Central Line-associated Bloodstream Research Articles

2024. Human Factor Considerations in Support of a Flexible IV Connector Safeguard to Prevent Central Line Associated Blood Stream Infections (CLABSI)

Abstract Background One of the sources of central line infections is contaminated and poorly disinfected IV connectors(CON). A recent study found 23% of IV-line CONs were contaminated with bacteria, despite strict infection control guidelines that include the use of alcohol-lined caps (ALC). Contamination (CONT) occurs after protective ALC has been removed in preparation for an infusion, and nurses perform their multiple tasks. These include purging air bubbles from the IV line, setting pumps, verifying medications, and keeping an eye on the patient. It is not surprising that nurses admitted that sterilization of IV CONs was not prior to 3% - 4% of infusions. Schielded IV connector Methods A flexible rounded shield extending above a standard needleless CON to protect it from CONT was designed and tested (Pat pend). A total of 4, 2 ICU Medical Inc. needleless CONs, one shielded and one unshielded, and two Komashine Inc. CONs, also one shielded and one unshielded were disinfected with 70% alcohol and their lines taped to the abdomen of 2 volunteers wearing loose shirts over the connectors. The CONs remained on the volunteers for 3 hours, in 2 sessions. All 16 CON ends were cultured on Columbia blood agar, and plates held 48 h. Readings were evaluated by statistical analysis of 16 predictions (coinflips). Results It was confirmed that the tested shielded CONs were easy to sterilize, connect to infusion lines and that there was ample space left to screw on and off alcohol caps. Colonies were absent from the protected connector ends, whereas all the unshielded ends grew several colonies. The probability of observing the projected efficacy results, 8 unshielded with subsequent bacterial growth, and eight shielded, remaining sterile, i.e. not growing bacteria is < 0.00002. The lack of contamination on the shielded ends proved that the air currents generated by the movements of the volunteers, between their skin and their skirts did not transport bacteria to the shielded connector ends. Conclusion A properly designed flexible contamination shield will prevent the proportion of line infections that are caused by human factors. Pls, submit severe adverse event reports (prolongation of hospitalization or death) caused by contemporary "defective" IV connectors to the FDA to change their faulty design. Disclosures All Authors: No reported disclosures.

CLABSI in Hemodialysis– New Face to an Old Foe; A Look at Current Trends and a Review of Literature

Background: Bloodstream infections are a potentially devastating complication of hemodialysis. This study aimed to elucidate the rates of CLABSI (Central Line Associated Blood Stream Infections)in a south Indian dialysis cohort and determine the catheter care and hygiene practices in the dialysis unit which might contribute to CLABSI Methods: A prospective observational study involving in-center dialysis patients with temporary access was conducted from June 2019 to December 2019. The catheter insertion and line handling techniques were monitored using a proforma adapted from the CDC (Center for Disease Control) guidelines. Adherence to infection control practices, rates of CLABSI identified using CDC surveillance definitions, and organisms identified were reported. Results and Discussion: The median rate of CLABSI in this dialysis unit was 1.68 per 1000 catheter days. Gram-positive organisms were the majority – 69.2% and 72.27% were drug-resistant pathogens. The adherence to infection control practices in hand sterility, use of barriers, and sterile insertion technique were 100% with respect to existing CDC guidelines. The use of sterile semi-transparent dressings, however, was 98.2%. 65% of all patients had soiled dressings on arrival to the hospital. Line handling protocols were followed in accordance with CDC guidelines in 97.1% of cases Conclusion: CLABSI rates in this institute are in keeping with those around the world. There is a predominance of gram-positive organisms causing CLABSI. Drug-resistant organisms represent an alarming 72.27%of all infections. Soiled dressing and home care of the dialysis catheters represent a neglected aspect of catheter care and should be addressed.

40. Risk factors for central venous access device failure due to central line associated blood stream infection (CLABSI): A multivariable analysis of 1892 catheters

40. Risk factors for central venous access device failure due to central line associated blood stream infection (CLABSI): A multivariable analysis of 1892 catheters

Reducing central-line associated bloodstream infections (CLABSIs) through patient accountability contracts: A pilot project for patients on Weill Cornell Medicine (WCM) bone marrow transplant (BMT) service.

