Literature Review: Catheter Use in Newborns

Bueno, T., Diz, A., Cervera, P., Pérez-Rodríguez, J., & Quero, J. (2008). Peripheral insertion of double-lumen central venous catheter using the Seldinger technique in newborns. Journal Of Perinatology, 28(4), 282-286.

1. This article assesses the risks associated with catheter insertion in neonates and the various complications that can arise as a result.

2. The design of the study pertained to 61 newborns between the years spanning 2003 to 2006. The authors compared through analysis the indications and complications that can occur when catheters are taken out of the newborn.

3. It seems from their outcome that placement is a very important metric that must be taken prior to insertion. In other words, medical staff must be careful where they insert the catheter as well as when they remove the catheter to avoid complications.

4. This is an important article to practice because it reasons that education of where the insert the catheter is critical to preventing infections.

Corzine, M., & Willett, L. (2010). Neonatal PICC: one unit's six-year experience with limiting catheter complications. Neonatal Network, 29(3), 161.

1. Corzine and Willett describe the varying complications that can result from central catheter insertion and the importance of safe dressing techniques.

2. To better inform medical practice, the authors study the management and placement associated with 491 PICCs over a 6-year time frame. The authors add that certain complication rates associated with infections can be minimized with proper dressing techniques.

3. The review in their outcomes the particular complications that did indeed result from their study.

4. They add that many of these complications could be prevented with proper maintaining and safety in hospital settings pertaining to neonates.

Franceschi, A., & da Cunha, M. (2010). Adverse events related to the use of central venous catheters in hospitalized newborns. Revista Latino-Americana De Enfermagem (RLAE), 18(2), 196-202. doi:S0104-11692010000200009

1. The article by Franceschi and Chollopetz da Cunha (2010) seeks to understand the risks associated with central venous catheter usage.

2. To understand the adverse risks that can potentially occur, the authors perform a study of 167 newborns to quantitatively know the best ways to reduce risks associated with PICC insertions. The study was performed in Brazil at the Hospital de Clinicas at Porto Alegre.

3. In their outcome, the authors describe that many complications can be potentially prevented by better handling of parenteral solutions and connections of the catheters. Moreover, additional data uncovered that most complications occur within 48 hours post-insertion.

4. This article is important to research as it provided several measures for better insertion to lessen the potential risks of catheter insertion.

Garland, J., Alex, C., Uhing, M., Peterside, I., Rentz, A., & Harris, M. (2009). Pilot trial to compare tolerance of chlorhexidine gluconate to povidone-iodine antisepsis for central venous catheter placement in neonates. Journal Of Perinatology, 29(12), 808-813. doi:10.1038/jp.2009.161

1. Garland et al.'s objective was to understand the rates associated with contact dermatitis with regard to central catheter placement in neonates. They note that catheter-related bloodstream infection is one of the most complex, but also the most common complications of catheterization in neonates.

2. To better understand this reasoning, the conducted a pilot study at two community hospitals.

3. They discovered that colonization was the primary outcome associated with bloodstream infection and that increased risk of dermatitis was not necessarily connected with cutaneous disinfection.

4. This article provides a basis for infection issues in medical practice but additional information may be needed since it was a pilot study.

Holzmann-Pazgal, , Kubanda, Davis, Khan, Brumley, & Denson, ,. (2012). Utilizing a line maintenance team to reduce central-line-associated bloodstream infections in a neonatal intensive care unit. Journal Of Perinatology, 32(4), 281-286. doi:10.1038/jp.2011.91

1. Holzmann-Pazgal et al. (2012) provide a meaningful discussion on the importance of line maintenance to reduce central-line associated bloodstream infections in NICUs.

2. To test their proposed measures of minimizing the risks associated with these infections, they quantitatively study a hospital with 240-beds in the NICU area that has 118 beds overall.

3. With the implementation of line maintenance, the rates significantly dropped by a total of 65% which indicated that if certain precautions and post-maintenance occur that that will decrease the about of CLABSI infections substantially.

4. The importance of this to clinical practice is that if hospitals start paying more attention to cleanliness in these NICUs, it will reduce the issues associated with infections.

Kane, E., & Bretz, G. (2011). Reduction in coagulase-negative staphylococcus infection rates in the NICU using evidence-based research. Neonatal Network, 30(3), 165-174. doi:10.1891/0730-0832.30.3.165

1. Kane and Bretz (2011) focus mainly on CoNS (coagulase-negative Staphylococcus) bloodstream infection as being a predominant cause of sepsis in the NICU and the preventative measures that can be taken to diminish its effects on morbidity.

