Bloodstream infections seem to be infrequent among outpatients receiving infusions through central and midline catheters. However, the rate of infection increases with bone marrow transplantation, parenteral nutrition, infusion therapy in a hospital clinic or physician's office, and use of multilumen catheters. Compared with implanted ports or peripherally inserted catheters, centrally inserted venous catheters may confer greater risk for bloodstream infection.

SUMMARYSevere pediatric head injury has negative consequences for children of all ages. Even mild and moderate head injury results in residual impairment for school-age children and adolescents. Data are needed on the effects of these less severe insults, especially for preschoolers. Although research on the impact of the child's head injury on the parent-child relationship and family functioning is limited, the experience is likely to be very stressful for the parent and the family. Indeed, family integrity may be at risk. Research is needed that examines the effects of a child's head injury for the parent and the family over time and identifies factors related to these outcomes.Accidental injury is the leading cause of death and acquired disability for children over 1 year of age. Children under 15 years of age account for 22.4% of over 35 million emergency department visits each year that result from injury. 42 Head injuries account for 29% of children's hospitalizations caused by injury. 34 Most pediatric head injuries are caused by accidental falls and motor vehicle accidents for 1-to 9-year olds and sports injuries for 5-to 9-year olds. 28 Continued progress in emergency medical care has led to increased survival of children with traumatic brain injury, but many survivors are at high risk for acute and chronic impairments in functioning. Thus, brain-injured children and their families face significant challenges because of impairment that affects the children's daily lives, their school performance, their future, and frequently, the well-being of family members and the family system. When a preschool child suffers an accidental head injury, families are suddenly faced with fears about the child's survival and current condition and uncertainty about the child's future. Hospitalization in a pediatric intensive care unit (PICU) may exacerbate these fears. 64, 66 Severely brain-injured school-age children and adolescents are often left with significant disabilities. 16 Even school-age children and adolescents with mild traumatic brain injuries experience decreased functional status initially and problems with neurobehavioral abilities, such as attention deficit and memory loss, for at least a year after the injury. 47 The stress associated with adapting to a "new" child with continuing but subtle deficits is likely to have negative effects for the parent's mental health, with potential deterioration of the parent-child and family relationships. The purpose of this article is to review the research on effects of head injury for the injured child, the parents, and the family.Address reprint requests to

A rapid rate of change in the home care arena has been widely documented and many more changes are likely to continue. This article presents the results of a descriptive study to characterize the use of licensed practical nurses (LPNs) within Ohio home care agencies. Among the findings were that that agencies use LPNs primarily in medical-surgical cases and that the use of LPNs is expected to increase.

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