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Updated: Feb 18, 2026
A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched
Daniele G Biasucci1, Mauro Pittiruti2, Alessandra Taddei3
11 Department of Intensive Care Medicine and Anesthesiology, "A. Gemelli" University Hospital Foundation, Catholic University of the Sacred Heart, Rome - Italy.
Insights
A new bundle significantly reduced central line infections in critically ill children by 90%. Key practices include ultrasound guidance, catheter tunneling, and simulation-based staff education for improved patient safety.
Area of Science:
- Pediatric critical care medicine
- Infectious disease prevention
- Medical device management
Background:
- Catheter-related bloodstream infections (CRBSIs) pose a significant risk to critically ill children.
- Existing management protocols for central venous catheters (CVCs) require optimization to reduce infection rates.
Purpose of the Study:
- To evaluate the effectiveness and safety of a novel three-component bundle for the insertion and management of centrally inserted central catheters (CICCs).
- To minimize CRBSIs in critically ill pediatric patients.
Main Methods:
- Implementation of a three-component bundle: insertion, management, and education.
- Bundle components included: 2% chlorhexidine for skin antisepsis, maximal barrier precautions, ultrasound-guided venipuncture, catheter tunneling, glue at exit site, sutureless securement, transparent dressing, chlorhexidine sponge dressing, and needle-free connectors.
- All CICCs were inserted by physicians trained via a standardized simulation program.
Main Results:
- A significant reduction in CRBSI rate was observed, dropping from 15 to 1.5 per 1000 catheter-days (a 90% decrease).
- CICCs inserted with the bundle remained in place for an average of 2.2 days longer.
- The study demonstrated a 10% CRBSI rate post-bundle implementation.
Conclusions:
- A comprehensive bundle incorporating ultrasound guidance, catheter tunneling, exit site glue application, and simulation-based education is effective in minimizing CR-BSIs in critically ill children.
- These practices reduce contamination, bacterial colonization, and improve aseptic technique adherence.
- The findings support the integration of this bundle into clinical practice to enhance patient safety.
Introduction:
The aim of this study was to evaluate the effectiveness and safety of a new three-component 'bundle' for insertion and management of centrally inserted central catheters (CICCs), designed to minimize catheter-related bloodstream infections (CRBSIs) in critically ill children.
Methods:
Our 'bundle' has three components: insertion, management, and education. Insertion and management recommendations include: skin antisepsis with 2% chlorhexidine; maximal barrier precautions; ultrasound-guided venipuncture; tunneling of the catheter when a long indwelling time is expected; glue on the exit site; sutureless securement; use of transparent dressing; chlorhexidine sponge dressing on the 7th day; neutral displacement needle-free connectors. All CICCs were inserted by appropriately trained physicians proficient in a standardized simulation training program.
Results:
We compared CRBSI rate per 1000 catheters-days of CICCs inserted before adoption of our new bundle with that of CICCs inserted after implementation of the bundle. CICCs inserted after adoption of the bundle remained in place for a mean of 2.2 days longer than those inserted before. We found a drop in CRBSI rate to 10%, from 15 per 1000 catheters-days to 1.5.
Conclusions:
Our data suggest that a bundle aimed at minimizing CR-BSI in critically ill children should incorporate four practices: (1) ultrasound guidance, which minimizes contamination by reducing the number of attempts and possible break-down of aseptic technique; (2) tunneling the catheter to obtain exit site in the infra-clavicular area with reduced bacterial colonization; (3) glue, which seals and protects the exit site; (4) simulation-based education of the staff.
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