小児集中治療室におけるミッドラインカテーテルの使用を増やすための実施戦略の開発とテスト
Mark D Weber1, Warren Frankenberger2, Amanda J Ullman3
1Children's Hospital of Philadelphia, Department of Anaesthesiology and Critical Care Medicine, Philadelphia, PA, United States; Children's Hospital of Philadelphia, Department of Advanced Clinical Practice, Philadelphia, PA, United States.
Background:
Paediatric critically ill patients are at risk of harm from central venous catheter overuse. We applied an implementation science approach to promote appropriate use of midline catheters. The aim of this study was to evaluate changes in clinician perceptions of midline catheters following the implementation of tailored intervention strategies and the effectiveness of implementation on midline use in the care of critically ill children.
Methods:
We used a mixed-method, prehybrid/posthybrid implementation-effectiveness design in a 75-bed paediatric intensive care unit. The study included three phases: pre-implementation (July-August 2023), implementation (September 2023), and post-implementation (October-November 2023). Focus groups informed barrier/facilitator mapping using implementation frameworks to develop intervention strategies. Pre-implementation/post-implementation surveys included 36 items assessing clinician perceptions of midline acceptability, feasibility, and appropriateness domains. Midline catheter utilisation rates assessed clinical effectiveness, and balancing metrics included vascular access harm and midline failure rates.
Findings:
Pre-implementation/post-implementation survey scores increased across all 36 items measuring midline perception (two items statistically significant in feasibility domain; p < 0.05). Midline use increased, from 3% to 7.2% during implementation and to 4.3% post implementation, though increases were not statistically significant. No increase in vascular access harm occurred, and midline failure rates decreased from 57.1% during the preimplementation phase to 14.3% during the postimplementation phase.
Conclusions:
A suite of tailored, theory-informed implementation intervention strategies supported and improved positive clinician perceptions of midline catheter utilisation. Clinical utilisation of midlines across implementation phases did not increase overall vascular access harm. The decrease in midline catheter device selection post-implementation highlights the need for sustained strategies. These findings offer a replicable framework for other paediatric settings to optimise vascular access device selection.
