Standardizing Umbilical Catheter Usage in Preterm Infants

Abstract

BACKGROUND AND OBJECTIVE: Absence of guidelines on umbilical arterial catheter (UAC) and umbilical venous catheter (UVC) use and inability to predict the hospital course may sway the frontline staff to overuse umbilical catheters in preterm infants. Our objective was to evaluate the feasibility of implementing guidelines standardizing the use of umbilical catheters and its impact on the incidence of sepsis and resource use.METHODS: All inborn infants delivered at ,33 weeks' gestation and admitted to the NICU were included in this quality improvement study. The primary outcome was proportion of infants receiving umbilical catheters. Secondary outcomes were central venous catheter (CVC) use and central line-associated bloodstream infection (CLABSI). RESULTS:The proportion of infants receiving UACs and UVCs was significantly lower in postintervention (sustainment) phase than in the preintervention phase (93 [42.3%] vs 52 [23.6%], P = .0001) and (137 [62.6%] vs 93 [42.3%], P = .0001), respectively. There was no corresponding increase in the proportion of infants receiving peripherally inserted central catheters (PICCs) or surgical CVCs (SCVCs) during the sustainment phase. There was a significant reduction in the proportion of infants receiving CVCs (UVC, PICC, and SCVC) in the sustainment phase. The incidence of CLABSI was similar in the preintervention and sustainment phases.CONCLUSIONS: Implementation of guidelines standardizing the use of umbilical catheters in the NICU is feasible. Fewer infants were exposed to the risk of UVC or UAC, and fewer resources were used. Pediatrics

Discrepancies in the normative neonatal blood pressure reference ranges

“…Although this may be true at the time of UAC placement (despite the absence of evidence-based guidelines for the placement of UAC [49][50][51][52]), it is likely not true close to the time of UAC removal in the majority of the cases. Thus, a large multicenter prospective study that includes BP measurements obtained from all neonates with UAC over a predefined (e.g.…”

Prävention von Gefäßkatheter-assoziierten Infektionen bei Früh- und Neugeborenen

“…II). 5 die Indikation zur Anlage (zur weiteren Nutzung) eines NAK durch erfahrene Neonatologen zu stellen und täg-lich zu reevaluieren [203] (Kat. II).…”

In vitro assessment of bacterial colonisation rates of goat umbilical cord segments using three embodiments of a novel neonatal umbilical catheter protection device

“…Each year, over 450 000 infants are born prematurely in the USA1 and approximately 250 000 are admitted to the neonatal intensive care unit2 where many receive umbilical catheters (UCs) for an average of 6–8 days 2–4. Umbilical catheterisation is the preferred route of access for many of these neonates as the procedure offers relatively easy and reliable access to the venous and arterial systems with the necessary flow rates to deliver medication, fluids, parenteral nutrition, as well as dependable haemodynamic monitoring.…”

“…Umbilical catheterisation is the preferred route of access for many of these neonates as the procedure offers relatively easy and reliable access to the venous and arterial systems with the necessary flow rates to deliver medication, fluids, parenteral nutrition, as well as dependable haemodynamic monitoring. However, the rate of central line-associated bloodstream infections (CLABSIs) in neonates with UCs is approximately five times greater than CLABSIs in the adult population with central catheters 2 5–8. Studies estimate that 5–10% of neonates with UCs develop CLABSIs, with the highest rates seen in infants weighing <1250 g 2 6–12.…”

“…However, the rate of central line-associated bloodstream infections (CLABSIs) in neonates with UCs is approximately five times greater than CLABSIs in the adult population with central catheters 2 5–8. Studies estimate that 5–10% of neonates with UCs develop CLABSIs, with the highest rates seen in infants weighing <1250 g 2 6–12. CLABSIs are the most common complication associated with UC placement and result in increased morbidity and a mortality rate of 7–11% 6 10 13 14.…”