Implementation of a Central Line Maintenance Bundle for Dislodgement and Infection Prevention in the NICU.
Anti-Infective Agents, Local
Bandages
Catheter-Related Infections
/ prevention & control
Catheterization, Central Venous
/ methods
Catheterization, Peripheral
/ methods
Central Venous Catheters
Humans
Infant, Newborn
Intensive Care Units, Neonatal
Intensive Care, Neonatal
/ methods
Patient Care Bundles
Prosthesis Failure
Quality Improvement
Journal
Advances in neonatal care : official journal of the National Association of Neonatal Nurses
ISSN: 1536-0911
Titre abrégé: Adv Neonatal Care
Pays: United States
ID NLM: 101125644
Informations de publication
Date de publication:
Apr 2019
Apr 2019
Historique:
pubmed:
6
11
2018
medline:
10
9
2019
entrez:
6
11
2018
Statut:
ppublish
Résumé
Infants in the newborn intensive care unit (NICU) often receive medications or nutritional support for extended periods. Due to the fragility of veins, central lines are often used. Adverse outcomes from central lines such as infections and line dislodgements, where the line terminates in a peripheral vessel rather than centrally, can drastically increase infant morbidity and mortality. Although evidence exists addressing the specialized needs of premature or smaller infants, there is far less evidence regarding infants that are larger, more physiologically complex, and have longer stays. Using evidence-based practice strategies, we examined the literature for central line maintenance practices specific to the NICU population and created a care maintenance bundle to reduce infection and line dislodgement rates. Furthermore, we examined implementation of this bundle. A systematic search of PubMed, Cochrane Library, and CINAHL provided evidence for a practice change for central line maintenance for our nontunneled central lines. During project implementation, infection and dislodgement rates for both tunneled and nontunneled lines were examined in order have a control and intervention group. Prior to central line maintenance bundle implementation, there were 19 total incidences of central line dislodgements and 5 central line infections (14 dislodgements and 4 infections were from nontunneled lines, 5 dislodgements and 1 infection from a tunneled line). Postintervention there were 1 total dislodgement and 4 central line infections (the dislodgement was from a nontunneled line and all infections were from tunneled lines). Although research has shown frequent, scheduled dressing changes using the chlorhexidine patch decreases infection rates, the risk of dislodgement and skin breakdown for NICU infants outweighs the potential benefit of decreased infection. Further research is needed to determine whether this central line maintenance bundle would be beneficial for tunneled central lines.
Sections du résumé
BACKGROUND
BACKGROUND
Infants in the newborn intensive care unit (NICU) often receive medications or nutritional support for extended periods. Due to the fragility of veins, central lines are often used. Adverse outcomes from central lines such as infections and line dislodgements, where the line terminates in a peripheral vessel rather than centrally, can drastically increase infant morbidity and mortality. Although evidence exists addressing the specialized needs of premature or smaller infants, there is far less evidence regarding infants that are larger, more physiologically complex, and have longer stays.
PURPOSE
OBJECTIVE
Using evidence-based practice strategies, we examined the literature for central line maintenance practices specific to the NICU population and created a care maintenance bundle to reduce infection and line dislodgement rates. Furthermore, we examined implementation of this bundle.
METHODS/SEARCH STRATEGY
METHODS
A systematic search of PubMed, Cochrane Library, and CINAHL provided evidence for a practice change for central line maintenance for our nontunneled central lines. During project implementation, infection and dislodgement rates for both tunneled and nontunneled lines were examined in order have a control and intervention group.
FINDINGS/RESULTS
RESULTS
Prior to central line maintenance bundle implementation, there were 19 total incidences of central line dislodgements and 5 central line infections (14 dislodgements and 4 infections were from nontunneled lines, 5 dislodgements and 1 infection from a tunneled line). Postintervention there were 1 total dislodgement and 4 central line infections (the dislodgement was from a nontunneled line and all infections were from tunneled lines).
IMPLICATIONS FOR PRACTICE
CONCLUSIONS
Although research has shown frequent, scheduled dressing changes using the chlorhexidine patch decreases infection rates, the risk of dislodgement and skin breakdown for NICU infants outweighs the potential benefit of decreased infection.
IMPLICATIONS FOR RESEARCH
CONCLUSIONS
Further research is needed to determine whether this central line maintenance bundle would be beneficial for tunneled central lines.
Identifiants
pubmed: 30394914
doi: 10.1097/ANC.0000000000000566
doi:
Substances chimiques
Anti-Infective Agents, Local
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM