Clinical audit on umbilical venous catheterization at NICU of Assiut University Children Hospital

Abstract

Introduction It is known that neonates have a friable Peripheral blood vessels and it is difficult to access, particularly in preterm so we use umbilical arterial catheters (UACs) and umbilical venous catheters (UVCs) to provide easy and rapid access during resuscitation, administration of fluids and parenteral nutrition, frequent blood sampling and blood transfusion in unstable neonates who need urgent intervention. Objectives To check the adherence of the physician to the accepted guidelines for umbilical venous catheterization at Neonatal Intensive Care unit of Assiut University Children Hospital, educate healthcare personnel about the proper method of insertion and maintenance of this line and educate them how to prevent intravascular catheter-related infections. Patient and methods This was prospective Clinical audit study, From the 1st of April 2020 up to the end of December 2020, included All newborn admitted to NICU, at Assiut University Children Hospital during the study period and in need for central lines. We applied Checklist Steps of Umbilical Catheterization (UVC) and determined the percentage of achievement of each step. Results The mean gestational age of the studied cases was 32.61 ± 2.68 weeks, The median birth weight (gram) of the studied cases was 1720, Out of 94 studied cases, 42 (44.7%) were males and 52 (55.3%) were females. and Regarding maturity; the vast majority of the studied cases were preterm (92.6%) and only seven cases (7.4%) were full-term. Concerning the steps of UVC insertion; those steps were done in 100% of cases (washing the cord with an antiseptic tincture, Insertion a sterile umbilical catheter into the vessel, detect a good blood flow through the catheter and adding Tape Bridge for further stability.followed by determining the length of catheter, Cutting the cord in a horizontal way with a scalpel to a length of 1 cm from skin, putting a sterile gloves, a mask and gown, Positioning of the catheter were verified by x-ray and Scrubbing hands to elbow was done in 90 (95.7%) 87 (92.6%), 84 (89.4%),77 (81.9%), 59 (62.8%) of the studied cases respectively. but other steps were done in lower percentages. Conclusion Those steps were done in 100% of cases (washing the cord with an antiseptic solution, Insertion a sterile umbilical catheter into the vessel, detecting a good blood flow through the catheter and Adding Tape Bridge for further stability, but there were defects in all other steps with different percentages.