Çocuklarda periferik intravenöz kateterizasyonda cilt antisepsisi için %5 NaHCO3: Randomize Kontrollü Bir Çalışma

Abstract

ÖZ Amaç: Periferik intravenöz kateterizasyon uygulamalarında, prosedürel sorunlar lokal veya sistemik enfeksiyonlara neden olabilir. Bu çalışmanın amacı kateterizasyon öncesi cilt antisepsisinde %5 Sodyum Bikarbonat'ın antimikrobiyal etkisini belirlemektir. Gereç ve Yöntem: Çalışma randomize, tek kör ve deneysel olarak yapıldı. Çalışmada periferik intravenöz kateterizasyon öncesi %5 Sodyum Bikarbonat ile cilt antisepsisi uygulandı. Karşılaştırma grubu olarak %2 Klorheksidin Glukonat ve %70 Alkol kullanıldı. Kateter antisepsi uygulandıktan sonra yerleştirildi. Kateterizasyondan bir ve 24 saat sonra deri sürüntüleri alındı ve analiz edildi. Lokal ve sistemik enfeksiyon bulguları ve vital bulgular 12 saatte bir ölçüldü. Bulgular: 5 Sodyum Bikarbonat cilt antisepsisinde antimikrobiyal etki gösterdi. Sistemik enfeksiyon bulgusu yoktu ve vital bulgular normal sınırlardaydı. En yaygın bakteriyel alt tip Staphylococcus hominis olup, çocukların %8,1'inin deri sürüntülerinde bulunmuştur. Sonuç: 5 sodyum bikarbonat çocuklarda cilt antisepsisi için etkili ve uygun maliyetli bir ajan olabilir. Periferik intravenöz kateterizasyondan önce cilt antisepsisi için kullanılabilir. Farklı konsantrasyonlardaki sodyum bikarbonat solüsyonlarının etkinliği araştırılmalıdır.

Keywords

• Antiseptik
• kateter ilişkili enfeksiyon
• klorheksidin glukonat
• hemşirelik bakımı
• periferik intravenöz kateterizasyon
• sodyum bikarbonat.

5% NaHCO3 for skin antisepsis in peripheral intravenous catheterization in children: A Randomized Controlled Study

Abstract

ABSTRACT Aim: In peripheral intravenous catheterization applications, procedural problems may cause local or systemic infections. The aim of this study was to determine the antimicrobial effect of 5% Sodium Bicarbonate in skin antisepsis before catheterization. Material and Method: The study was randomized, single blind and experimental. In the study, skin antisepsis was used with 5% sodium bicarbonate before peripheral intravenous catheterization. Chlorhexidine gluconate 2% and alcohol 70% were used as a comparison group. The catheter was inserted after antisepsis was applied. One and 24 hours after catheterization, skin swabs were taken and analyzed. Local and systemic infection findings and vital signs were measured every 12 hours. Results: 5% Sodium Bicarbonate showed antimicrobial effect in skin antisepsis. There was no evidence of systemic infection and vital signs were within normal limits. The most common bacterial subtype was Staphylococcus hominis, which was found in skin swabs of 8.1% of the children. Conclusions: The 5% sodium bicarbonate may be an effective and cost-effective agent for skin antisepsis in children. It can be used for skin antisepsis before peripheral intravenous catheterization. The efficacy of different concentrations of sodium bicarbonate solutions should be investigated.

Keywords

• Antiseptic
• catheter-related infection
• sodium bicarbonate.
• chlorhexidine gluconate
• nursing care
• peripheral intravenous catheterization

Ethical Statement

Ethics committee approval was obtained from the Istanbul University- Cerrahpaşa, Clinical Research Ethics Committee (10/07/2018/347).

