Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study
Author(s)
Inge Arnts1,2*,
Ninke Schrijvers1,
Coranne Meester1,
Joannes Groenewoud3,
Kian Djien Liem1
Affiliation(s)
1 Department of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 2 Department of Pain and Palliative Care, Nijmegen, The Netherlands. 3 Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
1 Department of Neonatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. 2 Department of Pain and Palliative Care, Nijmegen, The Netherlands. 3 Department of Health Evidence, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
ABSTRACT
Introduction: It is not known whether prone position of newborns with umbilical catheters increases the complication risk. Purpose: Analysing complications of umbilical catheters in newborns during prone positioning and analysing if local complications as a wet or red rim increase severe complications. Subjects: Newborns (< 24 weeks - 42 weeks gestational age) with an umbilical catheter, inserted on our third level 17-bed neonatal care unit. Design: A prospective observational pilot study (during September 2009-September 2010). Methods: Each neonate was positioned for at least 12 hours in 48 consecutive hours in the prone position. Results: 88 newborns were included. Central line associated bloodstream infection was the main reason for catheter removal due to complications. A wet or red umbilical rim did not increase the major complications. The relative risk for central line associated bloodstream infection in case of pus excretion was 3.3 as compared with clean umbilical stump (p = 0.015). There were no complications as excessive blood loss or obstructions. Conclusion: An umbilical catheter should not be considered as a contraindication for prone positioning. In case of wet rim or pus excretion from the umbilical stump, removal of the catheter should be seriously considered.
KEYWORDS
Umbilical Venous Catheters, Umbilical Arterial Catheters, Complications, Nursing Care, Prone Position, Newborns
Umbilical Venous Catheters, Umbilical Arterial Catheters, Complications, Nursing Care, Prone Position, Newborns
Cite this paper
Arnts, I. , Schrijvers, N. , Meester, C. , Groenewoud, J. and Liem, K. (2014) Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study. Open Journal of Nursing, 4, 859-867. doi: 10.4236/ojn.2014.412091.
Arnts, I. , Schrijvers, N. , Meester, C. , Groenewoud, J. and Liem, K. (2014) Umbilical Catheter Complications in Newborns during Prone Position: A Pilot Study. Open Journal of Nursing, 4, 859-867. doi: 10.4236/ojn.2014.412091.
References
[1] Bradshaw, W.T. and Furdon, S.A. (2006) A Nurse’s Guide to Early Detection of Umbilical Venous Catheter Complications in Infants. Advances in Neonatal Care, 6, 127-138. http://dx.doi.org/10.1016/j.adnc.2006.03.002 [2] Butler-O’Hara, M., Buzzard, C.J., Reubens, L., McDermott, M.P., DiGrazio, W. and D’Angio, C.T. (2006) A Randomized Trial Comparing Long-Term and Short-Term Use of Umbilical Venous Catheters in Premature Infants with Birth Weights of Less Than 1251 Grams. Pediatrics, 118, e25-e35. http://dx.doi.org/10.1542/peds.2005-1880 [3] Revel-Vilk, S. and Ergaz, Z. (2011) Diagnosis and Management of Central-Line Associated Thrombosis in Newborns and Infants. Seminars in Fetal & Neonatal Medicine, 16, 340-344. [4] Salonvaara, M., Riikonen, P., Kekomäki, R. and Heinonen, K. (1999) Clinically Symptomatic Central Venous Catheter-Related Deep Venous Thrombosis in Newborns. Acta Paediatrica, 88, 642-646.
http://dx.doi.org/10.1111/j.1651-2227.1999.tb00014.x [5] Sheridan, R.L. and Weber, J.M. (2006) Mechanical and Infectious Complications of Central Venous Cannulation in Children: Lessons Learned from a 10-Year Experience Placing More Than 1000 Catheters. Journal of Burn Care & Research, 27, 713-718. [6] Veldman, A., Nold, M.F. and Michel-Behnke, I. (2008) Thrombosis in the Critically Ill Neonate: Incidence, Diagnosis and Management. Vascular Health and Risk Management, 4, 1337-1348. [7] Furdon, S.A., Horgan, M.J., Bradshaw, W.T. and Clark, D.A. (2006) Nurses’ Guide to Early Detection of Umbilical Arterial Catheter Complications in Infants. Advances in Neonatal Care, 6, 242-256.
