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Neonatal invasive lines – reducing the risks
  1. J Mistri,
  2. K Richards,
  3. P Vallabhaneni,
  4. S Nittur,
  5. M Mansour
  1. Abertawe Bro Morgannwg University Health Board, Swansea, UK

Abstract

Background Umbilical catheters and percutaneous long lines are extensively used in neonatal intensive care with known, potentially fatal, complications. Increasingly, babies are being transferred within networks, therefore, potential risks should be addressed more widely.

Aims To audit the safety of central line use on our unit, against Department of Health (DoH) advice. And to assess the impact of attempts to reduce line sepsis.

Methods Data was collected prospectively on all lines inserted in our Neonatal Intensive Care Unit from 1 July 2009 to 31 December 2010.

During the first 6 months, our practice primarily followed local clinical governance guidelines. Practice changed in response to sepsis rates, and by the last 6 months, we were following Vermont Oxford Network ‘Potentially Better Practices’ aimed at reducing line related infections.

Results There were 552 admissions in 18 months. 199 lines were inserted (78% in VLBW babies), accounting for 993 catheter days.

Radiological confirmation of catheter tip prior to use, led to the repositioning of 36 lines from an original intra-cardiac placement. There were no cases of cardiac tamponade.

30 lines were complicated by catheter related infections (10 definite, 20 possible); 93% in VLBW babies. Line related sepsis dropped between the first and third 6-month epochs from 33.6 (16.8 definite) to 24.7 (2.5 definite) per 1000 catheter days.

Conclusions We demonstrated safe line placement, as per DoH guidance, and a pleasing reduction in catheter related infections after implementing improved practices. Other units may now wish to similarly monitor their use of lines, and adopt practices to reduce risks.

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