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Implementation of an ultrasound-guided approach for arterial line placements in neonates-quality improvement project
Marko Culjat1,2, Domagoj Dzaja3, Heather Colangelo4
1Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada. marko.culjat@sickkids.ca.
Objective:
Our goal was to improve placement success rates for peripheral arterial line (PAL) placements by introducing an ultrasound-guided (USg) approach. Our aim was to maintain success rates over 70% within 18 months.
Study Design:
Interventions included development of a training curriculum, and procedure standardization. Among 302 patients, 115 underwent USg catheter placement; the traditional method was used in 187 patients. Outcome measures were first-attempt and overall success rates. Process measures were proportion of PALs placed under US guidance, trainer availability, and trainee sign-off. Line complications were balancing measures. Statistical process control charts were used to monitor metrics.
Results:
Sustained improvement was seen with the USg approach. The USg approach had first and overall attempt success by the trainers (i.e., independent users) of 83.7% (77/92) and 96.5% (111/115), compared to 50.3% (82/163) and 73.8% (138/187) with the traditional approach.
Conclusion:
Introducing the USg approach had a significant impact on PAL placement success in neonatal patients.
