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Peripheral intravenous and central catheter algorithm: a proactive quality initiative.

Kerry A Wilder1, Susan C Kuehn, James E Moore

  • 1Neonatal Intensive Care Unit, Children's Medical Center Dallas, Texas.

Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses
|October 15, 2014
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Summary

A new algorithm significantly reduced severe peripheral intravenous (PIV) infiltrations and tissue damage in neonates. This quality improvement initiative improved patient safety in the neonatal intensive care unit (NICU).

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Area of Science:

  • Neonatal intensive care
  • Vascular access
  • Quality improvement

Background:

  • Peripheral intravenous (PIV) infiltrations causing tissue damage are a global concern, particularly in neonatal intensive care units (NICUs).
  • Difficult vascular access decisions complicate PIV management in neonates.
  • Standardized protocols are needed to mitigate risks associated with PIV catheters in vulnerable infant populations.

Purpose of the Study:

  • To develop and implement a decision-making algorithm for PIV catheter use in neonates.
  • To assess the effectiveness of this algorithm in reducing PIV infiltrations and associated tissue damage.
  • To improve patient safety and outcomes within the NICU setting.

Main Methods:

  • A quality improvement project involving a retrospective chart review for baseline data collection.
  • Development and implementation of a standardized PIV catheter decision pathway algorithm.
  • Daily manual counting of PIV catheters and events, alongside electronic medical record review, to track infiltration rates per 100 PIV days.

Main Results:

  • The rate of grade 4 PIV infiltrations decreased significantly from 2.8 to 0.83 per 100 PIV days (P = .00021) after algorithm implementation.
  • While total infiltrations slightly increased due to heightened reporting, severe (grade 4) infiltrations and tissue damage showed a marked reduction.
  • The implemented algorithm provided crucial guidance for vascular access decisions, contributing to reduced adverse events.

Conclusions:

  • The standardized decision pathway algorithm was instrumental in reducing severe PIV infiltrations and tissue damage in the NICU.
  • This quality improvement initiative demonstrates the positive impact of structured protocols on neonatal patient safety.
  • Further utilization of this algorithm can lead to sustained improvements in PIV care for neonates.