References

1. 1. Camacho-Ortiz A, Roman-Mancha AL. Forget skin scrubbing and other antiseptics: prevent catheter related infections using chlorhexidine plus alcohol. Ann. Transl. Med, 2016;4(4):81-3. http://dx.doi.org/10.3978/j.issn.2305-5839.2016.01.04
2. 2. Indarwati F, Mathew S, Munday J, et al. Incidence of peripheral intravenous catheter failure and complications in pediatric patients: Systematic review and meta-analysis. Int. J. Nurs. Stud, 2020;102:1-11. https://doi.org/10.1016/j.ijnurstu.2019.103488
3. 3. Aygun F, Aygun D, Cokugras H, et al. The frequency of catheter-related infections in pediatric patients; One year experience. J Pediatr Infect, 2017;11(2):76-81.
4. 4. Newman CD. Catheter-related bloodstream infections in the pediatric intensive care unit. Semin Pediatr Infect Dis, 2006;17:20-24. https://doi.org/10.5578/ced.201724
5. 5. Centers for Disease Control and Prevention (CDC). National Healthcare Safety Network (NHSN) Patient Safety Component Manual; 2020. Available from: https://www.cdc.gov/nhsn/datastat/
6. 6. Yasuda H, Sanui M, Abe T, et al. Comparison of the efficacy of three toPICal antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study. Critical Care, 2017;21(320):1-10. https://doi.org/10.1186/s13054-017-1890-z
7. 7. Abolfotouh AA, Salam M, Bani-Mustafa A, et al. Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Ther Clin Risk Manag, 2014;10:993–1001. http://dx.doi.org/10.2147/TCRM.S74685
8. 8. Zhang L, Cao S, Marsh N, et al. Infection risks associated with peripheral vascular catheters. Journal of Infection Prevention, 2016;17(5):207-13. http://dx.doi.org/10.1177/1757177416655472