2. The study incorporated several article searches for keywords associated with NICU issues such as hand hygiene, catheters, and premature infant. A variety of statistical data was studied in an effort to understand the issues of infection in NICU units between 1998 and 2003.

3. The essential outcomes of this study were cleanliness and educational emphasis in hospital and medical settings.

4. This article was very noteworthy as it offered a variety of clinical techniques and methods that medical settings can integrate into their practice.

Khattak, A., Ross, R., Ngo, T., & Shoemaker, C. (2010). A randomized controlled evaluation of absorption of silver with the use of silver alginate (Algidex) patches in very low birth weight (VLBW) infants with central lines. Journal Of Perinatology, 30(5), 337-342. doi:10.1038/jp.2009.169

1. The article by Khattak et al. (2010) sought to evaluate the absorption of silver when using silver alginate dressings in VLBW (very low birth weight) neonates.

2. The authors conducted a pilot study to determine the safety and obtained consent from the mother or both parents of each fo the infants. This study was approved by the Baylor Research Institute Institutional Review Board. The participants in the study were infants whose birth weights ranged between 500 to 1500 g and they were enrolled within a 72-hour time frame.

3. There is a minimal amount of literature that specifically speaks to the issue of silver toxicity in premature VLBW infants, however, the authors found that certain effects of silver in the study could be diminished by better preventative measures. However, the study was a preliminary evaluation of what to do with regard to silver dressings, and the authors note additional research is needed.

4. This article allows hospital settings to understand the importance of the utilization of certain dressings in NICUs with an emphasis on the effects that improper dressings will have on VBLWs.

Newman, N., Issa, A., Greenberg, D., Kapelushnik, J., Cohen, Z., & Leibovitz, E. (2012). Central venous catheter-associated bloodstream infections. Pediatric Blood & Cancer, 59(2), 410-414. doi:10.1002/pbc.24135

1. Newman et al. (2012) investigate the issues that are by and large associated with CLABSI infections in children under the age of 18. Much of the basis of their study is researched through the use of both Hickman and Port A Cath catheters, various types of insertion methods, the susceptibility of antibiotic data and certain pathological baselines that they obtained between 1998 and 2008 in a hemato oncology unit.

2. The study found statistically that pathogens could be reduced in certain types of catheter use and insertion sites.

3. It would seem from this study that catheter selection and implementation is the primary reasoning behind the outcome.

4. Therefore, nursing practice should understand the types of catheters they are using in order to prevent infections.

Paulson, P., & Miller, K. (2008). Neonatal peripherally inserted central catheters: recommendations for prevention of insertion and postinsertion complications. Neonatal Network, 27(4), 245.

1. Paulson and Miller (2008) state the importance of successful PICC placement in neonates in reducing any potential pain or problems that may happen in invasive procedures such as this. To better understand the importance, they perform a study identifying the best ways to insert PICC based on choosing the right vein. The authors add that most of the time, hospital staff do not know how to effectively and efficiently perform placement or ignore the various recommendations that are made. While care itself is individualized, the authors note that many of the issues that result from improper PICCs can be prevented with proper knowledge of the best ways to perform neonatal care.

2. Quantitative data was collected over the years between 1998 and 2005 at a Level II-III NICU to understand the various reasons associated with PICC and proper practices of treatment completion.

3. The outcomes of the study that the authors state is a table that lists the ways in which medical staff can prevent complications that tend to happen in NICUs.

4. This study was significant to medical practice because it will help other NICUs to know the best ways of handling care and performing proper preventative measures.

Ponnusamy, V., Venkatesh, V., Curley, A., Musonda, P., Brown, N., Tremlett, C., & Clarke, P. (2012). Segmental percutaneous central venous line cultures for diagnosis of catheter-related sepsis. Archives Of Disease In Childhood -- Fetal & Neonatal Edition, 97(4), F273-8.

1. Ponnusamy et al. (2012) seek to understand whether or not certain proactive cultures in CV lines could prevent infections. The authors wanted to examine the colonization of PCVLS (percutaneous central venous line segments) in neonates. 3

2. To do this, they analyzed the cultures in both the middle and proximal segments of the line as well as the tip of the line. Preterm infants were specifically examined.

3. The outcome of the study was not conclusive despite the somewhat interesting data that proactive cultures did have an effect in preventing sepsis.

4. This article provides a wealth of information despite the fact that further study is needed because all of the data collected was not sufficient to say that proactive cultures wholeheartedly prevent infections.

