Novel Neonatal Umbilical Catheter Protection and Stabilization Device in In vitro Model of Catheterized Human Umbilical Cords: Effect of Material and Venting on Bacterial Colonization

Abstract

Objective Umbilical central lines deliver life-saving medications and nutrition for neonates; however, complications associated with umbilical catheters (UCs) occur more frequently than in adults with central lines (i.e., line migration, systemic infection). We have developed a device for neonatal UC protection and stabilization to reduce catheter exposure to bacteria compared with the standard of care: “goal post” tape configuration. This study analyzes the effect of device venting and material on bacterial load of human umbilical cords in vitro.

Study Design Catheters were inserted into human umbilical cord segments in vitro, secured with plastic or silicone vented prototype versus tape, and levels of bacterial colonization were compared between groups after 7 days of incubation.

Results Nonvented plastic prototype showed increased bacterial load compared with goal post (p = 0.04). Colonization was comparable between the goal post and all vented plastic prototypes (p ≥ 0.30) and when compared with the vented silicone device (p = 1).

Conclusion A novel silicone device does not increase external bacterial colonization compared with the current standard of care for line securement, and may provide a safe, convenient alternative to standard adhesive tape for UC stabilization. Future studies are anticipated to establish safety in vivo, alongside benefits such as migration and infection reduction.

Keywords

umbilical arterial catheter - umbilical venous catheter - bloodstream infection - central line migration

