Author Of 3 Presentations
AN ALGORITHM FOR THE PROPER CHOICE OF CENTRAL VENOUS ACCESS IN NEONATAL INTENSIVE CARE UNIT.
Abstract
Background
Three main central venous access strategies are available in neonates: umbilical venous catheter (UVC), epicutaneo-caval catheter (ECC), and centrally inserted central catheter (CICC) via ultrasound cannulation of brachio-cephalic vein
Objectives
To help decision making in central line placement
Methods
Methods: We developed an algorithm for a rational approach to this decision (see figure), based on the features of each central line: (1) UVCs - applicable only in the first 24hours of life - are high performance lines, but they have limited duration being associated with a high risk of infection, thrombosis and dislocation; (2) ECCs are low-performance lines, with limited duration and relevant incidence of complications; (3) CICCs – though requiring specific skills of ultrasound insertion – are high performance lines, with low complications and extended duration, so that they are ideal in severe/unstable clinical conditions (haemodynamic instability requiring inotropes and monitoring; major congenital malformations; indication to surgery; severe bronchopulmonary dysplasia requiring ventilation and IV infusion; no superficial vein available for cannulation; etc.).
Results
Our algorithm has been adopted for the last two years in more than 800 neonates admitted to our NICU, reducing the variability due to the clinician’s preference or experience, and improving the appropriateness of choice
Conclusion
To our knowledge, this is the very first algorithm in this area: we think it is a right move towards a more rational approach to venous access in the newborn.
SECUREMENT OF CENTRAL VENOUS CATHETERS BY SUBCUTANEOUSLY ANCHORED SUTURELESS DEVICES IN NEONATES.
Abstract
Background
Accidental dislodgement of central venous catheters is a frequent complication in NICU and it often requires catheter replacement. Subcutaneously anchored sutureless devices (SAS) (Securacath) have been recently introduced in clinical practice for securement of different types of central catheters, but they have never been used in neonates.
Objectives
To evaluate safety and efficacy of SAS in neonates.
Methods
We adopted SAS for securement of all central venous catheters inserted in neonates via ultrasound-guided cannulation either of the brachio-cephalic vein (centrally inserted central catheters: CICC) or the femoral vein (femorally inserted central catheters: FICC).
Results
72 central catheters were inserted in 70 preterm and term neonates (3-4Fr power injectable polyurethane catheters; 62 CICC + 10 FICC) and they were all secured with SAS. Mean postmenstrual age at the time of insertion was 31 weeks (range 25 - 41 weeks) and mean weight was 1400 grams (range 580 - 4100 grams). SAS was easy to place in all cases. The median duration of the line was 5 weeks (range 10 days - 3 months). No accidental dislodgement of CICC or FICC was recorded. All SAS but one were left in place until elective removal of the catheter; only in one patient, early removal of SAS was necessary because of a skin ulcer caused by the device. In all patients, SAS removal was easy and uneventful, and it did not require any sedation or local anesthesia.
Conclusion
SAS was effective in preventing accidental catheter dislodgement in 100% of cases. Complications during insertion, maintenance and removal were negligible.
USE OF CYANOACRYLATE GLUE FOR THE SUTURELESS SECUREMENT OF EPICUTANEO-CAVAL CATHETERS IN NEONATES.
Abstract
Background
Accidental dislodgement is a frequent complication of epicutaneo-caval catheters (ECC) in NICU. Recently, cyanoacrylate glue (CG) has been widely used for securing different types of central lines. However, data about its safety and effectiveness in the neonatal population are not yet available
Objectives
To evaluate safety and efficacy of CG as a securement strategy for ECC.
Methods
We applied CG (Hystoacryl, BBraun) on the exit site of all ECC inserted in our NICU in 2018: the exit site was also covered with transparent semipermeable dressing (TSD) (Tegaderm, 3M). The results were compared with an historical cohort of infants whose ECC were secured using sterile strips (SteriStrips, 3M) and the same type of TSD.
Results
In 2018, 134 ECC (1-2 Fr polyurethane catheters) were inserted in 92 preterm and term neonates and all of them were secured with CG + TSD; 124 ECC inserted in 80 preterm neonates in 2017 were used as controls. Mean postmenstrual age at the time of insertion was 29 weeks in both groups. The use of CG was not associated with any side effect. The incidence of accidental dislodgement was significantly reduced from 35% to 20% (p <0.007). CG was safe and easy to apply, and it yielded the additional advantage of being very effective in preventing any bleeding/oozing at the puncture site. Removal of CG was consistently easy and uneventful.
Conclusion
Securement of ECC with CG + TSD is completely safe and it is effective in reducing the risk of catheter dislodgement.