Peripheral Intravenous Catheterization Practices And A New Approach To Skin Antisepsis: 5% NaHCO3
Özet
Peripheral intravenous catheters (PICs) are essential in modern healthcare for diagnosis and treatment, but they pose significant risks of catheter-related infections (CRIs). These infections are particularly complex in pediatric patients due to physiological and treatment differences. Effective skin antisepsis prior to catheter insertion is critical to preventing infections, which primarily stem from skin flora contamination. While traditional antiseptic solutions like 70% Alcohol, 2% Chlorhexidine Gluconate (CHG), and 10% Povidone Iodine are widely utilized, they present specific safety challenges in children, such as skin irritation, potential thyroid dysfunction, and restricted use in newborn infants. Consequently, recent research introduces a new approach utilizing a 5% Sodium Bicarbonate (NaHCO3) solution in distilled water. This alternative is non-volatile, inexpensive, non-toxic to infants, and effectively removes greasy skin secretions while successfully controlling microbial adhesion. Nursing compliance with standardized catheterization bundles—emphasizing rigorous hand hygiene, accurate vascular selection, proper fixation, and regular site monitoring—remains paramount in minimizing local or systemic complications and reducing overall healthcare costs. Although initial pediatric studies suggest that 5% NaHCO3 serves as a safe and effective skin antiseptic, healthcare professionals must conduct more evidence-based research to fully validate its comparative clinical efficacy and optimize pediatric PIC management workflows.
Referanslar
Adıgüzel, Ö. (2015). Klorheksidin. Turkiye Klinikleri J Endod-Special Topics, 1(2), 15-9.
Aktaş, E., Sarı, E.N., Seremet Keskin, A., Pişkin, N., Külah, C., & Cömert, F. (2011) Damar İçi Kateter ile İlişkili Enfeksiyon Etkenleri ve Antibiyotik Duyarlılıkları. Mikrobiyoloji Bülteni, 45(1), 86-92.
Aktaş, A., & Giray, B. (2010). Diş Hekimliğinde Klorheksidin: Özellikleri ve Güncel Kullanım Alanları. Türkiye Klinikleri J Dental Sci, 16(1), 51-8.
Albayrak, Ö. (2012). Periferik intravenöz kanül yeri ve kullanılan aseptik solüsyonun trombofilebit gelişimi üzerine etkisi. (Tez Danışmanı Prof. Dr. Mağfiret Kara Kaşıkçı). Atatürk Üniversitesi, Sağlık Bilimleri Enstitüsü, Hemşirelik Esasları Anabilim Dalı, Yüksek Lisans Tezi, Erzurum
Albay, A. (2005). El Antiseptiklerinde Cilt Koruyucu Maddeler: Katkıları Nelerdir? Antiseptik Etkinliğinde Değişiklik Yapar mı? El Antiseptiklerinde Kombinasyonlar: Farkları Nelerdir? 4. Ulusal Sterilizasyon Dezenfeksiyon Kongresi 20-24 Nisan, Samsun.
Avcı, D. (2015). Bazı antiseptik ve dezenfektanların antibakteriyel etkinliklerinin araştırılması. (Tez Danışmanı Prof. Dr. Müşerref Tatman Otkun) Çanakkale Onsekiz Mart Üniversitesi, Sağlık Bilimleri Enstitüsü, Tıbbi Mikrobiyoloji Anabilim dalı, Yüksek Lisans Tezi, Çanakkale.
Avşar, G., Özlü, Z.K., Gümüş, K.G., Özer, N., & Aytekin, A. (2013). Determination of the situation of nurses related to the application of peripheric venous catheter. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi, 2(4), 499-507.
Aygün, F., Aygün, D., Cokuğraş, H., Cam, H., & Camcıoğlu, Y. (2017). Çocuk hastalarda kateter ilişkili enfeksiyon sıklığı; Bir yıllık deneyim. Journal of Pediatric Infection, 11(2), 76-81.
Ben Abdelaziz, R., Hafsi, H., Hajji, H., Boudabous, H., Ben Chehida, A., Mrabet, A., Boussetta, K., Barsaoui, S., Sammoud, A., Hamzaoui, M., Azzouz, H., & Tebib, N. (2017). Full title: peripheral venous catheter complications in children: predisposing factors in a multicenter prospective cohort study. BMC Pediatrics, 17(208), 1-11.
