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Occlusion of the Great and Small Saphenous Vein Using Copolymeric Glue Based on N-Butyl Cyanoacrylate and Methacryloxy Sulfolane
Published on: December 9, 2022
Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications
Fiammetta Piersigilli1, Giulia Iacona2, Sarah Yazami3
1Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium. Fiammetta.piersigilli@saintluc.uclouvain.be.
Insights
Implementing a new central line bundle significantly reduced bloodstream infections and dislodgments in neonatal intensive care units. This evidence-based approach improved patient safety without causing glue-related complications.
Area of Science:
- Neonatal care
- Medical device securement
- Infection control
Background:
- Stable vascular access is critical for neonates in the NICU.
- PICC securement issues can lead to serious consequences and device failure.
- Tissue adhesive securement is proven safe and effective for neonatal catheters.
Purpose of the Study:
- To evaluate the impact of a central line dressing and maintenance bundle on catheter-related mechanical complications.
- To assess the effectiveness of a new PICC bundle in a level-III NICU.
- To reduce catheter-related mechanical complications and infections.
Main Methods:
- A quasi-experimental quality improvement project was conducted.
- A new PICC bundle including glue, a sutureless device (Griplock®), and transparent dressing was implemented.
- Complication rates were compared before and after bundle implementation.
Main Results:
- The new bundle significantly decreased central line-associated bloodstream infections (CLABSI) (p<0.001).
- Mechanical complications and dislocations were significantly reduced (p<0.0001).
- The average catheter dwell time increased significantly (p<0.05), with no observed glue-related complications.
Conclusions:
- The new neonatal PICC securement bundle effectively reduced CLABSI and dislodgment rates.
- No complications were associated with the use of glue in the neonatal population.
- Continuous implementation of evidence-based central line bundles is crucial for improving NICU patient safety and quality improvement.
Abstract:
A "bundle" is defined as a combination of evidence-based interventions that, if followed collectively and reliably, improve patient outcomes. The aim of this quasi-experimental study, conducted in a level-III NICU in Belgium, was to assess the impact of central line dressing and maintenance bundle implementation on the rate of catheter-related mechanical complications. We performed a quality improvement (QI) project. Prior to bundle implementation, neonatal PICC lines were secured by Steri-Strip® and occlusive dressing. We implemented a new PICC bundle consisting of the use of glue, sutureless device (Griplock®), and a transparent dressing to secure the catheter to the skin. We compared the rate of infections, mechanical complications, and dislocations before and after bundle implementation (periods 1 and 2, respectively). The use of glue resulted in a significantly decreased rate of central line-associated bloodstream infection (CLABSI) (p < 0.001), dislocations, and mechanical complications (p < 0.0001). During period 2, there was a significant increase for the average number of days the catheter stayed in place (p < 0.05). We did not observe catheter breakage or patient skin irritations attributable to the use of glue (not even in ELBW infants).
Conclusion:
The implementation of the new bundle to secure neonatal PICCs in our NICU was associated with a significant reduction in CLABSI and dislodgment rates, without glue-related complications. Active surveillance of CVC placement procedure, positioning, and management, as well as analysis of related complications is crucial for improving patient safety. Continuous implementation of up-to-date central line bundles based on best practice recommendations is a key for quality improvement in NICUs.
What Is Known:
• Stable vascular access is crucial in the NICU. Neonatal PICC securement issues can have serious consequences and are associated with device failure.
What Is New:
• Catheter securement with tissue adhesive is safe and effective in reducing failure and complication rates in the neonatal population.
