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Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications

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Abstract

A “bundle” is defined as a combination of evidence-based interventions that, if followed collectively and reliably, improve patient outcomes. The aim of this quasi-experimental study, conducted in a level-III NICU in Belgium, was to assess the impact of central line dressing and maintenance bundle implementation on the rate of catheter-related mechanical complications. We performed a quality improvement (QI) project. Prior to bundle implementation, neonatal PICC lines were secured by Steri-Strip® and occlusive dressing. We implemented a new PICC bundle consisting of the use of glue, sutureless device (Griplock®), and a transparent dressing to secure the catheter to the skin. We compared the rate of infections, mechanical complications, and dislocations before and after bundle implementation (periods 1 and 2, respectively). The use of glue resulted in a significantly decreased rate of central line–associated bloodstream infection (CLABSI) (p < 0.001), dislocations, and mechanical complications (p < 0.0001). During period 2, there was a significant increase for the average number of days the catheter stayed in place (p < 0.05). We did not observe catheter breakage or patient skin irritations attributable to the use of glue (not even in ELBW infants).

Conclusion: The implementation of the new bundle to secure neonatal PICCs in our NICU was associated with a significant reduction in CLABSI and dislodgment rates, without glue-related complications. Active surveillance of CVC placement procedure, positioning, and management, as well as analysis of related complications is crucial for improving patient safety. Continuous implementation of up-to-date central line bundles based on best practice recommendations is a key for quality improvement in NICUs.

What is Known:

• Stable vascular access is crucial in the NICU. Neonatal PICC securement issues can have serious consequences and are associated with device failure.

What is New:

• Catheter securement with tissue adhesive is safe and effective in reducing failure and complication rates in the neonatal population.

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Data are stored by FP and are available upon request.

Abbreviations

CLABSI:

Central line–associated bloodstream infection

CRBSI:

Catheter-related bloodstream infection

CVC:

Central venous catheter

nPICC :

Neonatal percutaneously inserted central catheter

NICU:

Neonatal Intensive Care Unit

QI:

Quality improvement

ELBW:

Extremely low birth weight

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Authors and Affiliations

  1. Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium

    Fiammetta Piersigilli, Katherine Carkeek, Catheline Hocq & Olivier Danhaive

  2. Faculty of Medicine, Imperial College London, London, UK

    Giulia Iacona

  3. Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium

    Sarah Yazami

  4. Saint Camillus International, University of Health Sciences, Rome, Italy

    Cinzia Auriti

  5. Division of Neonatology, Benioff Children’s Hospital, University of California San Francisco, San Francisco, CA, USA

    Olivier Danhaive

Authors
  1. Fiammetta Piersigilli
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  2. Giulia Iacona
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  3. Sarah Yazami
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  4. Katherine Carkeek
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  5. Catheline Hocq
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  6. Cinzia Auriti
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  7. Olivier Danhaive
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Contributions

All the authors have equally contributed to the conception and design of the work; the acquisition, analysis and interpretation of data. All the authors approved the present version for publication.

Corresponding author

Correspondence to Fiammetta Piersigilli.

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Ethical approval

The study complies with the Declaration of Helsinki and was approved by the Hospital Ethics Committee (Hospital Saint Luc, protocol number B4032021000102). Permission from the parents was obtained to review the charts and collect data of the babies.

Competing interests

The authors declare no competing interests.

Additional information

Communicated by Peter de Winter

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Piersigilli, F., Iacona, G., Yazami, S. et al. Cyanoacrylate glue as part of a new bundle to decrease neonatal PICC-related complications. Eur J Pediatr 182, 5607–5613 (2023). https://doi.org/10.1007/s00431-023-05253-0

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  • DOI: https://doi.org/10.1007/s00431-023-05253-0

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