Exit site management: neonatal european vascular access team - ESPR recommendation 7

Introduction Neonatal skin immaturity, increased transepidermal water loss, prolonged catheter dwell times, and repeated dressing manipulation expose neonates to a high risk of catheter-related infection, skin injury, dressing failure, and device dislodgement. Standardized exit site management is therefore a fundamental component of neonatal vascular access care. This article is part of a special series of ten recommendations for the management of neonatal vascular access, developed through a structured multidisciplinary consensus process integrating literature appraisal and expert deliberation.Methods and clinical application This recommendation provides evidence-based guidance for the management of exit sites of peripheral venous access devices, central venous access devices, and intra-arterial catheters in neonates. Key components include standardized assessment of the exit site and skin condition, risk-based application of Standard-ANTT® or Surgical-ANTT®, skin antisepsis adapted to gestational age, use of chlorhexidine-based solutions, securement with sutureless devices, application of octyl-butyl-cyanoacrylate glue, and use of semipermeable transparent dressings with high moisture vapor transmission rate (MVTR). Recommendations for dressing changes, complication monitoring, and catheter removal are also provided.Conclusion Standardized exit site management may reduce catheter-related infections, medical adhesive-related skin injury, dressing failure, and device dislodgement, while improving consistency of care and patient safety across neonatal units.Impact This recommendation provides evidence-based strategies for neonatal vascular access exit site management, including dressing selection, antisepsis, securement, and skin protection. Standardized exit site care may reduce catheter-related infections, dressing failure, skin injury, and device dislodgement in neonates. The recommendation promotes consistent use of aseptic non-touch technique (ANTT®), securement systems, and high MVTR dressings to preserve skin integrity and improve catheter stability. Implementing standardized exit site management practices enhances patient safety and reduces practice variation across neonatal centers.