What Skin Preparation is Recommended for Skin Disinfection Prior to Vascular Access Device Insertion for Pre-term Babies?

For pre-term neonates, low birth weight infants, and within the first 14 days of life, the Infusion Nurses Society Infusion Therapy Standards of Practice (9th ed.) recommends:

1. Use povidone-iodine, alcohol-based or aqueous chlorhexidine solution.

2. Use both aqueous and alcohol-based chlorhexidine with caution, weighing the benefits versus the risks of chemical burns to the skin. Systemic absorption has been reported due to skin immaturity; however, systemic effects are not documented. Studies have not established one antiseptic solution as superior for safety or efficacy in neonates

3. Avoid the use of tincture of iodine due to the potential deleterious effect on the neonatal thyroid gland.

4.  Remove povidone-iodine after the procedure is complete using sterile water or saline; while there is no evidence of sustained toxicity resulting from CHG remaining on the skin, an aqueous formulation may require removal due to its soapy consistency, which may affect dressing adherence.

 NOTE: This is level III evidence, which means it is based on:

One well-designed RCT, several well-designed clinical trials without randomization, or several studies with quasi-experimental designs focused on the same question. Includes 2 or more well-designed laboratory studies. 

So this is not high level evidence, but it’s the best we have at this point, taking into consideration risk of infection, skin injury and systemic absorption.

References

Kieran EA, O’Sullivan A, Miletin J, Twomey AR, Knowles SJ, O’Donnell CPF. 2% chlorhexidine-70% isopropyl alcohol versus 10% povidoneiodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial. Arch Dis Child Fetal Neonatal Ed. 2018;103(2):F101-F106. doi:10.1136/archdischild-2016-312193 

Nickel, B., Gorski, L., Kleidon, T., Kyes, A., DeVries, M., Keogh, S., Meyer, B., Sarver, M. J., Crickman, R., & Ong, J. (2024). Infusion therapy standards of practice. Journal of Infusion Nursing, 47(1S), S1-S285. 

Sathiyamurthy S, Banerjee J, Godambe SV. Antiseptic use in the neonatal intensive care unit - a dilemma in clinical practice: an evidence based review. World J Clin Pediatr. 2016;5(2):159-171. doi:10.5409/ wjcp.v5.i2.159

Sharma A, Kulkarni S, Thukral A, et al. Aqueous chlorhexidine 1% versus 2% for neonatal skin antisepsis: a randomised non-inferiority trial. Arch Dis Child Fetal Neonatal Ed. 2021;106(6):F643-F648. doi:10.1136/archdischild-2020-321174

Sharpe EL, Curry S, Wyckoff MM. Peripherally Inserted Central Catheters: Guideline for Practice (4th ed). National Association of Neonatal Nurses; 2022.

Vanzi V, Pitaro R. Skin Injuries and chlorhexidine gluconate-based antisepsis in early premature infants: a case report and review of the literature. J Perinat Neonatal Nurs. 2018;32(4):341-350. doi:10.1097/ JPN.0000000000000334

Last Updated on: 28/10/2024