duration of catheter functionality was significantly shorter in the saphenofemoral vein Cutdown group than that in the internal jugular vein catheterization group. However, we found no significant difference between the two groups in the prevalence rate of hematoma (p = 0. 794), bleeding (p = 0. 601), catheter blockage (p = 0. 989), site infection (p = 0. 684), sepsis (p = 0. 937), vein thrombosis (P = 0. 999), hemothorax (p = 0. 937) and pneumothorax (p = 0. 937). Vascular access through internal jugular vein resulted in a longer functional catheteriza-tion in ICU admitted children, compared with saphenofemoral vein Cutdown.

Background and Aim: Central vein access is a common procedure in infants and neonates. In this regard, Cutdown is a common central venous access technique. However, it is associated with complications, including catheter occlusion, infection, and spontaneous withdrawal. Catheter occlusion is a common complication of the Cutdown procedure and causes catheter dysfunction and subsequent catheter removal. In this study, we compared the effect of heparin lock with Taurolock on the maintenance of central vein catheter potency placed in the greater saphenous vein at the saphenofemoral junction and their subsequent complications. Materials and Methods: The children admitted to the pediatric hospital who required central vein access between December 2015 and July 2019 were recruited. There were two groups of patients. The first group received 0. 5 mL Taurolock solution. The solution contains (cyclo)taurolidine, heparin 500 IU/mL, and citrate (4%) before the catheter gets locked (Taurolock group). Another group received 0. 5 mL heparin (contains 500 IU/mL heparin) before the catheter lock (heparin lock group). After the treatment period, the average duration of catheter usage and heparin-induced bleeding complications were evaluated. Results: The average duration of catheter function was 13. 4 days and 9. 3 days in the Taurolock group, and the heparin lock group, respectively. The coagulation tests were performed on 179 patients (33. 9%) during hospitalization, no heparin-induced coagulopathies were reported. Conclusion: Using Taurolock after catheter use could significantly reduce catheter occlusion and increase the duration of catheter function. Taurolock reduces costs, prevents delays in treatment, and decreases pain sensation and discomfort in patients.

Introduction: One of the most important goals of general medical education is to achieve acceptable competencies in clinical skills. Medical schools have to take steps to meet International Standards for general Medical Education. The aim of this study was to determine the amount of medical students' clerkship exposures to expected clinical skills and compare with the Specified minimums at Isfahan University of Medical Sciences. Methods: This descriptive, cross-sectional study was conducted in 2015-16 academic year using census method (n=95). Educational Council of the clinical departments was provided with a checklist of the expected skills and the minimum number of exposures to those skills was determined. The number of exposures for each clinical skill during the clerkship period and the background information of the students were asked for in the checklist. Data were analyzed using one sample t-test, independent t-test, chi-square and Pearson and Spearman correlation coefficients. Results: None of the students could meet the minimum number of exposures established by the Educational Council in to the clinical skills venous Cutdown, anterior nasal packing, arterial blood sampling, venipuncture and serum infusion, splinting, basic CPR, pediatric routine vaccination, wound dressing with debridement and specialized washing process, suprapubic sampling, simple casting and cast removing, and superficial skin abscess drainage. The rate of conformity was adequate in CPR (ACLS, BCLS) and nasogastric intubation, but low in other skills. Conclusion: The lack of conformity of the exposures to the minimums expected in the number of exposures to the essential clinical skills and the weaknesses in the clinical training of the students indicate the poor quality of clinical education. It seems that achieving the desired conformity for each clinical skill depends on peripheral training and the greater collaboration of clinical residents and clinical faculty members.