• References

• 1 Martin JA, Hamilton BE, Osterman MJ, Curtin SC, Matthews TJ. Births: final data for 2013. Natl Vital Stat Rep 2015; 64 (01) 1-65
• 2 Shahid S, Dutta S, Symington A, Shivananda S. ; McMaster University NICU. Standardizing umbilical catheter usage in preterm infants. Pediatrics 2014; 133 (06) e1742-e1752
• 3 Simanovsky N, Ofek-Shlomai N, Rozovsky K, Ergaz-Shaltiel Z, Hiller N, Bar-Oz B. Umbilical venous catheter position: evaluation by ultrasound. Eur Radiol 2011; 21 (09) 1882-1886
• 4 Tiffany KF, Burke BL, Collins-Odoms C, Oelberg DG. Current practice regarding the enteral feeding of high-risk newborns with umbilical catheters in situ. Pediatrics 2003; 112 (1 Pt 1): 20-23
• 5 Edwards JR, Peterson KD, Mu Y. et al. National Healthcare Safety Network (NHSN) report: data summary for 2006 through 2008, issued December 2009. Am J Infect Control 2009; 37 (10) 783-805
• 6 Kabra NS, Kumar M, Shah SS. Multiple versus single lumen umbilical venous catheters for newborn infants. Cochrane Database Syst Rev 2005; (03) CD004498
• 7 Ramasethu J. Complications of vascular catheters in the neonatal intensive care unit. Clin Perinatol 2008; 35 (01) 199-222
• 8 Chien LY, Macnab Y, Aziz K, Andrews W, McMillan DD, Lee SK. ; Canadian Neonatal Network. Variations in central venous catheter-related infection risks among Canadian neonatal intensive care units. Pediatr Infect Dis J 2002; 21 (06) 505-511
• 9 Chiesa C, Panero A, Osborn JF, Simonetti AF, Pacifico L. Diagnosis of neonatal sepsis: a clinical and laboratory challenge. Clin Chem 2004; 50 (02) 279-287
• 10 Stoll BJ, Hansen N, Fanaroff AA. et al. Late-onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics 2002; 110 (2 Pt 1): 285-291
• 11 Butler-O'Hara M, Buzzard CJ, Reubens L, McDermott MP, DiGrazio W, D'Angio CT. 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 2006; 118 (01) e25-e35
• 12 O'Grady NP, Alexander M, Burns LA. et al; Healthcare Infection Control Practices Advisory Committee (HICPAC). Guidelines for the prevention of intravascular catheter-related infections. Clin Infect Dis 2011; 52 (09) e162-e193
• 13 Stoll BJ, Hansen NI, Adams-Chapman I. et al; National Institute of Child Health and Human Development Neonatal Research Network. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA 2004; 292 (19) 2357-2365
• 14 Grisaru-Soen G, Sweed Y, Lerner-Geva L. et al. Nosocomial bloodstream infections in a pediatric intensive care unit: 3-year survey. Med Sci Monit 2007; 13 (06) CR251-CR257
• 15 Ting JY, Goh VS, Osiovich H. Reduction of central line-associated bloodstream infection rates in a neonatal intensive care unit after implementation of a multidisciplinary evidence-based quality improvement collaborative: a four-year surveillance. Can J Infect Dis Med Microbiol 2013; 24 (04) 185-190
• 16 Mutlu M, Aslan Y, Kul S, Yılmaz G. Umbilical venous catheter complications in newborns: a 6-year single-center experience. J Matern Fetal Neonatal Med 2016; 29 (17) 2817-2822
• 17 Sulemanji M, Vakili K, Zurakowski D, Tworetzky W, Fishman SJ, Kim HB. Umbilical venous catheter malposition is associated with necrotizing enterocolitis in premature infants. Neonatology 2017; 111 (04) 337-343
• 18 Gupta R, Drendel AL, Hoffmann RG, Quijano CV, Uhing MR. Migration of central venous catheters in neonates: a radiographic assessment. Am J Perinatol 2016; 33 (06) 600-604
• 19 Hoellering A, Tshamala D, Davies MW. Study of movement of umbilical venous catheters over time. J Paediatr Child Health 2018; 54 (12) 1329-1335
• 20 Yamamoto AJ, Solomon JA, Soulen MC. et al. Sutureless securement device reduces complications of peripherally inserted central venous catheters. J Vasc Interv Radiol 2002; 13 (01) 77-81
• 21 Schears G. New standards to improve catheter stabilization and patient and worker safety. J Healthc Risk Manag 2006; 26 (04) 15-18
• 22 Gabriel J. Vascular access devices: securement and dressings. Nurs Stand 2010; 24 (52) 41-46
• 23 Gray ML. Securing the indwelling catheter. Am J Nurs 2008; 108 (12) 44-50 , quiz 50
• 24 Wilder KA, Wall B, Haggard D, Epperson T. CLABSI reduction strategy: a systematic central line quality improvement initiative integrating line-rounding principles and a team approach. Adv Neonatal Care 2016; 16 (03) 170-177
• 25 Kulali F, Çalkavur Ş, Oruç Y, Demiray N, Devrim İ. Impact of central line bundle for prevention of umbilical catheter-related bloodstream infections in a neonatal intensive care unit: a pre-post intervention study. Am J Infect Control 2019; 47 (04) 387-390
• 26 Dambkowski CL, Chehab EF, Shih JD, Venook R, Wall JK. An in vitro assessment of bacterial colonisation rates of goat umbilical cord segments using three embodiments of a novel neonatal umbilical catheter protection device. BMJ Innov 2016; 2: 93-98
• 27 Maki DG, Weise CE, Sarafin HW. A semiquantitative culture method for identifying intravenous-catheter-related infection. N Engl J Med 1977; 296 (23) 1305-1309
• 28 Liñares J, Domínguez MA, Martín R. Current laboratory techniques in the diagnosis of catheter-related infections. Nutrition 1997; 13 (4, Suppl): 10S-14S
• 29 Shih JD, Wood LSY, Dambkowski CL. et al. An in vitro bacterial surface migration assay underneath sterile barrier material commonly found in a hospital setting. J Perinatol 2017; 37 (07) 848-852
• 30 Guembe M, Martín-Rabadán P, Cruces R, Pérez Granda MJ, Bouza E. Sonicating multi-lumen sliced catheter tips after the roll-plate technique improves the detection of catheter colonization in adults. J Microbiol Methods 2016; 122: 20-22
• 31 Moretti EW, Ofstead CL, Kristy RM, Wetzler HP. Impact of central venous catheter type and methods on catheter-related colonization and bacteraemia. J Hosp Infect 2005; 61 (02) 139-145
• 32 Ranucci M, Isgrò G, Giomarelli PP. et al; Catheter Related Infection Trial (CRIT) Group. Impact of oligon central venous catheters on catheter colonization and catheter-related bloodstream infection. Crit Care Med 2003; 31 (01) 52-59
• 33 Corral L, Nolla-Salas M, Ibañez-Nolla J. et al. A prospective, randomized study in critically ill patients using the Oligon Vantex catheter. J Hosp Infect 2003; 55 (03) 212-219