Corso Lucia, Buttera Martina, Candia Francesco, Sforza Francesca, Rossi Katia, Lugli Licia, Miselli Francesca, Bedetti Luca, Baraldi Cecilia, Lucaccioni Laura, Iughetti Lorenzo, Berardi Alberto
School of Pediatrics Residency, University of Modena and Reggio Emilia, 41224 Modena, Italy.
Neonatal Intensive Care Unit, University Hospital of Modena, 41224 Modena, Italy.
Life (Basel). 2022 Dec 31;13(1):123. doi: 10.3390/life13010123.
The use of umbilical venous catheters (UVCs) has become the standard of care in the neonatal intensive care unit (NICU) to administer fluids, medications and parenteral nutrition. However, it is well known that UVCs can lead to some serious complications, both mechanical and infective, including CLABSI (Central Line-Associated Bloodstream Infections). Most authors recommend removing UVC within a maximum of 14 days from its placement. However, the last Infusion Therapy Standards of Practice (INS) guidelines recommends limiting the UVC dwell time to 7 to 10 days, to reduce risks of infectious and thrombotic complications. These guidelines also suggest as an infection prevention strategy to remove UVC after 4 days, followed by the insertion of a PICC if a central line is still needed. Nevertheless, the maximum UVC dwell time to reduce the risk of CLABSI is still controversial, as well as the time of its replacement with a PICC. In this study we reviewed a total of 177 articles, found by using the PubMed database with the following search strings: "UVC AND neonates", "(neonate* OR newborn*) AND (UVC OR central catheter*) AND (infection*)". We also analyze the INS guidelines to provide the reader an updated overview on this topic. The purpose of this review is to give updated information on CVCs infectious risks by examining the literature in this field. These data could help clinicians in deciding the best time to remove or to replace the UVC with a PICC, to reduce CLABSIs risk. Despite the lack of strong evidence, the risk of CLABSI seems to be minimized when UVC is removed/replaced within 7 days from insertion and this indication is emerging from more recent and larger studies.
在新生儿重症监护病房（NICU），使用脐静脉导管（UVC）已成为管理液体、药物和肠外营养的护理标准。然而，众所周知，UVC会导致一些严重的并发症，包括机械性和感染性并发症，其中就有中心静脉导管相关血流感染（CLABSI）。大多数作者建议在UVC放置后最多14天内将其拔除。然而，最新的《输液治疗实践标准》（INS）指南建议将UVC留置时间限制在7至10天，以降低感染和血栓形成并发症的风险。这些指南还建议作为一种感染预防策略，在4天后拔除UVC，如果仍需要中心静脉导管，则插入经外周静脉穿刺中心静脉置管（PICC）。然而，降低CLABSI风险的UVC最长留置时间以及用PICC替代它的时间仍存在争议。在本研究中，我们共检索了177篇文章，这些文章是通过使用PubMed数据库，采用以下检索词找到的：“UVC AND新生儿”、“（新生儿或新生婴儿）AND（UVC或中心导管*）AND（感染*）”。我们还分析了INS指南，为读者提供关于该主题的最新概述。本综述的目的是通过研究该领域的文献，提供关于中心静脉导管感染风险的最新信息。这些数据可以帮助临床医生决定拔除UVC或用PICC替代UVC的最佳时间，以降低CLABSI的风险。尽管缺乏有力证据，但在插入UVC后7天内将其拔除/更换似乎能使CLABSI风险降至最低，这一结论正从最近的大型研究中显现出来。
