Neonatal skin prep during central catheter insertion
Abstract:
Background and aim: 2% Chlorhexidine gluconate in 70% isopropyl alcohol (2% CHG in 70% IPA) is the recommended skin antiseptic for adult and children during central venous catheter (CVC) insertion but neonatal data are limited. We assessed skin toxicity of 2% CHG in 70% IPA for vascular catheter site preparation in preterm neonates using sterile disposable pre-measured devices.
Study design: Monocentric, retrospective, observational study conducted in tertiary level NICU on 146 neonates less than 32 weeks gestational age (GA) and younger than 15 days.
Methods: Infants were stratified in Group I (GA ⩽ 28 weeks) and Group II (GA = 29-32 weeks) and received skin disinfection with 2% CHG in 70% IPA for either umbilical venous catheters or epicutaneous caval catheters. We evaluated the incidence of skin lesions in preterm neonates who received skin disinfection 2% CHG in 70% IPA with the Neonatal Skin Condition Score. Numeric thresholds ⩽5, 5-7, and >7 were used to define mild, moderate, and severe skin infection respectively. The rate of central line associated bloodstream infection (CLABSI) was also calculated.
Results: Two hundred implanted catheters (100 per group) from 146 neonates were reviewed. While two cases of severe skin lesions occurred locally on the abdomen of two 24 weeks babies, no lesion was reported in Group II infants. We found a CLABSI rate of 16% with a rate of 17 infections per 1000 catheter days.
Conclusion: The use of 2% CHG in 70% IPA for skin disinfection during CVC implantation in preterm infants over 24 weeks GA does not lead to severe skin lesions.
Reference:
Capasso A, Paonessa A, Ferrara T, Grasso F, Capasso L, Migliaro F, Illiano A, Salome S, Zollo M, Amitrano A, Rachiglia M, Raimondi F. Use of 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection during central catheter insertion in premature neonates. J Vasc Access. 2025 Apr 10:11297298251330941. doi: 10.1177/11297298251330941. Epub ahead of print. PMID: 40211584.