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Implementation of a Central Line Maintenance Bundle for Dislodgement and Infection Prevention in the NICU
1Arizona State University, Phoenix, and Clinical Issues in Neonatal Care, Phoenix Children's Hospital, Arizona.
Insights
A new central line maintenance bundle for newborn intensive care units (NICUs) significantly reduced line dislodgements but did not decrease infections. Further research is needed for tunneled lines.
Area of Science:
- Neonatal intensive care
- Pediatric nursing
- Vascular access devices
Background:
- Newborn intensive care unit (NICU) infants often require prolonged medication or nutritional support via central lines.
- Central line-associated infections and dislodgements increase morbidity and mortality in vulnerable infants.
- Limited evidence exists for optimizing central line care in larger, complex infants with extended NICU stays.
Purpose of the Study:
- To identify evidence-based central line maintenance practices for NICU infants.
- To develop and implement a care bundle aimed at reducing central line infections and dislodgements.
- To evaluate the impact of the implemented bundle on adverse outcomes.
Main Methods:
- Systematic literature search of PubMed, Cochrane Library, and CINAHL for central line maintenance strategies.
- Development of a practice change bundle for nontunneled central lines.
- Comparative analysis of infection and dislodgement rates between control (pre-bundle) and intervention (post-bundle) groups, including both tunneled and nontunneled lines.
Main Results:
- Pre-intervention: 19 dislodgements and 5 infections (14 dislodgements/4 infections from nontunneled; 5 dislodgements/1 infection from tunneled).
- Post-intervention: 1 dislodgement and 4 infections (1 dislodgement from nontunneled; 4 infections from tunneled).
- The bundle significantly reduced central line dislodgements but did not show a significant decrease in infections.
Conclusions:
- Scheduled chlorhexidine dressing changes may decrease infection but pose risks of dislodgement and skin breakdown in NICU infants.
- The developed central line maintenance bundle effectively reduced dislodgements in NICU infants.
- Further investigation is required to ascertain the efficacy of this bundle for tunneled central lines in the NICU population.
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:
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:
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:
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:
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:
Further research is needed to determine whether this central line maintenance bundle would be beneficial for tunneled central lines.
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