Prefilled Saline Syringes versus Those Prepared at Bedside for Flushing Central Venous Catheters in Neonatal ICU

Abstract Background A central line-associated bloodstream infection (CLABSI) is defined as a laboratory-confirmed bloodstream infection not related to an infection at another site that develops within 48 hours of a central line placement. CLABSI is the most common type of nosocomial infection in this population and is a leading cause of morbidity and mortality in NICU. Therefore, more efforts are needed to reduce the incidence of CVC-related infections among NICU patients, and to enhance their survival and prognosis. Aim of the Work To compare the effect of using of prefilled saline syringes prepared in the laminar flow under complete aseptic conditions vs using ones prepared at bedside for central venous access flushing regarding risk of CLABSI, catheter permanence time, risk of thrombosis, and length of stay in our NICU. Patients and Methods This prospective randomized controlled trial in Ain Shams University Hospital NICU over a 6-month period from January 2023 till July 2023. They were selected through simple random sampling method to be divided into 2 groups: Group 1 (cases): 50 patients had their CVCs flushed by 3ml syringe prefilled with saline 0.9% prepared in the laminar flow on the same day. Group 2 (controls): 50 patients had their CVC flushed through manually prepared 3 ml syringe prepared at bedside from a common bottle of saline 0.9%. Results It was found that Group 1 patients had significantly lower incidence of CLABSI than Group 2 patients (4 versus 13 neonates) (p-value <0.0001). The incidence of CVC thrombosis was shown to be less in Group 1, however, this difference was non-significant (2 versus 1 neonate) (p-value 0.557). This study showed there was no statistically significant difference between both groups regarding the catheter permanence time (8.56 ± 6.52 versus 10.46 ± 6.29) (p-value 0.146). There was no statistically significant difference between both groups regarding the length of hospital stay in studied patients, 26.5 (14 – 37) in Group 1 versus 25 (12 – 32) in Group 2 (p-value 0.704). Conclusion The use of prefilled saline syringes for flushing of central venous catheters in neonates has shown to significantly reduce the risk of CLABSI, reduce incidence of catheter- related thrombosis, and flushing time, thus improve quality of care in neonatal ICU.