Abstract
Nosocomial sepsis remains an important cause of morbidity in neonatal intensive care units. Central venous catheters (CVCs) and parenteral nutrition (TPN) are major risk factors. In-line filters in the intravenous (IV) administration sets prevent the infusion of particles, which may reduce infectious complications. We randomized infants to in-line filter (for clear fluids and lipid emulsions) or no filter placement. Sepsis, nursing time and costs were assessed. IV sets without filters were changed every 24 h, IV-sets with filters every 96 h. Of 442 infants with a CVC, 228 were randomized to filter placement, 214 to no filter. No differences were found in clinical characteristics, CVC-use, and catheter days. Nosocomial sepsis occurred in 37 (16.2%) infants with filters, in 35 (16.3%) in the group without filter (NS). Nursing time to change the IV-administration sets was 4 min shorter in the filter-group (P<0.05). Costs of materials used were comparable.
In conclusion, the incidence of sepsis when using filters was not reduced but the nursing time for changing the intravenous sets was reduced without a difference in costs.
References
1 Avila-Figueroa C, DA Goldmann, DK Richardson, JE Gray, A Ferrari, J Freeman: Intravenous lipid emulsions are the major determinant of coagulase-negative staphylococcal bacteremia in very low birth weight newborns. Pediatr Infect Dis J17 (1998) 10Search in Google Scholar
2 Baier RJ, JA Bochini Jr, EG Brown: Selective use of vancomycin to prevent coagulase-negative staphylococcocal nosocomial bacteremia in high risk very low birth weight infants. Pediatr Infect Dis J17 (1998) 179Search in Google Scholar
3 Ball PA: Intravenous in-line filters: filtering the evidence. Curr Opin Nutr Metab Care6 (2003) 31910.1097/00075197-200305000-00009Search in Google Scholar
4 Baumgartner TG, GL Schmidt, RM Thakker, HS Sitren, JJ Cerda, SM Mahaffey, EM Copeland: Bacterial endotoxin retention by in-line intravenous filters. Am J Hosp Pharm43 (1986) 681Search in Google Scholar
5 Bethune K, PG Dip, M Allwood, C Grainger, C Wormleighton: Use of filters during the preparation and administration of parenteral nutrition: Position paper and guidelines prepared by a British Pharmaceutical Nutrition Group Working Party. Nutrition17 (2001) 403Search in Google Scholar
6 Fanaroff AA, SB Korones, LL Wright, J Verter, RL Poland, CR Bauer, JE Tyson, JB Philips III, W Edwards, JF Lucey, CS Catz, S Shankaran, W Oh: Incidence, presenting features, risk factors and significance of late-onset septicemia in very low birth weight infants. Pediatr Infect Dis J17 (1998) 593Search in Google Scholar
7 Freeman J, DA Goldmann, NE Smith, DG Sidebottom, MF Epstein, R Platt: Association of intravenous lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units. New Engl J Med323 (1990) 301Search in Google Scholar
8 Kacica MA, MJ Horgan, L Ochoa, R Sandler, ML Lepow, RA Venezia: Prevention of gram-positive sepsis in neonates weighing less than 1500 grams. J Pediatr125 (1994) 253Search in Google Scholar
9 Krediet TG, ME Jones, LJ Gerards, A Fleer: Clinical outcome of cephalotin versus vancomycin therapy in the treatment of coagulase-negative staphylococcal septicemia in neonates: relation to methicillin resistance and mecA gene carriage of blood isolates. Pediatrics103 (1999) e2910.1542/peds.103.3.e29Search in Google Scholar
10 Kunac DL, PA Ball, RS Broadbent: In-line Intravenous Filtration in Neonates. Help not hindrance. Austr J Hosp Pharm29 (1999) 321Search in Google Scholar
11 van Lingen RA, W Baerts, ACM Marquering, GJHM Ruijs: The use of in-line intravenous filters in sick newborn infants. Acta Paediatr93 (2004) 658Search in Google Scholar
12 O'Grady NP, M Alexander, EP Dellinger, JL Gerberding, SO Heard, DG Maki, H Masur, RD McCormick, LA Mermel, ML Pearson, II Raad, A Randolph, RA Weinstein: Guideline for the prevention of intravascular catheter-related infections. Pediatrics110 (2002) e5110.1542/peds.110.5.e51Search in Google Scholar
13 Spafford PS, RA Kikkin, C Cox, L Renbens, KR Powell: Prevention of central venous catheter related coagulase-negative staphylococcal sepsis in neonates. J Pediatr125 (1994) 259Search in Google Scholar
14 Spencer RC. Use of in-line filters for intravenous infusions. J Hosp Infect16 (1990) 28110.1016/0195-6701(90)90117-7Search in Google Scholar
15 Stoll BJ, T Gordon, SB Korones, S Shankaran, JE Tyson, CR Bauer, AA Fanaroff, JA Lemons, EF Donovan, W Oh, DK Stevenson, RA Ehrenkranz, LA Papile, J Verter, LL Wright: Late-onset sepsis in very low birth weight neonates: a report from the National Institute of Child Health and Human Development Neonatal Research Network. J Pediatr129 (1996) 63Search in Google Scholar
16 Stromberg C, J Wahlgren: Saving money with effective in-line filters. Intensive Care Nursing5 (1989) 109Search in Google Scholar
17 Trautman M, B Zauser, H Wiedeck, K Buutenschon, R Marre: Bacterial colonization and endotoxin contamination of intravenous fluids. J Hosp Infect37 (1997) 225Search in Google Scholar
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