Skin safety during umbilical venous catheter insertion using 2% chlorhexidine gluconate in 70% isopropyl alcohol: a prospective observational study

Umbilical venous catheter (UVC) placement in NICU requires effective antisepsis to minimize catheter-related bloodstream infections. Chlorhexidine gluconate (CHG) in isopropyl alcohol (IPA) is commonly used, but its safety in preterm infants is debated. This study evaluates the skin safety of 2% CHG in 70% IPA during UVC placement in neonates. A prospective analysis of neonates admitted to a tertiary NICU from January 2021 to December 2024 was conducted. Skin reactions were assessed at 30 min, 24 h, and 48 h post-procedure. The primary outcome was the incidence of skin lesions categorized according to a dermatitis severity score. Among 506 neonates, 48.4% had a gestational age ≤ 32 weeks. No severe lesions were observed. Erythema and discoloration were common but resolved within 48 h. The incidence of erythema decreased with increasing gestational age. Only two catheters were removed as a result of catheter-related bloodstream infections (0.89 per 1000 catheter days). 2% CHG in 70% IPA showed a favorable safety profile in neonates undergoing UVC placement when appropriate precautions were observed.