Taylor Jacqueline E, McDonald Susan J, Tan Kenneth
La Trobe University, Bundoora, Australia; Monash Newborn, Monash Medical Centre, Clayton, Australia.
La Trobe University, Bundoora, Australia; Midwifery Professorial Unit, Mercy Hospital for Women, Melbourne, Australia.
Aust Crit Care. 2014 Feb;27(1):36-42. doi: 10.1016/j.aucc.2013.11.002. Epub 2013 Dec 4.
Infection is the most common problem with central venous catheters (CVCs) in neonates. There are two published guidelines, including the Centers for Disease Control and Prevention (CDC), for the prevention of intravascular catheter-related infection that describes evidence-based practice to reduce nosocomial infection.
Our aims were to survey current medical and nursing management of central venous catheters in tertiary neonatal intensive care units in Australia and New Zealand and to compare with the CDC evidence-based practice guideline.
A cross sectional survey was performed across 27 Australian and New Zealand neonatal units in September 2012. Two web-based questionnaires were distributed, one to medical directors related to the insertion of CVCs while CVC "maintenance" surveys were sent to nurse unit managers.
Seventy percent (19/27) medical management and 59% (16/27) on nursing management surveys were completed. In all neonatal intensive care units (NICUs) there were guidelines for CVC maintenance and for 18 out of 19 there were guidelines for insertion. In the seven units using femoral lines, three had a guideline on insertion and four for maintenance. CVC insertion was restricted to credentialed staff in 57.9% of neonatal units. Only 26.5% used full maximal sterile barriers for insertion. Skin disinfection practices widely varied. Dressing use and dressing change regimens were standardised; all using a semi-permeable dressing. Duration of cleaning time of the access point varied significantly; however, the majority used a chlorhexidine with alcohol solution (68.8%). Line and fluid changes varied from daily to 96 h. The majority used sterile gloves and a sterile dressing pack to access the CVC (68.8%). In the majority of NICUs stopcocks were used (62.5%) with a needle-less access point attached (87.5%). In less than 50% of NICUs education was provided on insertion and maintenance.
There is diversity of current practices and some aspects vary from the CDC guideline. There is a need to review NICU current practices to align with evidence based guidelines. The introduction of a common guideline may reduce variations in practice.
感染是新生儿中心静脉导管（CVC）最常见的问题。目前有两项已发布的指南，包括疾病控制与预防中心（CDC）的指南，用于预防血管内导管相关感染，这些指南描述了减少医院感染的循证实践。
我们的目的是调查澳大利亚和新西兰三级新生儿重症监护病房中心静脉导管目前的医疗和护理管理情况，并与CDC循证实践指南进行比较。
2012年9月对澳大利亚和新西兰的27个新生儿病房进行了横断面调查。分发了两份基于网络的问卷，一份给与CVC插入相关的医疗主任，而CVC“维护”调查问卷则发送给各科室的护士长。
完成了70%（19/27）的医疗管理调查和59%（16/27）的护理管理调查。在所有新生儿重症监护病房（NICU）中都有CVC维护指南，19个中有18个有插入指南。在使用股静脉导管的7个科室中，3个有插入指南，4个有维护指南。57.9%的新生儿病房将CVC插入限制在有资质的工作人员。只有26.5%在插入时使用了完整的最大无菌屏障。皮肤消毒做法差异很大。敷料的使用和更换方案是标准化的；均使用半透性敷料。穿刺点清洁时间差异很大；然而，大多数使用氯己定酒精溶液（68.8%）。管路和液体更换时间从每日到96小时不等。大多数使用无菌手套和无菌敷料包来接触CVC（68.8%）。在大多数NICU中使用了三通阀（62.5%）并连接了无针接头（87.5%）。不到50%的NICU提供了关于插入和维护的培训。
目前的做法存在差异，有些方面与CDC指南不同。有必要审查NICU目前的做法以使其与循证指南保持一致。引入通用指南可能会减少实践中的差异。
