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The following course content

Introduction 

The use of central lines in newborns is a critical aspect of neonatal nursing, often necessitated by the need for long-term intravenous therapy to treat some medical conditions like prematurity and sepsis. These life-saving interventions, however, come with risks, such as infection and discomfort, which require specialized nursing expertise to mitigate. Recent research emphasizes the importance of strict infection prevention protocols and family-centered care to improve infant outcomes and support the emotional well-being of their parents (5).  

This course is meant to equip learners with the knowledge and skills necessary to provide safe, effective, and compassionate care to newborns requiring central lines, while supporting their families. By the end of this course, learners would be well-prepared to excel in central line use in newborns.

Indications of Use 

Central line use in newborns is a crucial medical intervention for specific clinical situations where intravenous access is essential for their well-being. The decision to use central lines in newborns is guided by various indications. See examples of indications below. 

Prematurity 

One common indication for central line use in newborns is their admission to the Neonatal Intensive Care Unit (NICU), often stemming from prematurity. Extremely premature infants born before twenty-eight weeks of gestation frequently have underdeveloped veins, challenging peripheral intravenous access. In such cases, central lines are essential for administering vital medications, parenteral nutrition, and other therapeutic interventions (1).  

Prolonged Intravenous Therapy 

Another indication for central line placement in newborns is when infants require prolonged intravenous therapy, such as antibiotics or chemotherapy. Peripheral venous access may not be sufficient or may cause discomfort and complications due to the extended duration of treatment. In such cases, central line insertion is warranted to provide continuous, reliable access, as recommended by the Centers for Disease Control and Prevention (4). 

Hemodynamic Monitoring and Critical Illness 

Newborns with critical medical conditions, such as congenital heart disease or respiratory distress syndrome, often require meticulous hemodynamic monitoring and frequent blood sampling. Peripheral access may not provide adequate blood flow for accurate monitoring or may limit the frequency of necessary blood tests. In scenarios like these, the placement of a central line, as outlined in clinical practice guidelines by (7), allows healthcare providers to continuously assess the infant’s hemodynamic status, administer medications, and obtain blood samples without causing unnecessary distress to the newborn.

Types of Central Lines 

The selection of the appropriate type of central line depends on the clinical condition and other factors like gestational age and the anticipated duration of therapy. Umbilical venous catheters (UVCs), peripherally inserted central catheters (PICCs), and central venous catheters (CVCs) are three common types, each with unique advantages and appropriate clinical scenarios. Let’s see the details below. 

Umbilical Venous Catheters (UVCs) 

One of the most frequently used central lines in newborns is the umbilical venous catheter (UVC). This catheter is inserted into the umbilical vein through the stump, providing direct access to the systemic circulation. UVCs are particularly advantageous for newborns as they offer a relatively simple insertion process, are less invasive, and can remain in place for an extended period (1). 

Peripherally Inserted Central Catheters (PICCs) 

Peripherally inserted central catheters (PICCs) are another valuable option for central vascular access in newborns, particularly when long-term therapy is anticipated. PICCs are typically inserted through a peripheral vein, such as the basilic or brachial vein, and advanced until the catheter tip resides in a larger central vessel. They are suitable for a wide range of therapeutic needs and can be used for extended durations, enabling the delivery of medications directly into the central circulation, ensuring optimal treatment while minimizing discomfort for the infant (8). 

Central Venous Catheters (CVCs) 

In specific clinical scenarios where critical care is necessary, such as neonatal intensive care units (NICUs), Central venous catheters (CVCs) may be used. CVCs are inserted into larger central veins, such as the superior vena cava or the inferior vena cava, via surgical or percutaneous methods. These catheters are reserved for situations requiring extensive monitoring, hemodynamic support, or complex therapies to ensure reliable access and comprehensive care (7). 

Education for Parents/Guardians 

Educating a parent(s)/guardian(s) (termed “parents” for the sake of this course) about the use of central lines in newborns is a vital aspect of neonatal care, ensuring informed decision-making and the overall well-being of both the infants and their families. Let’s see some ways that education is crucial. 