283 Background: Patients with cancer whom develop Central Line Associated Blood Stream Infections (CLABSIs) have increased mortality rates ranging from 12% to 40%. Transplant patients are particularly at risk due to cytotoxic chemotherapy regimens and/or graft-versus-host disease with risk for translocation of oral and gut flora to the bloodstream. At Weill Cornell Medicine, we had 102 CLABSIs in 2021, 25 (25%) of which attributed to patients in oncology units. The Bone Marrow Transplant (BMT) Unit, had 10 of the 25 (40%), 2.05 CLABSIs per 1000 central line inpatient days with a CLABSI standardized infection ratio (SIR) of 1.26 (above goal of 1). Methods: Our SMART aim was to reduce the number and rate of CLABSI events on the BMT unit by 10% from February 1, 2022 – June 30, 2022 by educating patients on preventive strategies and implementing a patient central-line maintenance “contract.” We had previously optimized evidence-based nursing interventions for CLABSI prevention which included adherence to central line maintenance best practices, weekly device rounds with Infection, Protection & Control to monitor compliance with dressing changes and IV tubing, annual CLABSI prevention competencies, peer-to-peer validation of blood culture lab draws, weekly quality-improvement huddles and interdisciplinary root cause analysis discussions for CLABSI events. Patient noncompliance with daily recommendations for central line care was identified as a possible CLABSI risk factor that was not previously addressed in the bundle. Newly-developed patient education and a “contract” was incorporated into the BMT admission process. Results: The BMT CLABSI patient education and contract was initiated with all new patients admitted to unit in February 1, 2022. Since starting, the BMT unit CLABSI SIR has decreased from 1.26 to 0.6, and from a CLABSI rate per 1000 central lines days of 2.05 to 0.97. Conclusions: Engaging patients in their own care of the central lines can significantly reduce overall risk of central line infections. Patients have positively responded to this pilot project. We have translated educational materials and contracts to other languages and are considering expansion into other units.

Effect of Nursing Care Bundle on Nurse's Performance Regarding Central Venous Line-Associated Blood Stream Infection

Effect of Nursing Care Bundle on Nurse's Performance Regarding Central Venous Line-Associated Blood Stream Infection

Effect of Nursing Care Bundle on Nurse's Performance Regarding Central Venous Line-Associated Blood Stream Infection

Effect of Nursing Care Bundle on Nurse's Performance Regarding Central Venous Line-Associated Blood Stream Infection

Decreasing Skin Breakdown Around Central Lines in Patients Receiving Thiotepa Prior to Bone Marrow Transplantation.

Skin breakdown occurring around central line dressings increases the risk for infection and bacteremia in all patients. The risk is magnified when experienced in pediatric patients receiving marrow-ablative therapy. A staff nurse on an inpatient pediatric oncology and bone marrow transplant unit noted an increased incidence of skin breakdown around central line dressings in patients receiving Thiotepa prior to bone marrow transplantation. Although there is a wealth of information surrounding routine care of central venous access devices, there is little evidence surrounding care with impaired skin integrity. A staff nurse turned to expert opinion and consensus revealed the use of nonocclusive dressings for central lines. A new protocol for changing central line dressings was developed to decrease the rate of skin breakdown. The protocol utilized gauze and a self-adherent wrap instead of tape to secure central lines. Bone marrow transplant staff nurses were educated prior to the practice change, and compliance was monitored through observation and review of documentation in the electronic medical record. A retrospective chart review compared the rate of skin breakdown and central line associated blood stream infections pre- and postpractice change. The overall percentage of skin breakdown surrounding central lines was reduced by over 80%.

Prospective clinical study on the incidence of catheter-related complications in a neurological intensive care unit: 4 years of experience.

Over the past decades, significant efforts have been made to reduce early and late catheter-related complications in critically ill patients, using approaches based on bundles of evidence-based interventions. In this prospective clinical study, the authors evaluated the incidence of catheter-related complications in their neuro-intensive care unit during a 4-year period, adopting systematically the GAVeCeLT bundles for the insertion and management of all central venous access devices: centrally inserted central catheters (CICCs), peripherally inserted central catheters (PICCs) and femorally inserted central catheters (FICCs). All early/immediate and late complications were recorded. On 486 central lines (328 CICCs, 149 PICCs and 9 FICCs), the only clinically relevant early/immediate complication was primary tip malposition (1%). In regards late infective complications, the authors did not record any case of catheter-related bloodstream infection; though, they observed one case of central line associated blood stream infection (one CICC; 0.14/1000 catheter days), and 15 cases of catheter colonization (12 CICCs and 3 PICCs; 2.09 episodes/1000 catheter days). Late non-infective complications were few: 14 accidental dislodgments (2.9%), 18 irreversible lumen occlusions (3.7%), and no episodes of symptomatic catheter-related thrombosis or tip migration. The systematic adoption of the GAVeCeLT bundles for CVAD insertion and maintenance was associated with a minimization of catheter-related complications. The strict adherence to the recommendations included in these bundles was the major determinant for clinical success.

