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Reducing Ischemic Injury From Indwelling Peripheral Arterial Catheters in a Pediatric Cardiac ICU: A Quality
Adam C Adler1, Stephanie Helman2, Cynthia Field2
1Division of Cardiovascular Anesthesiology, Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, Houston, TX.
Insights
A quality improvement initiative successfully reduced arterial catheter injuries in pediatric cardiac patients by implementing continuous flushing and daily safety assessments. This intervention led to a significant decrease in catheter-related harm, improving patient safety in the cardiac intensive care unit.
Area of Science:
- Pediatric Cardiology
- Quality Improvement Science
- Patient Safety
Background:
- Ischemic arterial catheter injuries pose a risk to children with heart conditions.
- Effective strategies are needed to minimize these complications in intensive care settings.
Purpose of the Study:
- To decrease the incidence of ischemic arterial catheter injuries in pediatric patients with congenital or acquired heart disease.
- To evaluate the impact of a quality improvement initiative on arterial catheter safety.
Main Methods:
- A quality improvement study was conducted with pre- and postintervention groups at a pediatric cardiac center.
- Interventions included transitioning to continuous arterial catheter infusion and implementing daily safety assessments.
- Data were collected on arterial catheter injuries and assessments per 1,000 catheter days and per month.
Main Results:
- The study analyzed 1,945 arterial catheters (7,197 catheter days).
- Arterial catheter injuries decreased by 38.7% (3.1 to 1.9 patients/month) and 55% per 1,000 catheter days (16.7 to 7.52).
- Concerning assessments reduced by 18.0% (25.5% to 20.9%).
Conclusions:
- Implementing a quality improvement initiative significantly reduced arterial catheter-associated harm in critically ill children with heart disease.
- Changes in local practices, including continuous flushing and daily assessments, improved patient safety.
- The study demonstrates the effectiveness of targeted interventions in a pediatric cardiac intensive care unit.
Objectives:
To reduce the number of ischemic arterial catheter injuries in children with congenital or acquired heart disease.
Design:
This is a quality improvement study with pre- and postintervention groups.
Setting:
University-affiliated pediatric cardiac center in a quaternary care freestanding children's hospital.
Patients:
All patients with an indwelling peripheral arterial catheter placed in the Children's Hospital of Philadelphia Cardiac Center associated with an admission to the Cardiac Intensive Cardiac Unit from January 2015 to July 2017 are included. Patients with umbilical arterial catheters were excluded from the cohort. The rate of arterial catheter injury is reported per 1,000 catheter days. The rate of "concerning" arterial catheter assessments is reported as a percentage of catheters per month.
Intervention:
Initial intervention replaced intermittent manual arterial catheter flushing with a continuous arterial catheter infusion system during the delivery of anesthesia. The second intervention implemented a daily arterial catheter safety assessment during cardiac ICU rounds with documentation of the assessment in the cardiac ICU daily attending progress note.
Measurements And Main Results:
Our project included 1,945 arterial catheters encompassing 7,197 catheter days. During the preintervention period, on average, 3.1 patients per month experienced an arterial catheter-related injury compared with 1.9 patients per month following intervention, a reduction of 38.7% (3.1 vs 1.9; p = 0.01). The rate of injury per 1,000 arterial catheter days was reduced from 16.7 pre intervention to 7.52 post intervention, a 55% overall reduction (16.7 vs 7.52; p = 0.0001). The rate of concerning arterial catheter nursing assessment based on our definition was reduced by 18.0% following our intervention cycles (25.5% vs 20.9%; p = 0.001) CONCLUSIONS:: Implementation of a quality improvement initiative and changing local practices reduced arterial catheter-associated harm in children with congenital and acquired heart disease requiring care in a cardiac ICU.
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