Informed Consent and Shared Decision-Making 

Educating parents about the use of central lines in their newborns facilitates informed consent and shared decision-making between healthcare providers and families. This is because parents need to understand the purpose, benefits, risks, and alternatives associated with central line placement before they can be able to make informed decisions. Consider a scenario where a newborn is born prematurely and requires a central line for parenteral nutrition. Through comprehensive education, parents can actively participate in discussions with healthcare providers, to make decisions that align with their values and preferences. This approach is consistent with ethical principles and guidelines outlined by the American Academy of Pediatrics (2), emphasizing the importance of respecting parental autonomy in medical decision-making. 

Mitigating Anxiety and Stress 

The prospect of a central line placement in a newborn can be emotionally distressing for their parents. Educating parents about the procedure, potential complications, and aftercare can help alleviate anxiety and stress. For instance, imagine a newborn diagnosed with a congenital heart condition necessitating a central venous catheter (CVC). By providing parents with information about what to expect during and after the procedure and strategies to support their infant, healthcare providers can empower better coping with the situation (5). Reducing parental stress can improve outcomes for both the infant and the family. 

Participation in Care 

Educated parents are better equipped to actively participate in their newborn’s care and monitor for any signs of complications or infections related to the central line. This proactive involvement can lead to early detection and timely intervention, ultimately improving patient safety and outcomes. In a scenario where a newborn has a Peripherally Inserted Central Catheter (PICC) for an extended course of antibiotics, informed parents can help identify signs of infection or line-related issues, allowing for prompt communication with the healthcare team and appropriate actions (4). 

Establishing Realistic Expectations 

Providing parents with comprehensive education helps set realistic expectations regarding the central line’s role in their newborn’s care. Understanding the limitations and benefits of central lines can prevent misconceptions and dissatisfaction. For instance, if a newborn requires a central line for intravenous antibiotics, parents should know that this intervention is critical to their infant’s treatment but does not eliminate all risks or challenges. Realistic expectations foster partnerships between healthcare providers and parents, promoting trust and open communication (2).

Before the Procedure 

Educating parents before the procedure of central line placement in their newborns ensures that they are well-informed, empowered to make decisions, and better prepared to support their newborn during this critical phase of care. Here are helpful vital aspects of education before the procedure. 

Purpose and Medical Necessity 

Parents should be informed about the specific medical necessity and purpose of central line placement in their newborn. This includes explaining the underlying medical condition that requires the central line, the expected benefits of the procedure, and how it will support the infant’s treatment and recovery. For instance, consider a scenario where a newborn is born prematurely at 26 weeks of gestation and requires a central line for parenteral nutrition. It would be helpful to provide parents with a clear understanding of how the central line will deliver essential nutrients directly into the bloodstream to support their infant’s growth and development (1). 

Procedure Details and Risks 

Parents should be informed about what to expect before, during, and after the procedure; potential risks, and complications such as infection, bleeding, or displacement of the line. In addition, parents need to be aware of the steps necessary to minimize risks, like sterile techniques and regular line maintenance to prevent infection (4). 

Alternatives and Decision-Making 

Parents should be educated about viable options for central line placement, if applicable, and engaged in shared decision-making. The nurse should describe the pros and cons of each option, allowing parents to actively participate in the decision-making process. When a newborn requires long-term intravenous therapy, the nurse can present parents with the choice between a central line and multiple peripheral venipunctures, highlighting the benefits of central line placement in terms of reduced pain and trauma for the infant (2). 

Monitoring and Preventive Measures 

Parents should receive detailed information about monitoring and preventive measures before the procedure. For example, proper line maintenance, hygienic practices, the signs and symptoms of infection or catheter malfunction, and when to seek medical attention. For instance, for a newborn with a central venous catheter (CVC), the nurse can educate parents on the importance of regular dressing changes and hand hygiene to reduce the risk of infection (7). 

Emotional Support and Coping Strategies 

Parents should be educated about available resources and coping strategies to help them navigate the stress and anxiety of caring for a critically ill newborn (5). 

