Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients

Mahieu, Ludo; Dooy, Jozef J. De; Lenaerts, A.E.; Ieven, Margareta; Muynck, A.O. De

doi:10.1053/jhin.2000.0930

Cited by 112 publications

(54 citation statements)

References 17 publications

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“…Central lines increase the risk of bloodstream infections. [12,13] Known risk factors for CLABSI include administration of TPN, [12,13] frequent manipulation of the line, [14] open vascular systems, [15] not using needleless connections [6] and the use of multiple access ports. [6] Conflicting data exist on which type of central line is associated with the highest risk for CLABSI and when prolonged catheter dwell time becomes a risk factor.…”

Section: Researchmentioning

confidence: 99%

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

et al. 2017

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Background. The rate of central-line-associated bloodstream infection (CLABSI) in South African (SA) public sector neonatal intensive care units (NICUs) is unknown. Tygerberg Children's Hospital (TCH), Cape Town, introduced a neonatal CLABSI surveillance and prevention programme in August 2012. Objectives. To describe CLABSI events and identify risk factors for development of CLABSI in a resource-limited NICU. Methods. A retrospective case-control study was conducted using prospectively collected NICU CLABSI events matched to four randomly selected controls, sampled from the NICU registry between 9 August 2012 and 31 July 2014. Clinical data and laboratory records were reviewed to identify possible risk factors, using stepwise forward logistic regression analysis. Results. A total of 706 central lines were inserted in 530 neonates during the study period. Nineteen CLABSI events were identified, with a CLABSI rate of 5.9/1 000 line days. CLABSI patients were of lower gestational age (28 v. 34 weeks; p=0.003), lower median birth weight (1 170 g v. 1 975 g; p=0.014), had longer catheter dwell times (>4 days) (odds ratio (OR) 5.1 (95% confidence interval (CI) 1.0 -25.4); p=0.04) and were more likely to have had surgery during their NICU stay (OR 3.5 (95% CI 1.26 -10); p=0.01). Significant risk factors for CLABSI were length of stay >30 days (OR 20.7 (95% CI 2.1 -203.2); p=0.009) and central-line insertion in the operating theatre (OR 8.1 (95% CI 1.2 -54.7); p=0.03). Gram-negative pathogens predominated (12/22; 54%), with most isolates (10/12; 83%) exhibiting multidrug resistance. Conclusion. The TCH NICU CLABSI rate is similar to that reported from resource-limited settings, but exceeds that of high-income countries. Prolonged NICU stay and central-line insertion in the operating theatre were important risk factors for CLABSI development. Intensified neonatal staff training regarding CLABSI maintenance bundle elements and hand hygiene are key to reducing CLABSI rates.

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Section: Researchmentioning

confidence: 99%

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

et al. 2017

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“…2,11 Among the infectious complications, the incidence of catheterrelated sepsis with positive blood culture was lower than that reported in other studies in newborns. 2,4,[12][13][14][15] A possible explanation for this low incidence is that the indication for catheter placement in 12 cases was a previous episode of nosocomial sepsis requiring antimicrobial treatment and hemodynamic support and excluding the diagnosis of sepsis unless a different microorganism was detected in blood cultures. Positive catheter tip colonization was also in the low range of published data.…”

Section: Discussionmentioning

confidence: 99%

“…Positive catheter tip colonization was also in the low range of published data. 10,16 Although catheter manipulation has been associated with increased risk of catheter-related sepsis, 15 when strict aseptic measures are applied and interventions concentrated, blood sampling through these catheters may avoid painful venipunctures without significantly increasing thrombosis, blockage and infection rates when 3 FG catheters are used. 17 In our study there was no case of withdrawal of the catheter due to blockage.…”

Section: Discussionmentioning

confidence: 99%

Peripheral insertion of double-lumen central venous catheter using the Seldinger technique in newborns

et al. 2008

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Result: Weight of the patients was <1 kg in 10%, and >2 kg in 75%. Catheters tip placement was as aimed, mostly superior cava vein (SCV), in 65.5%, and subclavian vein in remaining 34.5% and average duration of catheterization was 13.5 ± 9.6 and 8.9 ± 5.8 days, respectively. Blood sampling through both lumens was possible especially when the tip was at SCV. Reasons for catheter withdrawal were end of indication (45.9%), phlebitis/edema (21.3%), suspected infection (3.2%), accidental withdrawal (3.2%) and rupture of proximal end (3.2%). In three (4.9%) patients, withdrawal was due to serious complications (two cases of pleural leakage of infusion fluid and one breakage of the metallic guide). About 16.3% of the patients died with the catheter still in situ. Infection findings were positive tip culture (14.7%) and catheter-related sepsis (3.2%). Conclusion:Insertion of PIDLCC is possible in neonates. The incidence of complications, mostly mechanical, requires careful evaluation of indications, and strict adherence to the procedure of insertion and manipulation.

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“…The incidence of the most important complication, CRBI, varies from 5% to 26% in adults (15) and from 3% to 20% in children (7). When calculated in relation to the length of stay, the incidence of CRBIs in adults varies from 2.4 to 12 per 1000 catheter days (23,27).The incidence is higher in newborns (4.9 episodes of CRBI per 1000 catheter days), than in older children (2.4 episodes of CRBI per 1000 days) (19,20). The low incidence of CRBIs in our patients is probably related to the expertise of our staff members who maintain aseptic condition in all procedures involving both insertion and managing of CVCs.…”

Section: Discussionmentioning

confidence: 99%

Use of central venous catheters in children

Meštrović

Kovačević

Ercegovic

et al. 2006

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Catheter manipulations and the risk of catheter-associated bloodstream infection in neonatal intensive care unit patients

Cited by 112 publications

References 17 publications

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

Central-line-associated bloodstream infections in a resource-limited South African neonatal intensive care unit

Peripheral insertion of double-lumen central venous catheter using the Seldinger technique in newborns

Use of central venous catheters in children

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