Berry, A.M. (2013). A comparison of Listerine and sodium bicarbonate oral cleansing solutions on dental plaque colonisation and incidence of ventilator associated pneumonia in mechanically ventilated patients: A randomised control trial. Intensive and Critical Care Nursing, 29, 275—281.
Biasucci, D.G., Pittirutİ, M., Taddei, A., Picconi, E., Pizza, A., Celentano, D., Piastra, M., Scoppettuolo, G., & Conti, G. (2018). Targeting zero catheter-related bloodstream infections in pediatric intensive care unit: a retrospective matched case-control study. The Journal of Vascular Access, 19(2), 119–124.
Biçer, T. (2017). Öğrenci hemşirelerin intravenöz kateter bakımı ile ilgili bilgi düzeyleri. (Danışman Yard. Doç. Dr. Gamze Temiz) İstanbul Bilim Üniversitesi, Sağlık Bilimleri Enstitüsü, Hemşirelik Anabilim Dalı, Cerrahi Hastalıkları Hemşireliği, Yüksek Lisans Tezi İstanbul.
Bindler, R.C., & Ball, J.W. (2014). Çocuk hemşireliği klinik uygulama becerileri kitabı. (Çeviri Editörü, Nejla Canbulat Şahiner, Meltem Demirgöz). 4. Baskı, Nobel Akademik Yayıncılık, Ankara.
Boyce, J.M. (2019). Best products for skin antisepsis. American Journal of Infection Control, 47, A17−A22.
Boyd, S., Aggarwal, I., Davey, P., Logan, M., & Nathwan, D. (2011). Peripheral intravenous catheters: the road to quality improvement and safer patient care. Journal of Hospital Infection, 77, 37-41.
Brooks, N. (2016). Intravenous cannula site Management. Nursing Standard. 30(52), 53-62.
Cabrera-Jaime, S., Martínez, C., Ferro-García, T., Giner-Boya, P., Icart-Isern, T., Estrada-Masllorens, J.M., & Fernández-Ortega, P. (2018). 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, 32, 40–47.
Camacho-Ortiz, A., & Roman-Mancha, A.L. (2016). Forget skin scrubbing and other antiseptics: prevent catheter related infections using chlorhexidine plus alcohol. Annals Translational Medicine, 4(4), 81-83.
Casey, A.L., Badia, J.M., Higgins, A., Korndorffer, J., Mantyh, C., Mimoz, O., & Moro, M. (2017). Skin antisepsis: it’s not only what you use, it’s the way that you use it. Journal of Hospital Infection 96, 221-222.
Centers for Disease Control and Prevention (CDC), (2020). National Healthcare Safety Network (NHSN) Patient Safety Component Manual. January 2020.
Chiari, P., Gazineo, D., Pezzullo, O., Ricciardi, V., Caso, L., & Forni, C. (2014). Sodium hypochlorite in antisepsis of children’s and new-born babies’ skin prior to insertion of peripheral venous catheter. Journal of Hospital Administration, 3(6), 97-102.
Choudhury, A., Sidjabat, H.E., Zowawi, H.M., Marsh, M., Larsen, E., Runnegar, N., Paterson, D.L., McMillan, D.J., & Rickard, C.M. (2019). Skin colonization at peripheral intravenous catheter insertion sites increases the risk of catheter colonization and infection. American Journal of Infection Control 000, 1−5.
Cihan Erdoğan, B., & Denat, Y. (2016). Periferik İntravenöz Kateter Komplikasyonlarından İnfiltrasyon ve Hemşirelik Bakımı. Hemşirelikte Eğitim ve Araştırma Dergisi, 13(2), 157-162.
Cozantis, D., & Makela, P. (2008). The infected peripheral intravenous catheter: A degree of ignorance, neglect and indifference. Acta Anaesthesiologica Belgica, 59, 59-63.
Dalgleish, L., Jhattu, H., & Gomersall, J.S. (2015). Daily 2% chlorhexidine gluconate bath wash in a tertiary adult intensive care and high dependency units to reduce risk of hospital acquired multi resistant organisms: a best practice implementation project. JBI Database of Systematic Reviews & Implementation Reports, 13(6), 434 – 448.
Deshpande, P., Jain, A., & Shah, P.S. (2016). Outcomes associated with early removal versus retention of peripherally inserted central catheters after diagnosis of catheter- associated infections in neonates The Journal of Maternal-Fetal & Neonatal Medicine. 29(24), 4082–4087.
