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.