713 Mortality Benefit After Addition of Mid-level Support in Burn Intensive Care Unit

IntroductionBurn Intensive Care Units (BICU)s are resource-heavy and labor-intensive units with very sick patients. The removal of burns as a requirement from the surgical curriculum has decreased the number of rotating surgical trainees, but did not impact patient care needs. Our unit adopted an Advanced Practice Provider (APP) service model in fiscal year 2018 to provide consistent standardized clinical care, with surgical trainees rotating monthly, to mitigate the loss of residents over time. We aimed to critically evaluate the impact of an APP run BICU on mortality and quality improvement initiatives.MethodsPatients were identified using Institutional Burn Center registry, and linked to the clinical and administrative data. All patients admitted to the BICU between July 1, 2016 and June 30, 2020 were eligible for inclusion. All central line associated blood stream infections (CLABSI), catheter associated urinary tract infections (CAUTI), ventilator associated pneumonias (VAP) and mortality rates were compared. Demographics, length of stay (LOS), co-morbid conditions and mortality were evaluated. Statistical analysis was performed with Students’ t-test, and chi-squared tests. Significance was accepted as p< 0.05.ResultsThere were no significant differences in admission rates over the study period. The number of CLABSIs significantly decreased each year (15 (2017), 6 (2018), 5 (2019), 3 (2020)). The number of CAUTIs significantly decreased ((13 (2017), 6 (2018), 1 (2019), 3 (2020)). The number of VAPs significantly decreased ((15(2017), 12 (2018), 7 (2019), 3 (2020)). Mortality was unchanged from 2017-2019 but significantly decreased in 2020 ((2.2% (2017), 2.4% (2018), 2.5% (2019), 0.9% (2020)).ConclusionsThere were no significant differences in admission rates over the study period. The number of CLABSIs significantly decreased each year (15 (2017), 6 (2018), 5 (2019), 3 (2020)). The number of CAUTIs significantly decreased ((13 (2017), 6 (2018), 1 (2019), 3 (2020)). The number of VAPs significantly decreased ((15(2017), 12 (2018), 7 (2019), 3 (2020)). Mortality was unchanged from 2017-2019 but significantly decreased in 2020 ((2.2% (2017), 2.4% (2018), 2.5% (2019), 0.9% (2020)).

705 Reduction in Central Line Associated Blood Stream Infection Rate with a Central Line Change-Over Protocol

IntroductionBurn Intensive Care Units (BICU)s traditionally have changed central lines over a wire (COWs) as a method to reduce infection. To date, there is not a standard timeline for this process and every center has their own timeline for this process. We aimed to create a standardized process for this practice to then have a baseline for future study.MethodsThe Change-Over-Wire (COW) process was evaluated with the BICU Infection Control Nurse and Performance Improvement Manager. A protocol was developed that includes step-by-step detail that was modified until it was deemed practical and acceptable to all involved parties as the best practice for maintaining the most sterility as possible. The protocol was provided to the Central Line team, the ICU Advisory Board, and the UNC CLABSI committee for reviewResultsWhile the hospital as a whole does not standardly endorse routine COWs, the protocol was reviewed and accepted as best practice by both the ICU Advisory Board and the UNC CLABSI committee. Additionally, the BICU had an 80% reduction in CLABSI’s from FY 2017 to 2020 with implementation of this protocol (p value = 0091).ConclusionsHaving a standardized method for COWs both allows for best practice and a starting point for study. Endorsement by both hospital committees allows this practice to be the published standard by which future studies can be measured.

