Buttera Martina, Corso Lucia, Casadei Leonardo, Valenza Cinzia, Sforza Francesca, Candia Francesco, Miselli Francesca, Baraldi Cecilia, Lugli Licia, Berardi Alberto, Iughetti Lorenzo
University of Modena and Reggio Emilia, Via del Pozzo 71, 41224 Modena, Italy.
Pediatrics Unit, University Hospital of Modena, 41224 Modena, Italy.
Antibiotics (Basel). 2024 Oct 18;13(10):988. doi: 10.3390/antibiotics13100988.
Umbilical venous catheters (UVCs) are the standard of care in neonatal intensive care units (NICUs) to administer fluids, parenteral nutrition and medications, although complications may occur, including central line-associated blood stream infections (CLABSIs). However, the dwell time to reduce CLABSI risk remains an open issue.
We performed a single-center retrospective study of newborns hospitalized in the Modena NICU with at least one UVC inserted over a 6-year period (period 1: January 2011-December 2013; period 2: January 2019-December 2021). We selected a non-consecutive 6-year period to emphasize the differences in UVC management practices that have occurred over time in our NICU. The UVC dwell time and catheter-related complications during the first 4 weeks of life were examined.
The UVC dwell time was shorter in period 2 (median 4 days vs. 5 days, < 0.00001). Between the two periods, the incidence of CLABSIs remained unchanged ( 0.5425). However, in period 2, there was an increased need for peripherally inserted central catheters (PICCs) after UVC removal, with a rise in PICC infections after UVC removal ( 0.0239).
In our NICU, shortening UVC dwell time from 5 to 4 days did not decrease the UVC-related complications. Instead, the earlier removal of UVCs led to a higher number of PICCs inserted, possibly increasing the overall infectious risk.
脐静脉导管（UVC）是新生儿重症监护病房（NICU）进行液体输注、肠外营养和给药的标准护理措施，尽管可能会出现并发症，包括中心静脉导管相关血流感染（CLABSI）。然而，降低CLABSI风险的留置时间仍是一个未解决的问题。
我们对在摩德纳NICU住院的新生儿进行了一项单中心回顾性研究，这些新生儿在6年期间（第1阶段：2011年1月至2013年12月；第2阶段：2019年1月至2021年12月）至少插入了一根UVC。我们选择了一个非连续的6年时间段，以强调我们NICU中随着时间推移UVC管理实践的差异。对出生后前4周内的UVC留置时间和导管相关并发症进行了检查。
第2阶段的UVC留置时间较短（中位数4天对5天，<0.00001）。在两个阶段之间，CLABSI的发生率保持不变（0.5425）。然而，在第2阶段，UVC拔除后对外周静脉穿刺中心静脉导管（PICC）的需求增加，UVC拔除后PICC感染率上升（0.0239）。
在我们的NICU中，将UVC留置时间从５天缩短至4天并未降低与UVC相关的并发症。相反，UVC的早期拔除导致插入的PICC数量增加，可能增加了总体感染风险。
