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Reducing peripherally inserted central catheters in the neonatal intensive care unit.

A J Vachharajani1, N A Vachharajani2, H Morris3

  • 1Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.

Journal of Perinatology : Official Journal of the California Perinatal Association
|January 13, 2017
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Summary

Quality improvement methods successfully reduced peripherally inserted central catheter (PICC) use in infants. This initiative decreased PICC insertions by 37.5% without increasing central line-associated blood stream infections.

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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.