An audit of central venous catheter insertion and management practices in an Australian tertiary intensive care unit: A quality improvement project

IntroductionCentral venous catheters are often used in managing critically ill patients. Clinical practice guidelines and care bundles exist to prevent central line associated blood stream infections; however, detailed adherence to these guidelines and care bundles is unclear. AimThis study was aimed to describe clinicians’ adherence to recommended practices in central venous catheter insertion and management. MethodA cross-sectional prospective observational study was conducted in the intensive care unit of an Australian tertiary hospital over a four-month period. We observed a total of 50 nurses during post insertion management, and 10 physicians during central venous catheter insertion using purposely designed observation tools. ResultsOur audit identified 90% adherence to recommended practices in central venous catheter insertion and 60% to post insertion management. However, there were areas where participants’ practices were not congruent with evidence-based recommendations, including choice of central venous catheter insertion site, type of central venous catheters, dressing choice, aseptic technique, and documentation. ConclusionOur audit showed a detailed picture of clinician’s adherence to recommended practices in central venous catheter insertion and management. A clearer understanding of the barriers and facilitators of issues identified is needed to inform the design of future interventions to reduce central line related blood stream infections in the unit.

Poor Sensorium at the Time of Intubation Predicts Polymicrobial Ventilator Associated Pneumonia.

BackgroundVentilator-associated pneumonia (VAP) is the most common nosocomial infection in the intensive care unit and is associated with a high mortality rate.AimThe study was conducted to estimate the frequency, outcomes, and predictors of polymicrobial VAP.MethodsA prospective observational study was conducted in mechanically ventilated adult patients in the medical intensive care unit in a tertiary care hospital in India from July 2016 to July 2018 with a 30-day follow-up period. The patients were grouped into monomicrobial and polymicrobial VAP. We compared the 30-day outcome parameters such as discharge from hospital, in-hospital stay, death, and complications such as catheter associated urinary tract infection (CAUTI), central line associated blood stream infection (CRBSI), bacteremia and collapse of lung. The predictors of polymicrobial VAP were identified by multiple logistic regression.ResultsOut of 301 patients clinically diagnosed with VAP, 151 patients were excluded, and the remaining 150 developed 186 episodes of VAP during the study period. The incidence of polymicrobial VAP was 62.9%. Out of 150 patients, 51 patients had monomicrobial VAP, and 99 had polymicrobial VAP. On univariate analysis, diabetes mellitus and poor sensorium (Glasgow Coma Scale [GCS] score <8) during endotracheal intubation; 30-day outcome, mean days of mechanical ventilation after VAP diagnosis and days in ICU; and CAUTI were significantly associated with polymicrobial VAP. On multivariable logistic regression, poor sensorium (GCS score <8) at the time of endotracheal intubation was an independent predictor of polymicrobial VAP.ConclusionThe incidence of polymicrobial VAP is high in the medical ICU and is associated with increased duration of mechanical ventilation, hospital stay, and incidence of CAUTI. Poor GCS score was the single independent predictor of polymicrobial VAP.

Central Line Associated Blood Stream Infections and Effectiveness of Care Bundle Approach: A Prospective Cohort Study

Introduction: Insertion and maintenance of Central Venous Catheters (CVC) are integral components for the supportive care of critically ill neonates. Their use is often associated with the unavoidable risk of acquiring Healthcare Associated Infections (HAI) like Central Line Associated Blood Stream Infections (CLABSI) especially in resource limited public sector Neonatal Intensive Care Units (NICU). Adopting a care bundle approach to decrease CLABSI rates in such NICUs still remains a challenge. Aim: To determine the baseline CLABSI rate, identify the risk factors associated with it and also to determine the effectiveness of care bundle approach in decreasing CLABSI. Materials and Methods: An analytical prospective cohort study was conducted in Cheluvamba Hospital, attached to Mysore Medical College and Research Institute, Mysuru, Karnataka, India, from June 2018 to June 2020. In the preintervention phase (June 2018 to May 2019), the data of 307 neonates in whom Central Line (CL) was inserted were analysed to determine the baseline CLABSI rate and risk factors. CLABSI bundle involves a group of evidence-based practices which when implemented reliably and consistently have shown to significantly reduce CLABSI rates. CLABSI bundle was implemented in June 2019 and in the postintervention phase (July 2019 to June 2020), the data of 283 neonates were analysed and compared to those in the preintervention group in order to assess the effectiveness of the care bundle approach. Chi-square test was used to compare categorical variables whereas a two sample t-test was used to compare continuous variables. Results: A total of 41 CLABSI episodes were documented in the preintervention phase (Group 1) as compared to 12 in the postintervention phase (Group 2). Mean birth weight and gestational age was significantly lower in neonates with CLABSI as compared to neonates without CLABSI in both the groups. The incidence of CLABSI was significantly higher in neonates with a catheter dwell time of more than eight days and in those who received Total Parenteral Nutrition (TPN). Implementation of the CLABSI bundle resulted in the reduction of the baseline CLABSI rate from 16.25 to 8.3/1000 CL days; a significant reduction in the catheter dwell time and duration of NICU stay was also noted in group 2. Duration of NICU stay and death rate among neonates who developed CLABSI did not differ significantly between both the groups. Conclusion: Despite incorporating the care bundle approach, CLABSI rate remained to be high. Very preterm neonates with birth weight of &lt;1500 grams and NICU stay of more than 25 days were more likely to develop CLABSI. Significant reduction in CLABSI rates can be achieved with widespread implementation of the CLABSI bundle in resource limited NICUs across India.

