A national survey of percutaneous central venous catheter practices in neonates.

PURPOSE: This study was conducted to describe current practices for maintenance of percutaneous central venous catheters (PCVCs). DESIGN: A survey technique was used. SAMPLE: A national mailing to 511 nurseries resulted in a response from 309. Of those who responded, 206 reported using PCVCs. MAIN OUTCOME VARIABLE: Maintenance practices for PCVCs. RESULTS: The most common catheter site preparation technique was the use of Betadine, or Betadine and alcohol. Transparent dressings were the most commonly used site cover, and were changed when loose or soiled. Contamination precautions varied; most nurseries used Y-administration sets and extension tubing for medication administration into the PCVC system.

Catheter-related sepsis in the neonate: thinking critically about a persistent problem.

Catheter-related sepsis (CRS) is a clinical problem gaining increasing attention in the literature. Before strategies for reducing the incidence of CRS can be identified, a consistent definition of the problem must be developed. Critical thinking is an intellectual process used to reflect upon a topic of interest. The critical thinking process provides a framework for comprehensive analysis of patient care problems. The article describes the critical thinking process and proposes a model of critical thinking for practicing nurses. This model is applied to the development of comprehensive definitions for CRS that may be used by neonatal nurses for clinical and research purposes.

Percutaneous central venous catheters in neonates: a descriptive analysis and evaluation of predictors for sepsis.

The article describes the experience with percutaneous central venous catheters in 565 neonates with birth weights of 400 to 6810 g. The catheter-related sepsis incidence was 19.1%, or 13.5 infections per 1000 catheter days. By discriminant function analysis, 86% of all neonates studied were correctly classified into the confirmed sepsis and no sepsis groups on the basis of six predictor variables. The model did not accurately predict the neonates who would develop confirmed sepsis. The weight at catheter insertion and length of time for which the catheter was in place were identified as variables that contributed significantly to differentiation between sepsis and no sepsis groups.

Percutaneous central venous catheter-related sepsis in the neonate: an analysis of the literature from 1990 to 1994.

Percutaneous central venous catheters (PCVCs) have been used in neonates since the 1970s. During the 1980s, they were introduced in many NICUs. Most studies published to date employ a descriptive methodology. There are very few randomized clinical trials with PCVCs in neonates, and no integrated literature reviews have been published to date. Furthermore, infection in neonates with PCVCs has become a major concern. This integrated literature review was conducted to delineate the scope of the problem of sepsis in neonates with central venous catheters and to identify current research directed at methods to reduce catheter-related sepsis (CRS) in high-risk neonates. Twenty-five references were found and analyzed for this review. The definitions used to identify CRS in neonates varied greatly among studies. The method of calculating the CRS rate varied as well. The CRS rates ranged from 0 to 29 percent or from 0 to 15.3 infections per 1,000 catheter days. Strategies employed to reduce CRS rates are presented along with recommendations for future research.

Community health nursing assessment of neurodevelopment in high-risk infants.

All infants discharged from designated perinatal center neonatal intensive care units in Illinois are referred for follow-up home visits by community health nurses. These visits provide parental support, teaching, and anticipatory guidance plus physical and developmental assessment of the infant. The maternal and child nursing consultants who coordinate this follow-up program are frequently called upon to assist the community health nurses in physical/developmental assessment techniques. The neurodevelopmental component of the assessment, including areas of alertness, tone, head circumference, vision and hearing screening, plus primitive reflexes, is described.

Hemophilia B. Case study and intervention plan.

Persistent bleeding from the circumcision site or umbilicus of a newborn male should alert the neonatal nurse to the possibility of hemophilia. Treatment of hemophilia B requires immediate medical and nursing intervention as well as long-term follow-up so that psychosocial, developmental, and physiological needs of the infant and family are met. Most important, treatment requires an organized team approach. Information to assist the nurse in the treatment of the infant and family is presented.

Perinatal factors and the developmental outcome of preterm infants.

To determine the developmental outcome of sick preterm infants, a retrospective analysis of 101 preterm infant survivors, cared for a teaching hospital's neonatal intensive care unit, was conducted. Information regarding the one-year developmental outcome was compared with significant perinatal factors: birth weight, gestational age, neonatal mortality index, respiratory distress syndrome (RDS) severity, and high-risk pregnancy factors. Eighteen percent of all infants studied had developmental delays indicating an improved prognosis for preterm infants. Severe RDS survivors had the greatest incidence of developmental delays and the most high-risk pregnancy histories.