Absorption and Tolerability of Aqueous Chlorhexidine Gluconate Used for Skin Antisepsis Prior to Catheter Insertion in Preterm Neonates

OBJECTIVE: To assess chlorhexidine absorption and skin tolerability in premature infants following skin antisepsis with 2% aqueous chlorhexidine gluconate (CHG) prior to peripherally inserted central catheter (PICC) placement. STUDY DESIGN: Neonates less than 32 weeks gestation had skin cleansed with CHG prior to PICC placement. CHG concentrations were measured on serial blood samples. Skin integrity was evaluated for 2 weeks after CHG exposure. RESULTS: Twenty infants were enrolled; median gestational age 28 2/7 weeks (range 24 3/7–31 4/7). Ten infants had detectable serum chlorhexidine concentrations (range 1.6–206 ng/ml). Seven of these infants had their highest serum concentration 2 to 3 days following exposure. No CHG-related skin irritation occurred in any infant. CONCLUSION: CHG was detected in the blood of preterm infants receiving CHG skin antisepsis for PICC insertion. Highest serum concentrations occurred 2 to 3 days after exposure. Further investigation is needed to determine the clinical relevance of CHG absorption in preterm infants.