Reducing peripherally inserted central catheters in the neonatal intensive care unit

Area of Science:

• Neonatal intensive care
• Medical quality improvement
• Pediatric vascular access

Background:

• Peripherally inserted central catheters (PICCs) are crucial for neonatal care but carry risks.
• Umbilical venous catheters (UVCs) are often used in neonates, raising questions about concurrent PICC necessity.
• Optimizing vascular access device utilization is essential for patient safety in neonatal intensive care units (NICUs).

Purpose of the Study:

• To implement and evaluate a quality improvement initiative aimed at reducing the number of PICCs inserted in infants already utilizing UVCs.
• To assess the impact of the intervention on PICC insertion rates and central line-associated blood stream infections (CLABSIs).

Main Methods:

• A tertiary NICU introduced a critical thinking questionnaire and updated feeding guidelines to prompt reassessment of PICC necessity.
• A pre-intervention cohort (86 infants) was compared to a post-intervention cohort (115 infants) using Fisher's exact test.
• Infants in both groups had birth weights between 1000-1500g and received UVCs.

Main Results:

• PICC insertions decreased by 37.5% post-intervention (77.9% vs 48.7%).
• The rate of central line-associated blood stream infections showed no significant increase (2.49 vs 2.82 per 1000 UVC days).
• Statistical analysis confirmed the significant reduction in PICC use (P<0.001).

Conclusions:

• Quality improvement methods are effective in reducing unnecessary PICC insertions in neonates with UVCs.
• The implemented strategy achieved its goal without compromising patient safety regarding CLABSIs.
• This approach offers a scalable model for optimizing vascular access device management in NICUs.