Amikacin-heparin lock for prevention of catheter-related bloodstream infection in neonates with extended umbilical venous catheters use: A randomized controlled trial

Objective: To ascertain the safety and the efficacy of amikacin-heparin lock technique in the prevention of catheter- related-bloodstream infection (CRBSI) in neonates with extended umbilical venous catheters (UVCs) use and to determine the applicability of keeping UVCs in situ for 14 days. Methods: A randomized controlled - blind trial was conducted on neonates who were expected to require UVC for at least 48 hours. Babies were randomized to have the catheter locked twice daily for 20 minutes either with heparinized normal saline (n = 42) or heparinized saline containing amikacin 1.5 mg/mL (n = 41). The blood glucose level was measured at the end of indwelling time and any episode of hypoglycemia was recorded. Doppler ultrasound was performed for the umbilical, portal and inferior vena cava veins. Surveillance cultures were taken from enrolled patients' skin to detect colonization by amikacin-resistant organisms. The UVCs were removed whenever their use was deemed unnecessary or at the 14th day after insertion. Results: There were 4 CRBSI episodes (definite, probable) in amikacin-heparin lock group and 12 episodes in the saline-heparin lock group (RR: 0.34; 95% CI: (0.02-0.65); p = 0.01). Density incidence of CRBSIs was 3.6 per 1000 catheter days in amikacin- heparin lock group and 18.4 per 1000 catheter days in saline-heparin lock group (RR: 0.19 CI: (0.08-0.67), p = 0.02). No amikacin-resistant organisms were recovered from any of the cultures. Transient asymptomatic hypoglycemia occurred in 13 (15.6%) neonates at the end of catheter-lock period. No portal or inferior vena cava thrombosis was detected in any of our babies. Conclusions: Amikacin-heparin lock reduced the incidence of CRBSI in neonates with extended UVCs use, without promoting amikacin resistance.