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2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial
Catheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. To inform the feasibility and design of a definitive randomised controlled trial (RCT) of two antiseptic formulations, the authors conducted the Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) feasibility study to assess catheter colonisation, sepsis, and skin morbidity.
Their conclusion: the data from the ARCTIC study suggest that both 2% CHG-aqueous solution and 2% CHG-70% IPA can be used safely in preterm neonates when applied using a strict procedure to limit overexposure. Their use was associated with a large reduction in the risk of catheter colonisation by potentially harmful bacteria compared with historical rates using weaker preparations. A definitive trial is feasible, but based on the very low catheter colonisation rate or combined rate of CRS and CAS, a very large sample size is required. Newer agents such as octenidine now require formal evaluation in preterm neonates. But with such low rates of catheter colonisation and sepsis, conducting any definitive efficacy RCT of antiseptics now poses a formidable challenge. Other ways to distinguish between disinfection agents may be needed, such as registry or real-world data-based assessments of safety and efficacy, or else snapshot audits involving a limited number of centres willing to adopt uniform strict protocols and standardised procedures for catheter care and sampling.Authors :
Paul Clarke 1 2, Aung Soe 3, Amy Nichols 4, Helen Harizaj 3, Mark A Webber 2 5, Louise Linsell 6, Jennifer L Bell 6, Catherine Tremlett 7, Priyadarsini Muthukumar 4, Santosh Pattnayak 3, Christopher Partlett 6, Andrew King 6, Ed Juszczak 6, Paul T Heath 8
- 1 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK paul.clarke@nnuh.nhs.uk
- 2 Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
- 3 Neonatal Intensive Care Unit, Medway Maritime Hospital, Gillingham, Kent, UK.
- 4 Neonatal Intensive Care Unit, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
- 5 Quadram Institute Bioscience, Norwich, Norfolk, UK.
- 6 National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK.
- 7 Department of Microbiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK.
- 8 Centre for Neonatal and Paediatric Infection, Infection and Immunity, Saint George’s University of London, London, UK.
- Correspondence to
Professor Paul Clarke, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, Norfolk, UK; paul.clarke@nnuh.nhs.uk
Clarke P, Soe A, Nichols A, et al. Arch Dis Child Fetal Neonatal Ed
- PMID: 37907266
- DOI: 10.1136/archdischild-2023-325871
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Modified Seldinger Technique
During the presentation of Dr. V. D’Andrea at the pre-congress of the jENS, he showed us a movie on how to apply the MST technique – Modified Seldinger Technique.
Modified Seldinger Technique (MST) is a safe and effective method for neonatal ECC insertion. In this video, he uses a small needle ( with a diameter of 0,55!), which is inserted and then cannulated with a guidewire. The needle is then removed and a combined dilator and peelable cannula is placed over the guidewire. When the guidewire and the dilator are removed the 1-2 Fr ECCs can be inserted through the peelable cannula.Authors : Dr. V. D’Andrea
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Visualization of superficial veins in neonates (RaSuVA protocol and NIR technology) and insertion of epicutaneo-cava catheters
During our successful pre-congress session @JENS_Congress, Dr. V. D’Andrea, gave us an amazing presentation with a lot of information and insights.
He talked us through different bundles, protocols, techniques and technologies.
Dr. D’Andrea gave us a lot of tips, and an important message to take home as well.Authors : Dr. V. D’Andrea
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Technique of intraosseous access in neonates
During our pre-congress session @JENS_Congress, Dr. Bernhard Schwaberger MD PhD Neonatologist, Division of Neonatology, Medical University of Graz, Austria and active member of the NEVAT, spoke and gave a very interesting workshop about the technique of IO access in neonates. This technique is not so well known but he learned us a lot!
You can find his presentation here.Authors : Dr. Bernhard Schwaberger
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How to prevent infections?
During our pre-congress session @JENS_Congress, Prof. F. Piersigilli, member of the advisory board, gave a very interesting presentation about all the topics that can have an impact on infections related to catheters.
You can find her presentation here.
You can also meet her at the 4th international Neo-CUP meeting in Rome on the December 15th!Authors :
Prof. F. Piersigilli -
Securement and Protection of the Catheter Exit Site. Fixation, Glue and TransparantDressings
During our pre-congress session @JENS_Congress, Mr. R. van Rens, member of the NEVAT,
presented a very interesting presentation about the securement of the catheter exit site.
