الفهرس 
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Abstract
With advancing neonatal healthcare, the use of central venous lines has become an essential part of management of neonates, as neonates particularly have poor peripheral access especially with prolonged incubation, these uses include haemodynamic monitoring and the delivery of life saving treatments such as intravenous fluids, blood products, antibiotics and total parenteral nutrition (TPN).
Neonates represent a specific population with a high risk of nosocomial infection, but CLABSI remains the most common nosocomial infection in NICUs, which is associated with increased mortality, increased length of hospital and intensive care unit stay, treatment interruptions, and increased complications.
Diagnosis of central line infections in neonates is challenging. Clinical findings only are unreliable for establishing a diagnosis of CRBSI, because no characteristic clinical features of CRBSI exist to distinguish this infection from infections arising from other body sites. So in addition to clinical suspicion, conventional methods of diagnosing CRBSI generally require that the catheter has to be removed and cultured.
Prevention of CLABSI is paramount, using a variety of measures including the use of single lumen CVC instead of multiple lumen, using maximum sterile barriers & antiseptic techniques, minimal line accessing and applying Anti-infective lock therapy (ALT) which means instillation of an antibiotic or antiseptic solution into the catheter lumen for a certain period of time (dwelling time) after which the lock solution is withdrawn & infusion of intravenous fluids is resumed.
Because the majority of BSIs associated with IVDs are caused by gram-positive organisms, particularly coagulase-negative staphylococci, vancomycin in combination with heparin has been the best studied prophylactic lock solution.
Our study was carried out in neonatal intensive care unit of Menoufia University Hospital during the period from (January 2016 - February 2017) on 50 non-septic neonates, 25 of them were locked by vancomycin-heparin lock solution, while the other 25 were not locked &follow up the development of CRBSI.
In our clinical trial, locking of CVCs with vancomycin-heparin solution for 20 minutes twice daily markedly reduced the incidence of CRBSI, as there was highly significant statistical difference between incidence of CRBSI development in locked group (16%) compared to (48%) in non locked group. Also markedly reduced incidence of catheter colonization especially with staphylococci, as only one neonate (4%) in vancomycin-heparin lock group developed catheter colonization by acinetobacter bacteria, whereas (20%) in non-locked group developed colonization mostly was due to staphylococci (16%) and (4%) due to enterobacter. So vancomycin-heparin lock solution is likely to be effective in preventing CRBSIs that are caused by vancomycin-susceptible gram-positive bacteria like staphylococci.