cmcdermott

While the catheters are sutured and a bridge using tape or a commercial device is used when the infant is nursed in high humidity there are potential problems. Checking the position once a day is inadequate when in humidity the tape comes apart unless it is regularly checked and pressed together again (if you can understand what I mean). At each procedure, nursing cares, disturbance of the baby a quick glance at the line ensuring the tape is adherent is ideal. Making sure like we do with chest drains that there is no pull on the line is also important. I have heard of an adhesive produce that is available for PICCs but hasn't been tested in neonates. Would something like that be an option for the future?

We also use the bulkier Accu Check. Our lab validated with laboratory values before we implemented it and it performed better than the Hemecue. We have found it is not good with values below 2.6mmol/L. If we have concerns we send a lab sample as comparing one POCT test with another is not useful as one or both could be inaccurate

We use heparinised Glucose 5% in our UACs however the down side is that you cannot use the glucose measurement.

We will shortly be changing our standardised lipid infusions from syringes to bags which will have a 48hr hang time. Several units in Ireland have already adapted to a 48hr (over several years) hang time for an aqueous bag and we have not noted any increase in infection. Theoretically it should reduce the risk as you are breaking the central line only once every 48hrs as apposed to every day. Despite initial concerns from the neonatal nurses they have embraced the change and are looking forward to changing the lipids to 48 hours as well. The biggest risk is that when the lipids are infused as a separate infusion errors can occur when setting the infusion rates unless there are robust systems in place for checking, prompts on the pumps etc. Unfortunately we have discovered that no one is manufacturing a light protected IV administration set in any colour other than shades of yellow which would help clearly distinguish each infusion. Therefore labelling the lines will be important both before and after the pump, two -person checks at each change of infusion and subsequent infusion rate changes, hourly checking set rate and volume infused and checks at each shift changeover. Another suggestion following an error in the UK is to consider having dedicated pumps for Lipid infusions only.

We are in the process of setting it up and plan to use for infants <32 weeks mainly because that is the gestation we send a nursing team from NICU to attend and they will set it up

We use chlorhexidine 0.05% solution for Umbilical lines and some PICC lines and take great care to ensure that the solution is only applied to the smallest area necessary and does not spill down the side of the baby and under their back. We have rarely seen burns with this concentration.

We change the aqueous portion every 48 hours (lipid every 24 as per manufacturer but that is potentially to change) and have been doing so for several years with no issues. The practice is being recommended in the National Guidelines for Parenteral Nutrition in Neonatal and Paediatric settings. There is no good evidence to suggest it is harmful and indeed the 24 hour change of infusions and administration sets seems to be based purely on custom and practice. We have made considerable savings too. The bags have to be clearly marked with a label stating date and time they are hung to avoid prolonging hang times. ESPGHAN guidelines suggested up to 72 hours but we decided to keep with 48 and try get everyone on board Christine

In out unit the nursing staff prepare the medication in a designated corner of the unit. Fluids are prepared and giving set primed at the cotside

We also do not use heparin or locks but run an infusion at 1ml/hr. If not required we remove the line ASAP