http://dx.doi.org/10.1016/j.adnc.2006.06.001 [8] Lin, S.J., Kolz, P.F., Davis, W. and Vicari, F. (2009) Lower Extremity Ischemia Following Umbilical Artery Catheterization: A Case Study and Clinical Update. International Journal of Surgery, 7, 182-186. [9] Balaguer, A., Escribano, J., RoquéiFiguls, M. and Rivas-Fernandez, M. (2013) Infants Position in Newborns Receiving Mechanical Ventilation. Cochrane Database of Systematic Reviews, 28, 3.
http://dx.doi.org/10.1002/14651858.CD003668 [10] Sahni, R., Saluja, D., Schulze, K.F., Kashyap, S., Ohira-Kist, K., Fifer, W.P. and Myers, M.M. (2003) Quality of Diet, Body Position and Time after Feeding Influence Behavioral States in Low Birth Weight Infants. Pediatric Research, 52, 399-404. http://dx.doi.org/10.1016/j.adnc.2006.06.001 [11] O’Grady, N.P. Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A.G., Rupp, M.E. and Saint, S., Centres for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee (2011) Guidelines for the Prevention of Intravascular Catheter-Related Infections. American Journal of Infection Control, 39, S1-S34. [12] Centers for Disease Control and Prevention/National Healthcare Safety Network. Protocol correction, clarifications and additions; device associated module CLABSI. This protocol has not yet been added to the current posted NHSN protocols. January 2014. [13] Schelonka, R.L., Chai, M.K., Yoder, B.A., Hensley, R.M., Brockett, R.M. and Ascher, D.P. (1996) Volume of Blood Required to Detect Common Neonatal Pathogens. The Journal of Pediatrics, 129, 275-278.
http://dx.doi.org/10.1016/S0022-3476(96)70254-8 [14] Van der Zwet, W.C., Kaiser, A.M., van R.M., E., Berkhof, J., Fetter, W.P.F., Parlevleit, G.A. and Vandenbroucke, C.M.J.E. (2005) Nosocomial Infections in a Dutch Neonatal Intensive Care Unit: Surveillance Study with Definitions for Infection Specifically Adapted for Newborns. Journal of Hospital Infection, 61, 300-311.
http://dx.doi.org/10.1016/j.jhin.2005.03.014 [15] Horan, T.C., Andrus, M. and Dudeck, M.A. (2008) CDC/NHSN Surveillance Definition of Health Care-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. American Journal of Infection Control, 36, 309-332. [16] Nash, P. (2006) Umbilical Catheters, Placement, and Complication Management. Journal of Infusion Nursing, 29, 346-352. [17] Antunes, L.C., Rugolo, L.M. and Crocci, A.J. (2003) Effect of Preterm Infant Position on Weaning from Mechanical Ventilation. The Journal of Pediatrics, 79, 239-244. [18] Kabra, N.S., Kumar, M. and Shah, S.S. (2005) Multiple versus Single Lumen Umbilical Venous Catheter for Newborn Infants. Cochrane Database of Systematic Reviews, 20, Article ID: CD004498. [19] Mahieu, L.M., de Muynck, A.O., Leven, M.M., de Dooy, J.J., Goossens, H.J. and Van Reempts, P.J. (2001) Risk Factors for Central Vascular Catheter-Associated Bloodstream Infections among Patients in a Neonatal Intensive Care Unit. Journal of Hospital Infection, 48, 108-116. http://dx.doi.org/10.1053/jhin.2001.0984 [20] Schwab, F., Geffers, C., Barwolff, S., Ruden, H. and Gastmeier, P. (2007) Reducing Neonatal Nosocomial Bloodstream Infections through Participation in a National Surveillance System. Journal of Hospital Infection, 65, 319-325. [21] Schulman, J., Stricof, R., Stevens, T.P., Horgan, M., Gase, K., Holzman, I.R., Koppel, R.I., Nafday, S., Gibbs, K., Angert, R., Simmond, S.A., Furdon, S.A. and Saiman, L., New York State Regional Perinatal Care Centres (2011) Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline after Bundles and Checklists. Pediatrics, 127, 436-444. [22] Chien, L., Macnab, Y., Aziz, K., Andrews, W., McMillan, D. and Lee, S. (2002) The Canadian Network Variations in Central Venous Catheter-Related Infections Risk among Canadian Neonatal Intensive Care Units. Pediatric Infection Disease Journal, 21, 505-511. http://dx.doi.org/10.1097/00006454-200206000-00006 [23] Arnts, J.J.A., Bullens, L.M., Groenewoud, J.M.M. and Liem, K.L. (2014) Comparison of Complication Rates between Umbilical and Peripherally Inserted Central Venouscatheters in Newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43, 205-215.