Stevens, T., & Schulman, J. (2012). Evidence-based approach to preventing central line-associated bloodstream infection in the NICU. Acta Paediatrica. Supplement, 101(464), 11-16. doi:10.1111/j.1651-2227.2011.02547.x

1. Stevens and Schulman (2012) review the existing practices and methodology that pertain to CLABSI reduction. They define first what CLABSI is and how it is basically a preventable complication, but necessary nevertheless in modern NICU care by today's medical standards. They identify that recent studies have demonstrated that certain care practices and bundle of practices can have a positive impact on routine clinical care.

2. Their study was more of a qualitative study in that they observed methodology and techniques from an evidence-based approach. The number of techniques that they explored were transformational QI methods and the need for teamwork, for example.

3. This particular article can have a positive effect on the research as it supports the proposed changes associated with how to minimize the rates of CLABSI infections.

4. It seems that clinical practice can benefit tremendously from teamwork and paying more attention to how they handle catheters since they are based on the author's study, almost unavoidable in today's NICUs.

Vital signs: central line-associated blood stream infections --- United States, 2001, 2008, and 2009. (2011). MMWR: Morbidity & Mortality Weekly Report, 60(8), 243-248.

1. Vital signs: central line-associated blood stream infections --- United States, 2001, 2008, and 2009 seeks to understand the variations in infection rates associated with the years 2001, 2008 and 2009.

2. In order to study this, the article collected information from the Centers for Disease Control and Prevention and estimated data per three different settings: outpatient hemodialysis facilities, inpatient wards, and ICUs. Data was collected over a period of days and analyzed.

3. In the outcome, the article reasons that infections decreased by 2009 when compared to 2001 in all three settings noting that more medical data and education were available.

4. Hence, this provides clinical practice with useful information pertaining to minimizing infections and excessive healthcare costs.

Wagner, M., Bonhoeffer, J., Erb, T., Glanzmann, R., Häcker, F., Paulussen, M., & ... Heininger, U. (2011). Prospective study on central venous line associated bloodstream infections. Archives Of Disease In Childhood, 96(9), 827-831. doi:10.1136/adc.2010.208595

1. Wagner et al. (2011) diagnose the various characteristics associated with CLABSI in one particular institution and the best catheters to use.

2. Their respective methodology with this study was done between April of 2008 to March of 2009 and the participants in the study, 152 neonates (88 of which were male), were heavily reviewed in terms of lab records and history. Additionally, the participants' parents were provided with a questionnaire, which the authors stated to be standard practice.

3. The outcome of the study showed the incidences were CLABSI was more than likely to occur in terms of catheter insertion time frame for neonates.

4. This particular study assists in understanding the types of catheters that are best with regard to the characteristics of neonates in NICUs.

Wirtschafter, D., Pettit, J., Kurtin, P., Dalsey, M., Chance, K., Morrow, H., & ... Kloman, S. (2010). A statewide quality improvement collaborative to reduce neonatal central line-associated blood stream infections. Journal Of Perinatology,30(3), 170-181. doi:10.1038/jp.2009.172

1. Wirtschafter et al. (2010) discuss the risks associated with central line-associated bloodstream infections. The authors state the common prevention nursing strategies associated with these infections and seek to understand better ways of reducing the morbidity rates of hospital patients.

2. To do this, they set up an improvement program that included five different interventions: leadership commitments, potential best practices, collaborative process between members, audit and feedback process and quality improvement techniques. These intervention processes were done in 13 regional NICUs.

3. The outcomes that were the result of these intervention programs reduced the rates of CLABSI infections and there ended up being a less amount of infections as a result.

4. The significance of this to nursing/clinical practice is that hospitals can now implement these types of intervention programs that will hopefully continue to reduce the risks associated with central-line bloodstream infections.

Wu, J., & Mu, D. (2012). Vascular catheter-related complications in newborns. Journal Of Paediatrics & Child Health,48(2), E91-5. doi:10.1111/j.1440-1754.2010.01934.x

1. Wu and Mu (2012)'s article discusses the invasive aspects associated with NICUs and how both central and peripheral vascular catheters can assist in serving many essential functions in the NICU. 2.

2. Additionally, they study the growing epidemic of risks associated with the improper insertion or extended catheter use in neonates.

3. The study provides statistical data in order to present the need for awareness of proper handling when catheters are used in the NICU.

4. This particular article provides additional information on the importance of education in clinical practice regarding catheter insertion.