Device Associated Hospital Acquired Infections in a Tertiary Care Hospital in Western Odisha

Introduction: Hospital Acquired Infection (HAI) is defined as infection that is acquired after 48 hours of admission in hospital for a reason other than that infection and the infection was neither present nor incubating at the time of admission. Device Associated Hospital Acquired Infections (DAHAIs) mainly Central Line Associated Blood Stream Infection (CLABSI), Ventilator Associated Pneumonia (VAP) and Catheter Associated Urinary Tract Infection (CAUTI) pose significant threat to patients associated with prolonged hospital stays, greater healthcare costs and increased mortality. Surveillance of Device Associated Infections (DAI) can reduce the incidence of Nosocomial Infections (NI) by as much as 32% and lead to reduced healthcare costs. Aim: To determine the microbiological profile of device associated HAI and to find the antimicrobial susceptibility pattern of the isolated organisms. Materials and Methods: This was a hospital based crosssectional study conducted in the Department of Microbiology, from November 2015 to October 2017. The study was targeted at three common DAHAIs: CAUTI, CLABSI and VAP. Patients admitted to clinical wards with 48 hours of indwelling devices like urinary catheter, central line and with endotracheal intubation developing signs and symptoms of DAI were included in the study. Specimen was collected with all aseptic precautions. Samples were processed by standard bacteriological methods. Isolates obtained were characterised by biochemical methods. Antibiotic susceptibility tests were done by Kirby Bauer discdiffusion method. Total of 425 samples were included in the study of which 152 (35.76%) showed positive growth and in 273 (64.24%) samples culture was sterile. The samples were collected from Intensive Care Unit (ICU) and various wards. The results were expressed in terms of mean, percentage and rate. Results: A CAUTI was the most common 53.28%, followed by VAP 37.51% and then CLABSI 9.21%. Escherichia coli was most commonly isolated organism 38 (23.45%) followed by Staphylococcus aureus 30 (18.51%). In CAUTI Escherichia coli (38.27%) was most commonly isolated and Acinetobacter baumannii (32.25%) was most commonly seen in VAP and in CLABSI Candida spp. (31.57%) was predominantly isolated. Conclusion: This study gave an insight into the incidence and prevalence of DAHAIs and helps in instituting various interventional strategies to prevent these infections.

A Case of Sepsis by a Rare Pathogen Delftia acidovorans in a Patient Undergoing Chemotherapy

Patients undergoing chemotherapy for any malignant disease are at a higher risk of developing central line related blood stream infection, as a result of lack of proper care of the central line used for giving chemotherapy. Here, a case of sepsis by an unusual pathogen Delftia acidovorans is shown in a 29-year-old female patient undergoing chemotherapy for breast cancer with no other related co-morbidities and family history. On investigation, elevated procalcitonin showed presence of bacterial sepsis. Despite of empirical antimicrobial therapy, the patient showed features of continued sepsis. Blood specimens were taken and sent as paired sets of BACTEC blood culture bottles. This was identified as Delftia acidovorans which is rarely known to cause central line related blood stream infection and has a ubiquitous presence and cause infection mostly in immunocompromised patients. Empirical therapy was continued in the patient but could not be revived because of sudden episode of bradycardia. This report highlights the significance of appropriate diagnosis and treatment of such rare pathogen as a causative pathogen for sepsis. In this report, authors also emphasise the need of education of patients and healthcare providers for proper care of any chemoport inserted to avoid incidence of central line associated blood stream infection.