[1] Bradshaw, W.T. and Furdon, S.A. (2006) A Nurse’s Guide to Early Detection of Umbilical Venous Catheter Complications in Infants. Advances in Neonatal Care, 6, 127-138. http://dx.doi.org/10.1016/j.adnc.2006.03.002 [2] Butler-O’Hara, M., Buzzard, C.J., Reubens, L., McDermott, M.P., DiGrazio, W. and D’Angio, C.T. (2006) A Randomized Trial Comparing Long-Term and Short-Term Use of Umbilical Venous Catheters in Premature Infants with Birth Weights of Less Than 1251 Grams. Pediatrics, 118, e25-e35. http://dx.doi.org/10.1542/peds.2005-1880 [3] Revel-Vilk, S. and Ergaz, Z. (2011) Diagnosis and Management of Central-Line Associated Thrombosis in Newborns and Infants. Seminars in Fetal & Neonatal Medicine, 16, 340-344. [4] Salonvaara, M., Riikonen, P., Kekomäki, R. and Heinonen, K. (1999) Clinically Symptomatic Central Venous Catheter-Related Deep Venous Thrombosis in Newborns. Acta Paediatrica, 88, 642-646.
http://dx.doi.org/10.1111/j.1651-2227.1999.tb00014.x [5] Sheridan, R.L. and Weber, J.M. (2006) Mechanical and Infectious Complications of Central Venous Cannulation in Children: Lessons Learned from a 10-Year Experience Placing More Than 1000 Catheters. Journal of Burn Care & Research, 27, 713-718. [6] Veldman, A., Nold, M.F. and Michel-Behnke, I. (2008) Thrombosis in the Critically Ill Neonate: Incidence, Diagnosis and Management. Vascular Health and Risk Management, 4, 1337-1348. [7] Furdon, S.A., Horgan, M.J., Bradshaw, W.T. and Clark, D.A. (2006) Nurses’ Guide to Early Detection of Umbilical Arterial Catheter Complications in Infants. Advances in Neonatal Care, 6, 242-256.
http://dx.doi.org/10.1016/j.adnc.2006.06.001 [8] Lin, S.J., Kolz, P.F., Davis, W. and Vicari, F. (2009) Lower Extremity Ischemia Following Umbilical Artery Catheterization: A Case Study and Clinical Update. International Journal of Surgery, 7, 182-186. [9] Balaguer, A., Escribano, J., RoquéiFiguls, M. and Rivas-Fernandez, M. (2013) Infants Position in Newborns Receiving Mechanical Ventilation. Cochrane Database of Systematic Reviews, 28, 3.
