Catheter-related bloodstream infections in infants who have undergone neonatal surgery

Abstract

Background: Catheter-related bloodstream infections (CRBSI) represent a feared complication in neonates with surgically placed central venous catheters. Infections can be a tough experience for the infant and family in terms of pain, discomfort, complications, delayed infant-parent attachment and development and at worst, death. Registering treatment-related infections is an important part of quality assurance efforts, and few studies have dealt with nursing documentation of symptoms and signs of CRBSI. Objective: The objective of the study was to identify documentation practices and examine what symptoms and clinical signs registered nurses document in a group of patients with and without CRBSI who have undergone neonatal surgery. The aim was to identify and evaluate nursing documentation, thus contributing to greater knowledge about CRBSI and its prevention, and better treatment. The study focuses on the following research question: How do registered nurses document clinical observations that raise suspicion of catheter-related bloodstream infections in infants who have undergone neonatal surgery? Method: We conducted a pilot study with a retrospective case control design using descriptive analyses. We used a self-developed assessment chart in order to gather data from written and electronic observation forms, charts and nursing documentation in the patient documentation systems DIPS and Metavision. The sample included five infants in the CRBSI group and ten in the control group. Results: Pulse and temperature were most frequently documented in both groups. Fever was documented in the case of three of the five infants in the CRBSI group while in the control group, fever was not documented. Clinical signs of infection were most frequently documented in the CRBSI group. Observations of the insertion site of the central venous catheter when changing dressings, and the child's behaviour were most frequently documented in the control group. Conclusion: The documentation of fever is the symptom that most clearly distinguishes the CRBSI group from the control group. The total number of documented registrations of clinical signs of infection is higher in the CRBSI group than in the control group. This may indicate that fever is the factor that determines which clinical signs of infection are observed and documented in the ensuing patient care pathway. A number of observations were not documented in either of the groups and what was documented can appear to be random and unsystematic.