2% chlorhexidine gluconate aqueous versus 2% chlorhexidine gluconate in 70% isopropyl alcohol for skin disinfection prior to percutaneous central venous catheterisation: the ARCTIC randomised controlled feasibility trial

Paul Clarke, Aung Soe, Amy Nichols, Helen Harizaj, Mark A. Webber, Louise Linsell, Jennifer L. Bell, Catherine Tremlett, Priyadarsini Muthukumar, Santosh Pattnayak, Christopher Partlett, Andrew King, Ed Juszczak, Paul T. Heath

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Objective: Catheter-related sepsis (CRS) is a major complication with significant morbidity and mortality. Evidence is lacking regarding the most appropriate antiseptic for skin disinfection before percutaneous central venous catheter (PCVC) insertion in preterm neonates. To inform the feasibility and design of a definitive randomised controlled trial (RCT) of two antiseptic formulations, we conducted the Antiseptic Randomised Controlled Trial for Insertion of Catheters (ARCTIC) feasibility study to assess catheter colonisation, sepsis, and skin morbidity. Design: Feasibility RCT. Setting: Two UK tertiary-level neonatal intensive care units. Patients: Preterm infants born <34 weeks' gestation scheduled to undergo PCVC insertion. Interventions: Skin disinfection with either 2% chlorhexidine gluconate (CHG)-aqueous or 2% CHG-70% isopropyl alcohol (IPA) before PCVC insertion and at removal. Primary outcome: Proportion in the 2% CHG-70% IPA arm with a colonised catheter at removal. Main feasibility outcomes: Rates of: (1) CRS, catheter-associated sepsis (CAS), and CRS/CAS per 1,000 PCVC days; (2) recruitment and retention; (3) data completeness. Safety outcomes: Daily skin morbidity scores recorded from catheter insertion until 48 hours post-removal. Results: 116 babies were randomised. Primary outcome incidence was 4.1% (95% confidence interval: 0.9% to 11.5%). Overall catheter colonisation rate was 5.2% (5/97); CRS 2.3/1000 catheter days; CAS 14.8/1000 catheter days. Recruitment, retention and data completeness were good. No major antiseptic-related skin injury was reported. Conclusions: A definitive comparative efficacy trial is feasible, but the very low catheter colonisation rate would make a large-scale RCT challenging due to the very large sample size required. ARCTIC provides preliminary reassurance supporting potential safe use of 2% CHG-70% IPA and 2% CHG-aqueous in preterm neonates. Trial registration number: ISRCTN82571474.

Original languageEnglish
Pages (from-to)202-210
Number of pages9
JournalArchives of Disease in Childhood - Fetal and Neonatal Edition
Issue number2
Early online date31 Oct 2023
Publication statusPublished - 19 Feb 2024


  • Infectious Disease Medicine
  • Microbiology
  • Neonatology
  • Sepsis

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