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Umbilical Line Securement Bundle to Reduce Line Loss in the Neonate
Kirsten M Lepp1, Brigit M Carter, Lisa C Bain
1DNP Program, Duke University School of Nursing, and Neonatal Intensive Care Unit, Lucile Packard Children's Hospital Stanford, Palo Alto, California (Dr Lepp); Diversity, Equity, and Inclusion, American Association of Colleges of Nursing, Washington, District of Columbia (Dr Carter); Department of Pediatrics and Neonatology, Stanford University School of Medicine, Palo Alto, California (Dr Bain); and Neonatal Intensive Care Unit, Lucile Packard Children's Hospital Stanford, Palo Alto, California (Mrs Antonini).
Background:
Umbilical line migration not only increases the risks of complications but also results in malposition and, ultimately, loss of the umbilical line.
Purpose:
To evaluate the use of an umbilical line securement bundle to reduce unintended line discontinuation after line adjustment in the neonate at a single 40-bed Level IV neonatal intensive care unit.
Methods:
A pre-post design of 75 neonates, preimplementation (n = 50) and postimplementation (n = 25), was analyzed using data collection from the electronic health record.
Results:
There was a 37.5% absolute reduction in removal of the umbilical line due to malposition after line adjustment utilizing the umbilical line bundle, standardizing the adjustment order, nursing process, and follow-up x-ray evaluation. This absolute reduction has clinical significance although not statistically significant. Provider compliance rates with line adjustment order bundle were 75%, decreasing with additional adjustments (50%). Nursing staff reported comfort with umbilical line management, ranging from 63% to 87% on different tasks.
Implications For Practice:
The use of umbilical line bundles reduces rates of line discontinuation due to malposition. The adoption of umbilical line bundles in neonatal intensive care unit practice may help to prevent unintended line discontinuation.
Implications For Research:
There is a need for continued research regarding the use of secondary securement devices for decreased rate of malposition and the timing and methods for surveillance of umbilical line position.