During the Procedure 

Educating parents while their newborn receives treatment via a central line is crucial for ensuring the safety and well-being of both the infant and the family. Here are essential vital aspects for education. 

Infection Prevention and Line Care 

Parents should receive comprehensive education on infection prevention and the proper care of the central line. They should be educated about the importance of maintaining a sterile environment around the line, including hand hygiene, dressing changes, and handling any equipment connected to the line. In addition, they should be provided with guidance on recognizing signs of infection, such as fever or redness at the insertion site (4). 

Monitoring and Recognizing Complications 

Parents need to be trained to watch their newborn for any signs of complications like redness, swelling, or leakage; and what to do if they observe any concerning changes. Additionally, they should be provided with guidance on monitoring the newborn’s general health, including temperature, heart rate, and overall comfort (7). 

Medication Administration and Management 

If the central line is used for medication administration, parents should receive detailed instructions on the proper administration techniques and medication schedules. The nurse needs to explain the purpose of each medication, potential side effects, storage, how to dispose of supplies, and the importance of adhering to the prescribed regimen (1). 

Follow-Up Care 

As the infant’s condition improves, parents should be given proper guidance on what to expect after the central line is removed and any necessary follow-up appointments or tests (8). 

Post-Procedure Care 

Educating parents after their newborn completes treatments via a central line is crucial to both ensuring a smooth transition to post-treatment care and promoting the well-being of the infant and the family. Here are some key aspects for education. 

Wound Care 

Parents should receive comprehensive education on what to expect during the removal procedure, any potential discomfort for the infant, and the importance of keeping the site clean and dry to prevent infection (4). 

Transition to Oral Medications or Feeding 

If the central line was used for medication administration or nutrition, parents should be educated on the smooth transition to oral medications or feeding to ensure proper nutrition and growth (1). 

Monitoring for Late-Onset Complications: 

Parents need to be informed about the possibility of late-onset complications or side effects related to central line treatments like infections or thrombosis, the signs and symptoms to look for, and when to seek medical attention (7). 

Follow-Up Care and Appointments 

Parents need to be guided on any necessary follow-up care and appointments after central line removal, what to expect during them, and why they are essential for monitoring the infant’s health and recovery (8). 

Emotional Support and Coping Strategies 

Parents should be given resources and coping strategies to help them transition from intensive treatment to post-treatment care and home life (5).

Preventing Central Line-Associated Bloodstream Infection 

Central Line-Associated Bloodstream Infection (CLABSI) is a severe and potentially life-threatening healthcare-associated infection that occurs when bacteria or other pathogens enter the bloodstream through a central venous catheter, leading to systemic infection. Signs of CLABSI include fever, chills, and an elevated white blood cell count. In newborns, CLABSI can manifest as a severe complication, potentially leading to sepsis and organ dysfunction (3). Here are some methods of prevention below. 

Hand Hygiene 

Parents must thoroughly clean their hands with soap and water or an alcohol-based hand sanitizer before and after any contact with the central line (4). 

Proper Catheter Insertion and Maintenance 

Healthcare providers should ensure that catheter insertion is performed using maximal sterile barrier precautions and that lines are appropriately secured and dressed (7).

Chlorhexidine Skin Antisepsis 

Parents should use chlorhexidine gluconate (CHG) for skin antisepsis at the catheter insertion site. CHG is a recommended antiseptic agent known to reduce the risk of infection (6). 

Daily Review and Prompt Removal 

Parents should routinely assess the necessity of central lines and promptly remove them when they are no longer needed to reduce the duration of catheterization (3). 

Family Education and Engagement 

Healthcare providers should educate and engage parents in central line care and infection prevention practices, encouraging parents to actively participate in their newborn’s care and promptly report any signs of infection (6).

Going Home with a Central Line 

Going home with a central line introduces certain risks and challenges. Please see some examples below. 

Risk of Central Line-Associated Bloodstream Infections 

Newborns with central lines face an ongoing risk of CLABSI, even after discharge, caused by inadequate central line care or hygiene at home (6). 

Potential Line Complications 

Central lines can be prone to complications, including dislodgment, blockages, or catheter-related thrombosis. These complications can disrupt the infant’s treatment and require immediate medical attention (1). 

