CVCs and Nystatin?

[kerussll]

Hello all!

Quick question for all you NICU peeps :) On my unit we have a lot of CVC's...especially Broviacs and PICC lines. It is standard protocol that every baby with a CVC is on prophylactic nystatin (a swab to their mouths) My question is....why? Do CVC's cause thrush? Or are they worried about fungus from the mouth somehow infecting the bloodstream? I've worked here a year and my old hospital never did this. Nobody was able to explain this during orientation and now I just feel silly asking after giving it for so long :) Anybody else work on a unit that does this? Thanks a bunch!

[prmenrs, RN]

Pts w/central lines are way more @ risk for infections of any sort, and frequently get antibiotics. Antibiotics lead to yeast overgrowth in the entire GI tract, not just the mouth. If you can keep the yeast flora down, the pt will [hopefully] do better in the long run.

Also, whatever disease/disorder lead to the necessity of a central line means that the pt is immunocompromised to start, having a line ups the risk even more.

I hope that helps.

[NicuGal, MSN, RN]

I've never heard of that practice. Does your team have any evidence based articles to share?

[TiffyRN, BSN, PhD]

I have never heard of prophylactic nystatin for mouth care for patients with CVLs. In the unit where I work infants with CVLs receive prophylactic IV diflucan like every 3 days at the beginning and the longer they have one, the closer the dosing becomes (I guess their risk of systemic fungal infection goes up as time passes).

[Sun*shine]

Interesting topic, thanks for bringing it up. Our unit does this, but not every baby with a CVC gets Nystatin, there are a set of risk factors that indiciate its use. We put 0.5ml down the NG and 0.5ml in the mouth. I feel that 0.5ml in the mouth of our tiny prems is a large volume. We use pink oral sponges to apply it (same size I used on adult wards) and so most is soaked up by the sponge anyway. Often the ET tape obstructs the mouth so plenty ends up on the chin lol, and being inexperienced I'm really scared to squeeze anything in there that'd risk dislodging their tube. Sorry to go off topic, but speaking of this does anyone have any tips on good quality mouth care for really tiny ventilated babies?

[imaginations]

We use pink oral sponges to apply it (same size I used on adult wards) and so most is soaked up by the sponge anyway. Often the ET tape obstructs the mouth so plenty ends up on the chin lol, and being inexperienced I'm really scared to squeeze anything in there that'd risk dislodging their tube. Sorry to go off topic, but speaking of this does anyone have any tips on good quality mouth care for really tiny ventilated babies?

Can you use ear bud cotton sticks instead for tiny wee premie mouths?

[Sun*shine]

Can you use ear bud cotton sticks instead for tiny wee premie mouths?

That's an excellent idea Never thought of that because I don't think we stock them.

[kvani,rn]

We have been told not to use cotton q-tips as they can ahead fibers into the babes mouth. My unit stocks foam mouth swabs that are the same size as a standard q-tip for this purpose.

[imaginations]

We have been told not to use cotton q-tips as they can ahead fibers into the babes mouth. My unit stocks foam mouth swabs that are the same size as a standard q-tip for this purpose.

That's great. I'd never heard that. We have cotton oral mouth swabs (like giant q-tips) and then regular ones (which we tend to use for applying cream to lips etc) but that size could def work for a little prems mouth care.