Dettenkofer, M., Wilson, C., Gratwohl, A., Schmoor, C., Bertz, H., Frei5, R., , Heim, D., Luft, D., Schulz, S., & Widmer, A.F. (2009). Skin disinfection with octenidine dihydrochloride for central venous catheter site care: a double-blind, randomized, controlled trial. Clinical Microbiology and Infection, 16, 600–606.
Ding, L., Wu, H.L., Zhu, J.H., Ding, M., Wang, Y.L., & Xu, X.J. (2014). Superiority of 5% NaHCO3 for preoperative hair removal in patients undergoing coronary artery bypass graft surgery with a limb vein: a randomized controlled trial. European Journal of Cardio-Thoracic Surgery, 46, e28–e32.
Donlan, R.M. (2011). Biofilm elimination on intravascular catheters: Important considerations for the infectious disease practitioner. Healthcare Epidemiology, 52, 1038-1045.
Elçi, H. (2016). Pediatri ünitelerinde takılan kateterlerin takibi ve değerlendirilmesi. (Tez Danışmanı Doç. Dr. Derya Alabaz). Çukurova Üniversitesi Tıp Fakültesi Çocuk Sağlığı ve Hastalıkları Anabilim Dalı Uzmanlık Tezi, Adana.
Elkhunovich, M., Barreras, j., Pinero, V.B., Ziv, N, Vaiyani, A., & Mailhot, T. (2017). The use of ultrasound for peripheral IV placement by vascular Access team nurses at a tertiary children’s hospital. The Journal of Vascular Access, 18(1), 57,63.
Erdoğan, B.C. (2014). Nöroşirürji kliniğinde periferik intravenöz kateter uygulanan hastalarda flebit ve infiltrasyon gelişme durumu ve etkileyen etmenler. (Danışman Yrd. Doç. Dr. Yıldız Denat). Adnan Menderes Üniversitesi, Sağlık Bilimleri Enstitüsü, Hemşirelik Anabilim Dalı, Hemşirelik Esasları, Yüksek Lisans Tezi, Aydın.
Ersöz, Ş.E. (2016). Santral ve periferik venöz kateter uygulamalarında oktenidin hidroklorür, klorheksidin diglukonat ve povidon iyodürün antiseptik etkilerinin karşılaştırılması. Abant İzzet Baysal Üniversitesi, Tıp Fakültesi, Anesteziyoloji ve Reanimasyon Anabilim Dalı, Uzmanlık Tezi, Bolu.
Ersöz, Ş.E., Akkaya, A., Koçoğlu, E., Tekelioğlu, Ü.Y., Demirhan, A., Bilgi, M., & Koçoğlu, H. (2016). Oktenidin hidroklorür, klorheksidin glukonat ve povidon iyodürün, santral ve periferik venöz kateter uygulamalarında antiseptik etkilerinin karşılaştırılması. Abant Medical Journal, 5(1), 16-22.
Eser Mete, G., Ustalar Özgen, S., Çiğdem, B., & İsbir, O. (2009). Povidon iyot ile cilt hazırlığı sonrası gelişen cilt reaksiyonları. Sağlık Bilimleri Fakültesi Hemşirelik Dergisi, 52-56.
Farha, M.A. French, S., Stokes, J.M., & Brown, E.D. (2018). Bicarbonate alters bacterial susceptibility to antibiotics by targeting the proton motive force. ACS Infectious Diseases, 4, 382−390.
Gorski, L.A. (2017). The 2016 infusion therapy standards. Home Healthcare Now, 35(1), 10-18.
Hartman, J.H., Bena, J.F., Morrison, S.L., & Albert, N.M. (2020). Effect of Adding a Pediatric Vascular Access Team Component to a Pediatric Peripheral Vascular Access Algorithm. Pediatric Health Care, 34, 4−9.
Helm, R.E., Klausner, J.D., Klemperer, J.D., Flint, L.M., & Huang, E. (2015). Accepted but unacceptable: Peripheral IV catheter failure. Journal of Infusion Nursing, 38(3), 189-203.
Hastane İnfeksiyonları Dergisi (2019). Ulusal damar erişimi yönetimi rehberi 2019. (Editör, Serhat Ünal). Hastane İnfeksiyonları Dergisi, 23(1), Bilimsel Tıp Yayınevi, Ankara.
Huang, E.Y., Chen, C., Abdullah, F., Aspelund, G., Barnhart, D.C., Calkins, C.M., Cowles, R.A., Downard, C.D., Goldin, A.B., Lee, S.L., St. Peter, S.D., & Arca, M.J. (2011). Strategies for the prevention of central venous catheter infections: an American Pediatric Surgical Association outcomes and clinical trials committee systematic review. Journal of Pediatric Surgery, 46, 2000–2011.