The presentation can you find here!Authors
Mr. R. van Rens, MaANP -
Ultrasound-guided vascular access in newborns: basics and application
During our successful pre-congress session @JENS_Congress, Dr. R. van der Lee, member of the advisory board, started with a very interesting and complete presentation on Ultrasound-guided vascular access in newborns: basics and application.
You can find the full presentation here!Authors :
Dr. R. van der Lee -
Sustainable neonatal CLABSI surveillance: consensus towards new criteria in the Netherlands
Central line-associated bloodstream infections (CLABSI) are a main focus of infection prevention and control initiatives in neonatal care. Standardised surveillance of neonatal CLABSI enables intra- and interfacility comparisons which can contribute to quality improvement. To date, there is no national registration system for CLABSI in neonatal care in the Netherlands and several criteria are used for local monitoring of CLABSI incidence rates.
To achieve standardised CLABSI surveillance the authors conducted a consensus procedure with regard to nationwide neonatal CLABSI surveillance criteria (SC).
The consensus procedure consisted of three expert panel rounds.
The expert panel achieved consensus on Dutch neonatal CLABSI SC.
Neonatal CLABSI is defined as a bloodstream infection occurring more than 72 h after birth, associated with an indwelling central venous or arterial line and laboratory confirmed by one or more blood cultures.
In addition, the blood culture finding should not be related to an infection at another site and one of the following criteria can be applied: 1. a bacterial or fungal pathogen is identified from one or more blood cultures; 2. the patient has clinical symptoms of sepsis and 2A) a common commensal is identified in two separate blood cultures or 2B) a common commensal is identified by one blood culture and C-reactive protein level is above 10 mg/L in the first 36h following blood culture collection.
The conclusion is that the newly developed Dutch neonatal CLABSI SC are concise, specified to the neonatal population and comply with a single blood culture policy in actual neonatal clinical practice. International agreement upon neonatal CLABSI SC is needed to identify best practices for infection prevention and control.Authors : I. E. Heijting* , T. A. J. Antonius , A. Tostmann , W. P. de Boode , M. Hogeveen and J. Hopman on behalf of the Working Group on Neonatal Infectious Diseases of the Section of Neonatology of the Dutch Paediatric Society
*Correspondence: ilja.heijting@radboudumc.nl 1 Department of Paediatrics, Division of Neonatology, Amalia Children’s Hospital, Radboud University Medical Center, Radboud Institute for Health Sciences, Internal Postal Code 804, Geert Grooteplein Zuid 10, 6525GA Nijmegen, The Netherlands
Full list of author information is available at the end of the article -
Brachiocephalic vein cannulation in a 830 gr baby – live case
By Dr. Christian Breschan
Department of Anesthesia, Klinikum Klagenfurt, Klagenfurt, Austria
Active member of the NEVAT -
Innovative dressing and securement of tunneled central venous access devices in pediatrics: a pilot randomized controlled trial
Central venous access device (CVAD) associated complications are a preventable source of patient harm, frequently resulting in morbidity and delays to vital treatment. Dressing and securement products are used to prevent infectious and mechanical complications, however current complication rates suggest customary practices are inadequate. The aim of this study was to evaluate the feasibility of launching a full-scale randomized controlled efficacy trial of innovative dressing and securement products for pediatric tunneled CVAD to prevent complication and failure.
The primary outcome of study feasibility was established by elements of eligibility, recruitment, attrition, protocol adherence, missing data, parent and healthcare staff satisfaction and acceptability, and effect size estimates for CVAD failure (cessation of function prior to completion of treatment) and complication (associated bloodstream infection, thrombosis, breakage, dislodgement or occlusion). Dressing integrity, product costs and site complications were also examined.
The authors concluded that improving the security and dressing integrity of tunneled CVADs is likely to improve outcomes for pediatric patients.
Further research is necessary to identify novel, effective CVAD securement to reduce complications, and provide reliable vascular access for children.Authors : Amanda J. Ullman1,2*, Tricia Kleidon2,3, Victoria Gibson2,3, Craig A. McBride2,4,5, Gabor Mihala2,5,6, Marie Cooke1,2 and Claire M. Rickard1,2
Correspondence : a.ullman@griffith.edu.au
1 School of Nursing and Midwifery, Griffith University, Nathan, Queensland, Australia
2 Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Nathan, Queensland, AustraliaFull list of author information is available at the end of the article
Ullman et al. BMC Cancer (2017) 17:595 DOI 10.1186/s12885-017-3606-9