Reducing central line associated blood stream infections in a tertiary care pediatric hematology-oncology: A quality improvement study

Reducing central line associated blood stream infections in a tertiary care pediatric hematology-oncology: A quality improvement study

1151. Clinical Characteristics of Persistent Staph Aureus Bacteremia in Children

BackgroundPersistent Staphylococcus aureus bacteremia (pSAB) is a poorly defined entity, but associated with significant morbidity and mortality in children. We aim to better describe the epidemiological features of this clinical entity.MethodsWe performed a retrospective case series analysis of pediatric patients with pSAB at a single center children’s hospital using electronic medical data from 2016 – 2020. Bacterial persistence was defined as culture growth > 72 hours after first blood culture. ResultsTwenty-two patients with pSAB were included in the analysis. Sources of persistent infection were endovascular infection (n=11, 50%), osteoarticular infection (n=6, 27%,), isolated central line associated blood stream (n=4, 18%), isolated skin and soft tissue infection (n=2, 9%), and no known primary infectious site (n=1). Methicillin resistance occurred in 41% (n=9) of cases of pSAB. Total duration of therapy varied, with a median of 4 weeks from negative cultures (range of 2 – 8 weeks). Total days of positive cultures in pSAB were not significantly associated with methicillin susceptibility of the bacterial isolate, use of double gram-positive coverage, nor presence of a central venous catheter. Use of double gram-positive coverage occurred in 50% of cases with a mean duration of therapy of 11 days, most frequently in cases of septic thrombophlebitis (Table 1). Rifampin and gentamicin were the most commonly used agents. Table 1. Clinical Characteristics of Children Treated with Double Gram-Positive Coverage ConclusionChildren presenting with persistent S. aureus bacteremia present with a heterogenous group of underlying conditions and epidemiological features. While pediatric recommendations for double gram-positive coverage for synergy have not been established, their use for pSAB is common, especially in endovascular infections where culture persistence is often an expected outcome. Further research should examine risk factors for pSAB and define optimal treatment modalities and duration. Disclosures All Authors: No reported disclosures

Central line associated blood stream infection(CLABSI) in pediatric oncology:quality improvement(QI) study phase 1 results

Central line associated blood stream infection(CLABSI) in pediatric oncology:quality improvement(QI) study phase 1 results

Prevention and Nursing Management for Central Line Associated Blood Stream Infection

Central line associated blood stream infection (CLABSI), is a substantial contributor to in-hospital morbidity and death, as well as increased cost and length of stay in the intensive care unit (ICU). CLABSIs are one of the most deadly for each infection is expected to have a mortality rate of 12-25 percent. CLABSI prevention is important, and nurses play a vital role. Nurses are required to complete initial training as well as annual competence tests for central venous catheter protocol and other skills to ensure that they are delivering direct care to patients using the most up-to-date evidence-based practices.&#x0D; Conclusion: CLABSI prevention bundles are the best method for implementing many interventions at once in addition to standardizing practice. Standard prevention bundles in addition to routine CLABSI education for staff are the most effective methods for preventing infection; it is inevitable that compliance with bundles will vary across healthcare institutions.

Modified Seldinger technique for neonatal epicutaneo-caval catheter insertion: A non-randomised retrospective study.

Epicutaneo-Caval Catheters (ECCs) are critical for good neonatal care. No previous studies have evaluated which insertion method provides the highest likelihood of success. This study aimed to compare the success rates and cost of modified Seldinger technique (MST) and split needle technique (SNT). MST was introduced to St Michael's Neonatal Unit, SNT was already in use. Routinely documented data on ECC insertion was retrospectively collected from the clinical notes. Practitioners were able to use their preferred insertion method. A sub-group analysis of success rates in patients born at ⩾35-weeks GA was performed. There was a significantly higher first pass (53% vs 26%; p = 0.014) and overall (72% vs 40%; p = 0.0046) successful ECC insertion rate with fewer venipunctures per successful ECC with MST (2.5 vs 6.5; p = 0.002). Logrank test demonstrated a significantly higher successful ECC insertion with MST for patients of all GA (p = 0.003) and for neonates born at ⩾35 weeks (p = 0.015). The cost per successful MST ECC was £156.41 versus £152.51 for SNT. In this uncontrolled retrospective study, there was a higher chance of successful ECC insertion with MST, with a reduced number of venipunctures and similar costs per successful ECC. Further work in randomised studies is needed to verify this finding and should focus on other clinical outcomes, including rates in central line associated blood stream infections.