Parental Stress and Anxiety 

Parents may experience high stress and anxiety levels when responsible for central line care at home, impacting their ability to provide adequate care to their baby (5). 

Limited Mobility 

A central line can restrict a newborn’s mobility and limit opportunities for normal developmental activities, such as tummy time and skin-to-skin contact (2). 

Home Environment Challenges: 

The home environment may present additional challenges in maintaining central line care standards, such as proper storage of supplies, maintaining sterility, and providing a safe and clean space for the newborn. (8).  

What Parents/Guardians Need to Know 

To mitigate the above risks and challenges, healthcare providers and families can implement the strategies and solutions below. 

Preventing Central Line-Associated Bloodstream Infections (CLABSI) 

Rigorous infection prevention measures must be consistently practiced. Healthcare providers should educate parents about maintaining sterile techniques during central line care at home, emphasizing proper hand hygiene, dressing changes, and a clean environment. They should also educate parents about promptly reporting of any signs of infection, such as fever or redness at the insertion site, to enable early intervention (6). 

Managing Line Complications 

Parents should receive thorough training on recognizing and responding to potential line complications. They should have the knowledge and skills to perform simple troubleshooting procedures, such as clamping the line in case of dislodgment and promptly contacting healthcare providers when issues arise. Additionally, establishing a clear line of communication with a dedicated healthcare team for immediate guidance and intervention can help address complications swiftly (1).

Alleviating Parental Stress and Anxiety 

Recognizing the emotional burden parents may experience is essential. Healthcare providers can offer continuous emotional support and access to mental health resources and support groups. Additionally, ensuring that parents feel confident in their ability to care for their newborn’s central line by providing comprehensive education and ongoing guidance to help alleviate anxiety (5). 

Promoting Mobility and Development 

A central line can restrict a newborn’s mobility and limit opportunities for normal developmental activities, such as tummy time and skin-to-skin contact (2). Despite the limitations imposed by central lines, healthcare providers should encourage parents to engage in developmental activities that are safe and feasible. Guiding alternative ways to promote bonding and development, such as gentle touch and cuddling, can help parents maintain a meaningful connection with their infant while adhering to central line care protocols (2). 

Overcoming Home Environment Challenges 

Organizing the home environment for central line care is crucial. Healthcare providers can offer practical tips for creating a dedicated, clean, organized space for central line supplies. Additionally, reinforcing the importance of maintaining a sterile field during central line care can help parents navigate home environment challenges effectively (8).

Supporting the Family 

Supporting families as they transition from the hospital to home with a newborn who has a central line is vital for ensuring the infant’s well-being and the family’s confidence in providing care. Here are some ways nurses can offer support. 

Comprehensive Education 

Healthcare providers should educate parents about central line care, hygiene, and emergency procedures (7). 

Emotional Support 

Healthcare providers should acknowledge the stress and anxiety of caring for newborns with a central line at home and offer emotional support to parents (5). 

24/7 Accessibility 

Healthcare providers should ensure that parents have access to someone for guidance and assistance around the clock (3). 

Regular Follow-Up 

Healthcare providers should schedule follow-up appointments and home visits to assess the infant’s condition and provide additional guidance (2). 

Collaborative Care 

Parents should collaborate with other healthcare providers and community resources to ensure a seamless transition and ongoing support (1).

Conclusion

This course was meant to equip learners with the knowledge and skills necessary to provide safe, effective, and compassionate care to newborns requiring central lines, while supporting their families. We discussed the indications and types of central lines, infection prevention strategies, and the crucial role of family education and support in ensuring the safety and well-being of newborns requiring central line care. 

After completing this Central Line Use in Newborns course, we hope that healthcare providers will be empowered with the knowledge and skills necessary to enhance the quality of care provided to newborns with central lines. By adhering to best practices, offering comprehensive family education, and implementing stringent infection prevention measures, healthcare professionals can significantly contribute to improved outcomes, reduced complications, and enhanced well-being for newborns and their families in the challenging journey of central line use in neonatal care.

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