Indarwati, F., Mathew, S., Munday, J., & Keogh, S. (2020). Incidence of peripheral intravenous catheter failure and complications in paediatric patients: Systematic review and meta-analysis. International Journal of Nursing Studies 102, 1-11.
Infusion Nursing Society (INS), (2016). Infusion therapy standards of practice. Journal of İnfusion Nursing, 39(1S).
Jacob, J.T., & Gaynes, R. (2019). Intravascular catheter-related infection: Prevention. UptoDate Erişim Tarihi: 21.07.2019. https://www.uptodate.com/contents/intravascular- catheter-related-infection-prevention/print
Karpanen, T.J., Casey, A.L., Whitehouse, T., Nightingale, P., Da I., & Elliott, T.S.J. (2016). Clinical evaluation of a chlorhexidine intravascular catheter gel dressing on short-term central venous catheters. American Journal of Infection Control 44, 54-60.
Kieran, E.A., O’Sullivan, A., Miletin, J., Twomey, A.R., Knowles, S.J., & O’Donnell, C.P.F. (2018). 2% chlorhexidine–70% isopropyl alcohol versus 10% povidone– iodine for insertion site cleaning before central line insertion in preterm infants: a randomised trial. Archives of Disease in Childhood. Fetal and Neonatal Edition, 103, F101–F106.
Letscher-Bru, V., Obszynski, C.M., Samsoen, M., Sabou, M., Waller, J., & Candolfi, E. (2013). Antifungal Activity of Sodium Bicarbonate Against Fungal Agents Causing Superficial Infections. Mycopathologia, 175, 153-158.
Lim, K.S., & Kam, P.C.A. (2008). Chlorhexidine – pharmacology and clinical applications. Anaesth Intensive Care, 36, 502-512.
Martín-Rabadán, P., Pérez-García, F., Flores, E.Z., Nisa, E.S., Guembe, M., & Bouza, E. (2017). Improved method for the detection of catheter colonization and catheter-related bacteremia in newborns. Diagnostic Microbiology and Infectious Disease, 87, 311–314.
McCallum, L., & Higgins, D. (2012). Care of peripheral venous cannula sites. Nursing Times, 108, 34/35, 12-15.
Mcgrath, D.R., & Mccrory, D. (2005). An audit of pre-operative skin preparative methods. Annals of the Royal College of Surgeons of England, 87, 366–368.
Mee-Marquet N.L. (2007). Efficacy and safety of a two-step method of skin preparation for peripheral intravenous catheter insertion: a prospective multi-centre randomised trial. BMC Anesthesiology. 7(1), 1-8.
Miles, G., Newcomb, P., & Spear, D. (2015). Comparison of dwell-times of two commonly placed peripheral ıntravenous catheters: Traditional vs. ultrasound-guided Open Journal of Nursing, 5, 1082-1088.
Newman, C.D. (2006). Catheter-related bloodstream infections in the pediatric intensive care unit. Seminars in Pediatric Infectious Diseases, 17, 20-24.
O’Grady, N.P., Alexander, M., Burns, L.A., Dellinger, E.P., Garland, J., Heard, S.O., Lipsett, P.A., Masur, H., Mermel, L.A., Pearson, M.L., Raad, I.I., Randolph, A.G., Rupp, M.E., & Saint, S. (2017). Guidelines for the prevention of intravascular catheter-related infections 2011, (Update 2017) American Journal of Infection Control, 39, S1-34.
Öztürk, R. (2000). Kateter infeksiyonlarında klinik, tanı ve tedavi. ANKEM Dergisi, 14(4), 460-467.
Özyazıcıoğlu, N., & Arıkan, D. (2007). Çocuklarda periferal kanül uygulamaları. Atatürk Üniversitesi Hemşirelik Yüksekokulu Dergisi, 10(3), 93,100.
Paioni, P., Kuhn, S., Strassle, Y., Seifert, B., & Bergerve, C. (2020). Risk factors for central line−associated bloodstream infections in children with tunneled central venous catheters. American Journal of Infection Control 48, 33−39.
Palece, A., & Cescon, F. (2013). Effectiveness of 10% povidone-iodine drying time before Peripheral Intravascular Catheter insertion: preliminary results from an explorative quasi-experimental study. The Revista Latino-Americana de Enfermagem, 21, 47-51.
