Reducing Peripheral Intravenous Catheter Extravasation in Neonates: A Quality Improvement Project.
J Wound Ostomy Continence Nurs
; 48(1): 31-38, 2021.
Article
en En
| MEDLINE
| ID: mdl-33427807
ABSTRACT
PURPOSE:
Our objective was to reduce total and severe peripheral intravenous extravasation (PIVE) incidence by 40% in our neonatal intensive care unit. SETTING/APPROACH:
This quality improvement initiative was performed at an academic, free-standing suburban children's hospital, in a level 4 neonatal intensive care unit from June 2017 to April 2018. Baseline extravasation data for a period of 6 months prior to the initiative were reviewed, along with a nursing knowledge questionnaire and random audits of catheter stabilization techniques. A Pareto chart and a key driver diagram were created to identify the most common causes of extravasations and lead to a series of process changes. We implemented 4 Plan-Do-Study-Act (PDSA) cycles (1) dressing protocol for peripheral intravenous vascular (PIV) catheter securement that instituted standardized securement and safer equipment; (2) education on PIV assessment and maintenance, concentrating on hourly evaluation and documentation; (3) guidance algorithm for PIVE identification and treatment; and (4) escalation policy, limiting the number of placement attempts and increased use of a "superuser" team.OUTCOMES:
The overall prevalence of extravasations decreased by 54%, from 73 preintervention to 40 at postintervention. At baseline, 52% (38/73) extravasations were severe; however, those in the severe category decreased by 35% (14/40) postintervention. The overall rate of adherence to the PIV catheter management algorithm approached 95%; whereas adherence to the securement guideline fluctuated between 80% and 98%. IMPLICATION FOR PRACTICE The implementation of these new practice recommendations along with the education has resulted in a decreased rate and severity of extravasation. Frequent audits and reinforcements are integral to sustainment and to ensure accountability for the implemented procedures.
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Cateterismo Periférico
/
Unidades de Cuidado Intensivo Neonatal
/
Cuidado Intensivo Neonatal
/
Extravasación de Materiales Terapéuticos y Diagnósticos
/
Mejoramiento de la Calidad
/
Enfermería de Cuidados Críticos
Tipo de estudio:
Guideline
/
Prognostic_studies
/
Qualitative_research
/
Risk_factors_studies
Límite:
Child
/
Humans
/
Newborn
Idioma:
En
Revista:
J Wound Ostomy Continence Nurs
Asunto de la revista:
ENFERMAGEM
Año:
2021
Tipo del documento:
Article