Neonatal Intensive Care Unit (NICU), Women's Wellness and Research Center (WWRC), Hamad Medical Corporation (HMC), Doha, Qatar.
Medical Research Center, Hamad Medical Corporation (HMC), Doha, Qatar.
J Vasc Access. 2021 Mar;22(2):243-253. doi: 10.1177/1129729820928182. Epub 2020 Jun 30.
Until the 1980s, central vascular access in the Neonatal Intensive Care Unit was predominantly delivered by umbilical catheters and only and if needed by surgical cutdowns or subclavian vein catheterization through blind percutaneous venipuncture. In the early 1980s, epicutaneo-caval catheters were successfully introduced.
In our Neonatal Intensive Care Unit, a dedicated team to insert epicutaneo-caval catheters was formally established in January 2017, including 12 neonatologists and 1 neonatal nurse practitioner. A before- versus after-intervention study was designed to determine whether the establishment of the epicutaneo-caval catheter insertion team is associated with increased success rates and a decreased risk of catheter-related complications. Success rates and other catheter-related parameters were traced from 2016 onward. Collected data were analyzed for three consecutive years: 2016, 2017, and 2018.
The epicutaneo-caval catheter team inserted 1336 catheters over 3 years. Both first prick (from 57.7% to 66.9%; p = 0.023) and overall success (from 81.7% to 97.6%; p < 0.0001) rates significantly improved. In 2018, the number of tunneled or surgically inserted central venous catheters came down to zero (p < 0.0001). Overall catheter-related complications were significantly lower following the epicutaneo-caval catheter team's establishment (p < 0.0001) while there was no significant decrease noted (p = 0.978) in central line-associated bacterial stream infection rates.
A dedicated epicutaneo-caval catheter team is a promising intervention to increase success rates and significantly decrease catheter-related complications in Neonatal Intensive Care Unit. Standardizing epicutaneo-caval catheter placement is important; however, standardizing catheter maintenance seems essential to the improvement of central line-associated bacterial stream infection rates.
直到 20 世纪 80 年代，新生儿重症监护病房的中央血管通路主要通过脐导管提供，只有在需要时才通过外科切开或盲穿锁骨下静脉置管。20 世纪 80 年代初，成功引入了经皮股静脉导管。
在我们的新生儿重症监护病房，一个专门的团队于 2017 年 1 月正式成立，负责插入经皮股静脉导管，该团队由 12 名新生儿科医生和 1 名新生儿护士组成。我们设计了一项干预前后研究，以确定经皮股静脉导管插入团队的建立是否与更高的成功率和更低的导管相关并发症风险相关。从 2016 年开始跟踪成功率和其他与导管相关的参数。连续三年（2016 年、2017 年和 2018 年）收集的数据进行了分析。
经皮股静脉导管团队在 3 年内插入了 1336 根导管。首次穿刺（从 57.7%到 66.9%；p = 0.023）和总体成功率（从 81.7%到 97.6%；p < 0.0001）均显著提高。2018 年，隧道或手术插入的中心静脉导管数量降至零（p < 0.0001）。经皮股静脉导管团队成立后，导管相关并发症总体发生率显著降低（p < 0.0001），而中心静脉相关血流感染率无显著下降（p = 0.978）。
专门的经皮股静脉导管团队是一种提高新生儿重症监护病房成功率和显著降低导管相关并发症的有前途的干预措施。标准化经皮股静脉导管置管术很重要；然而，标准化导管维护对于降低中心静脉相关血流感染率似乎至关重要。