http://dx.doi.org/10.1002/14651858.CD003668 [10] Sahni, R., Saluja, D., Schulze, K.F., Kashyap, S., Ohira-Kist, K., Fifer, W.P. and Myers, M.M. (2003) Quality of Diet, Body Position and Time after Feeding Influence Behavioral States in Low Birth Weight Infants. Pediatric Research, 52, 399-404. http://dx.doi.org/10.1016/j.adnc.2006.06.001 [11] O’Grady, N.P. Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A.G., Rupp, M.E. and Saint, S., Centres for Disease Control and Prevention, Healthcare Infection Control Practices Advisory Committee (2011) Guidelines for the Prevention of Intravascular Catheter-Related Infections. American Journal of Infection Control, 39, S1-S34. [12] Centers for Disease Control and Prevention/National Healthcare Safety Network. Protocol correction, clarifications and additions; device associated module CLABSI. This protocol has not yet been added to the current posted NHSN protocols. January 2014. [13] Schelonka, R.L., Chai, M.K., Yoder, B.A., Hensley, R.M., Brockett, R.M. and Ascher, D.P. (1996) Volume of Blood Required to Detect Common Neonatal Pathogens. The Journal of Pediatrics, 129, 275-278.
http://dx.doi.org/10.1016/S0022-3476(96)70254-8 [14] Van der Zwet, W.C., Kaiser, A.M., van R.M., E., Berkhof, J., Fetter, W.P.F., Parlevleit, G.A. and Vandenbroucke, C.M.J.E. (2005) Nosocomial Infections in a Dutch Neonatal Intensive Care Unit: Surveillance Study with Definitions for Infection Specifically Adapted for Newborns. Journal of Hospital Infection, 61, 300-311.
http://dx.doi.org/10.1016/j.jhin.2005.03.014 [15] Horan, T.C., Andrus, M. and Dudeck, M.A. (2008) CDC/NHSN Surveillance Definition of Health Care-Associated Infection and Criteria for Specific Types of Infections in the Acute Care Setting. American Journal of Infection Control, 36, 309-332. [16] Nash, P. (2006) Umbilical Catheters, Placement, and Complication Management. Journal of Infusion Nursing, 29, 346-352. [17] Antunes, L.C., Rugolo, L.M. and Crocci, A.J. (2003) Effect of Preterm Infant Position on Weaning from Mechanical Ventilation. The Journal of Pediatrics, 79, 239-244. [18] Kabra, N.S., Kumar, M. and Shah, S.S. (2005) Multiple versus Single Lumen Umbilical Venous Catheter for Newborn Infants. Cochrane Database of Systematic Reviews, 20, Article ID: CD004498. [19] Mahieu, L.M., de Muynck, A.O., Leven, M.M., de Dooy, J.J., Goossens, H.J. and Van Reempts, P.J. (2001) Risk Factors for Central Vascular Catheter-Associated Bloodstream Infections among Patients in a Neonatal Intensive Care Unit. Journal of Hospital Infection, 48, 108-116. http://dx.doi.org/10.1053/jhin.2001.0984 [20] Schwab, F., Geffers, C., Barwolff, S., Ruden, H. and Gastmeier, P. (2007) Reducing Neonatal Nosocomial Bloodstream Infections through Participation in a National Surveillance System. Journal of Hospital Infection, 65, 319-325. [21] Schulman, J., Stricof, R., Stevens, T.P., Horgan, M., Gase, K., Holzman, I.R., Koppel, R.I., Nafday, S., Gibbs, K., Angert, R., Simmond, S.A., Furdon, S.A. and Saiman, L., New York State Regional Perinatal Care Centres (2011) Statewide NICU Central-Line-Associated Bloodstream Infection Rates Decline after Bundles and Checklists. Pediatrics, 127, 436-444. [22] Chien, L., Macnab, Y., Aziz, K., Andrews, W., McMillan, D. and Lee, S. (2002) The Canadian Network Variations in Central Venous Catheter-Related Infections Risk among Canadian Neonatal Intensive Care Units. Pediatric Infection Disease Journal, 21, 505-511. http://dx.doi.org/10.1097/00006454-200206000-00006 [23] Arnts, J.J.A., Bullens, L.M., Groenewoud, J.M.M. and Liem, K.L. (2014) Comparison of Complication Rates between Umbilical and Peripherally Inserted Central Venouscatheters in Newborns. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 43, 205-215.