Rai, C.A., Khera, C.A., Jain, M., Krishnakumar, M., & Sreevastava, B.D.K. (2019). Bacterial colonization of peripheral intravenous cannulas in a tertiary care hospital: A cross sectional observational study. Medical Journal Armed Forces İndia, 75, 65– 69.
Rickard, C.M., Webster, J.M., Wallis, M.C., Marsh, N., McGrail, M.R., French, V., Foster, L., Gallagher, P., Gowardman, J.R., Zhang, L., McClymont, A., & Whitby, M. (2012). Routine versus clinically indicated replacement of peripheral intravenous catheters: a randomised controlled equivalence trial. Lancet, 380, 1066–1074.
Rundjan, L. (2011). Skin antiseptic choice to reduce catheter-related bloodstream infections. Paediatrica Indonesiana, 51(6), 345-350.
Serane, T.V., & Kothendaraman, B. (2016). Incidence and risk factors of infections associated with peripheral intravenous catheters. Journal of Infection Prevention, 17(3), 115–120.
Suliman, M., Saleh, W., Al-shiekh, H., Taan, W., & AlBashtawy, M. (2020). The incidence of peripheral intravenous catheter phlebitis and risk factors among pediatric patients. Journal of Pediatric Nursing, 50, 89–93.
Şenol, S. (2015). Dezenfektan Ürünlerin Yenidoğan ve Çocuk Cilt Bakımında Kullanımı. (Editor Prof.Dr. Suzan Yıldız). Turkiye Klinikleri J Pediatr Nurs-Special Topics, 1(2), 39-45
Şimşek, A. (2020). Çocuklarda Kateter Uygulamalarına Bağlı Enfeksiyonların Önlenmesinde %5 NaHCO3, %2 Klorheksidin Glukonat ve %70 Alkolün Etkilerinin Karşılaştırılması. (Tez Danışmanı Prof. Dr. Suzan Yıldız) İstanbul Üniversitesi-Cerrahpaşa, Lisansüstü Eğitim Enstitüsü, Çocuk Sağlığı ve Hastalıkları Hemşireliği Anabilim Dalı, Doktora Tezi. İstanbul.
Timsit, J., Dubois, Y., Minet, C., Bonadona, A., Lugosi, M., Ara-Somohano, C., Hamidfar-Roy, R., & Schwebel, C. (2011). New materials and devices for preventing catheter-related infections. Annals of Intensive Care, 1(34), 1-9.
Turken, M., Kilinc Toker, A., Zincirlioglu, Ç., & Köse, Ş. (2019). Risk factors and incidence of catheter-related bloodstream infections in a tertiary hospital ICU. Eurasian Journal of Medıcal Investigation, 3(1), 32–36.
Unbeck, M., Förberg, U., Ygge, B.M., Ehrenberg, A., Petzold, M., & Johansson, E. (2015). Peripheral venous catheter related complications are common among paediatric and neonatal patients. Acta Pædiatrica, 104, 566–574.
Vinograd, A.M., Zorc, J.J., Dean, A.J., Abbadessa, M.K.F., & Chen, A.E. (2017). Pediatric Emergency Care, 1-5.
World Health Organization (WHO) (2017). Global guidelines for the prevention of surgical site infection. WHO Library Cataloguing-in-Publication Data, Switzerland.
Wu, H., Xu, Y., & Shi, J. (2017). 5% NaHCO3 ıs appropriate for skin cleaning with central venous catheters. The American Journal of the Medical Sciences, 353(1), 12– 16.
Yasuda, H., Sanui, M., Abe, T., Shime, N., Komuro, T., Hatakeyama, J., Matsukubo, S., Kawano, S., Yamamoto, H., Andoh, K., Seo, R., Inoue, K., Noda, E., Saito, N., Nogami, S., Okamoto, K., Fuke, R., Gushima, Y., Kobayashi, A., Takebayashi, T., Lefor, A.K., & Japanese Society of Education for Physicians and Trainees in Intensive Care (JSEPTIC) Clinical Trial Group, (2017). Comparison of the efficacy of three topical antiseptic solutions for the prevention of catheter colonization: a multicenter randomized controlled study. Critical Care, 21(320), 1- 10.
Zhang, L., Cao, S., Marsh, N., Ray-Barruel, G., Flynn, J., Larsen, E., & Rickard, C.M. (2016). Infection risks associated with peripheral vascular catheters. Journal of Infection Prevention. 17(5), 207-213.
