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

Fiammetta Piersigilli; Giulia Iacona; Sarah Yazami; Katherine Carkeek; Catheline Hocq; Cinzia Auriti; Olivier Danhaive

doi:10.1007/s00431-023-05253-0

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

Eur J Pediatr. 2023 Dec;182(12):5607-5613. doi: 10.1007/s00431-023-05253-0. Epub 2023 Oct 10.

Authors

Fiammetta Piersigilli¹, Giulia Iacona², Sarah Yazami³, Katherine Carkeek⁴, Catheline Hocq⁴, Cinzia Auriti⁵, Olivier Danhaive^{4

6}

Affiliations

¹ Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium. Fiammetta.piersigilli@saintluc.uclouvain.be.
² Faculty of Medicine, Imperial College London, London, UK.
³ Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Brussels, Belgium.
⁴ Division of Neonatology, Cliniques Universitaires Saint Luc, Université Catholique de Louvain, Avenue Hippocrate 10, 1200, Brussels, Brussels, Belgium.
⁵ Saint Camillus International, University of Health Sciences, Rome, Italy.
⁶ Division of Neonatology, Benioff Children's Hospital, University of California San Francisco, San Francisco, CA, USA.

PMID: 37816981
DOI: 10.1007/s00431-023-05253-0

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.

Keywords: CLABSI; Central venous catheter; Glue; NICU; Neonate; PICC; Securement.

MeSH terms

Catheter-Related Infections* / epidemiology
Catheter-Related Infections* / etiology
Catheter-Related Infections* / prevention & control
Catheterization, Central Venous* / methods
Central Venous Catheters*
Cyanoacrylates / adverse effects
Humans
Infant
Infant, Newborn
Intensive Care Units, Neonatal

Substances

Cyanoacrylates