Care Bundle for Neonatal Vascular Access

1. The Line Team
2. Catheter Type
3. Insertion Site
4. Use Maximum Aseptic/ Barrier Precautions
5. Skin Preparation
6. Securing and Dressing of Line
7. Safe Disposal of Sharps
8. Documentation
9. Care of Line Following Insertion

1. The Line Team

Central to all aspects of CVC insertion. An operator must be assessed as competent by a member of the team before inserting any vascular access unsupervised.

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2. Catheter Type

Choose most appropriate

• Peripheral cannula,
• Double/single lumen umbilical venous catheter,
• Umbilical arterial catheter,
• Nutriline PICC line (2Fr),
• Double lumen long line
• Premicaths

Central venous lines with stylets are available to aid insertion. Seldinger packs are also available to use with 2 Fr lines. These should be used for difficult lines.
Refer to Peripherally Inserted Central (PIC) Lines in Neonates guideline, Insertion of peripheral arterial line

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3. Insertion Site

When selecting the vein or artery be aware of the possible complications associated with insertion. Peripheral cannulae should not be attempted in the common long line sites - i.e. ante-cubital fossae and long saphenous vein.

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4. Use Maximum Aseptic/ Barrier Precautions

Please refer to the following guidelines Hand Hygiene Policy, Aseptic Technique, Matching Michigan checklist on insertion guideline.

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5. Skin Preparation

Clean site with 2% chlorhexidine /70% alcohol and allow to dry for 30 seconds.
For peripheral lines use 0.67ml Chlora Prep
For Umbilical lines and CVC use 1.5ml Chlora Prep
In babies under 30 weeks use DABBING motion.

CAUTION – in babies under 28 weeks clean solution off with sterile water to avoid skin burns – ensure no pooling of solution under baby.

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6. Securing and Dressing of Line

1. CVC – anchor line using Steri-strip, do not encircle the limb. Secure with a semi-permable transparent dressing to allow full observation of insertion site and limb. Dressings should be assessed every day to ensure they are clean and intact. This should be documented in the IPC booklet daily.
2. Umbilical lines – secure using single suture either side of line. Use clean zinc oxide tape to secure to line following confirmation x-ray. Venous and arterial lines should be secured separately.
3. Peripheral Lines – anchor line using Steri-strip and secure with a semi-permable transparent dressing to allow full observation of insertion site and limb.
   

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7. Safe Disposal of Sharps

Please ensure all sharps are disposed of safely and the trolley is left clean.

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8. Documentation

CVC and Umbilical lines insertion – complete Matching Michigan and insertion of line in IPC booklet.
Peripheral insertion – complete IPC booklet, every attempt must be documented. Ensure removal of device is also recorded.

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9 Care of Line Following Insertion

Hourly VIP scores, complete Saving Lives document every shift, ensure lines are not trapped, tangled and all connections are secure. See Saving Lives guidance, SOP for Venous Access Ongoing Care

For arterial lines ensure limbs are pink, warm and well perfused at all times. Any concerns seek medical attention immediately.