9. 9. Rundjan L. Skin antiseptic choice to reduce catheter-related bloodstream infections. Paediatr. Indones, 2011;51(6):345-350. https://doi.org/10.14238/pi51.6.2011.345-50
10. 10. Sonmez Duzkaya D, Canbulat Sahiner N, Uysal G, et al. Chlorhexidine-ımpregnated dressings and prevention of catheter-associated bloodstream infections in a pediatric intensive care unit. Crit. Care Nurse, 2016;36(6):e1-e7. http://dx.doi.org/10.4037/ccn2016561
11. 11. Suliman M, Saleh W, Al-shiekh H, et al. The incidence of peripheral intravenous catheter phlebitis and risk factors among pediatric patients. J. Pediatr. Nurs, 2020;50:89–93. https://doi.org/10.1016/j.pedn.2019.11.006
12. 12. Boyce JM. Best products for skin antisepsis. Am. J. Infect. Control, 2019;47:A17−A22. https://doi.org/10.1016/j.ajic.2019.03.012
13. 13. Ersoz SE, Akkaya A, Kocoglu E, et al. Comparison of the antiseptic effects of octenidine hydrochloride, chlorhexidine gluconate and povidone iodide in central and peripheral venous catheter applications. Abant Medical Journal, 2016;5(1):16-22. https://doi.org/10.5505/abantmedj.2016.94824
14. 14. Wu H, Xu Y, Shi J. 5% NaHCO3 is appropriate for skin cleaning with central venous catheters. Am J Med Sci, 2017;353(1):12–16. https://doi.org/10.1016/j.amjms.2016.10.010
15. 15. Clarke P, Craig JV, Wain J, et al. Safety and efficacy of 2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheter insertion in preterm neonates: the ARCTIC randomised-controlled feasibility trial protocol. BMJ Open 2019;9:1-8. https://doi.org/10.1136/bmjopen-2018-028022
16. 16. Kieran EA, O’Sullivan A, Miletin J, et al. 2% chlorhexidine–70% isopropyl alcohol versus 10% povidone–iodine for insertion site cleaning before central line insertion in preterm infants: A randomized trial. Arch Dis Child Fetal Neonatal Ed, 2018;103:F101–F106. https://doi.org/10.1136/archdischild-2016-312193
17. 17. McCord H, Fieldhouse E, El-Naggar W. Current Practices of Antiseptic Use in Canadian Neonatal Intensive Care Units. Am. J. Perinatol, 2018;1:1-5. https://doi.org/10.1055/s-0038-1661406.
18. 18. Cabrera-Jaime S, Martínez C, Ferro-García T, et al. Efficacy of Plantago major, chlorhexidine 0.12% and sodium bicarbonate 5% solution in the treatment of oral mucositis in cancer patients with solid tumour: A feasibility randomised triple-blind phase III clinical trial. European Journal of Oncology Nursing 2018;32:40–47. https://doi.org/10.1016/j.ejon.2017.11.006
19. 19. Letscher-Bru V, Obszynski CM, Samsoen M, et al. Antifungal Activity of Sodium Bicarbonate Against Fungal Agents Causing Superficial Infections. Mycopathologia, 2013;175:153-158. https://doi.org/10.1007/s11046-012-9583-2
20. 20. Madeswaran S, Jayachandran S. Sodium bicarbonate: A review and its uses in dentistry. Indian J Dent Res, 2018;29:672-7. Available from: https://www.ijdr.in/text.asp?2018/29/5/672/244935
21. 21. Farha MA, French S, Stokes JM, et al. Bicarbonate alters bacterial susceptibility to antibiotics by targeting the proton motive force. ACS Infect. Dis, 2018;4:382−390. https://doi.org/10.1021/acsinfecdis.7b00194
22. 22. Maki DG, Kluger DM, Crnich CJ. The risk of bloodstream infection in adults with different intravascular devices: A systematic review of 200 published prospective studies. Mayo Clin Proc, 2006;81(9):1159-1171. https://doi.org/10.4065/81.9.1159
23. 23. Casey AL, Badia JM, Higgins A, et al. Skin antisepsis: it’s not only what you use, it’s the way that you use it. Journal of Hospital Infection, 2017;96:221-222 http://dx.doi.org/10.1016/j.jhin.2017.04.019
24. 24. Gorski LA. The 2016 infusion therapy standards. Home Healthc, 2017;35(1):10-18. http://dx.doi.org/10.1097/NHH.0000000000000481
25. 25. Infusion Nursing Society (INS). Infusion Nursing Grand Rounds. J. Infus. Nurs, 2016;40(5):266–268. https://doi.org/10.1097/nan.0000000000000241
26. 26. Mermel LA, Allon M, Bouza E, et al. Clinical practice guidelines for the diagnosis and management of ıntravascular catheter-related ınfection: 2009 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 2009;49:1–45. http://dx.doi.org/10.1086/599376
27. 27. O’Grady NP, Alexander M, Burns LA, et al. Guidelines for the prevention of intravascular catheter-related infections 2011, (Update 2017) American Journal of Infection Control 2017;39:S1-34. 28. Yilmaz E. Common Infections and Evidence-Based Practices in Intensive Care Units. Common infections and evidence-based practices in intensive care units. (Editor Ozer N). Intensive Care Nurs 1st Edition. Ankara, Turkey Clinics, 2019;27-36.
28. 29. Ben Abdelaziz R, Hafsi H, Hajji H, et al. Peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study. BMC Pediatrics, 2017;17(208):1-11. https://doi.org/10.1186/s12887-017-0965-y
29. 30. Akyyildiz B, Kondolot M, Akcakus M, et al. Evaluation of our patients who underwent central venous catheterization in the pediatric intensive care unit: our experience of two years. Journal of Child Health and Diseases, 2009;52:63-67.
30. 31. Aktas E, Sari EN, Seremet Keskin A, et al. Infection Factors and Antibiotic Susceptibility Associated with Intravenous Catheter. Mikrobiyol Bul, 2011;45(1):86-92.