A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit.

BACKGROUND: Timely central venous access is essential in the care of critically ill neonates. Peripherally inserted central catheters (PICCs) are the preferred form of central venous access when umbilical venous catheters cannot be placed or are discontinued. However, time delays increase risk for injury from peripheral intravenous lines and may contribute to inconsistent delivery of necessary fluids and medications. PURPOSE: The aim of this quality improvement project was to decrease wait times for PICC placement in the neonatal intensive care unit (NICU). METHODS: A unit-based PICC team was developed consisting of NICU nurses and attending neonatologists and implemented in 2 phases. Data were collected from chart reviews before, during, and after implementation of the team. We tracked time between PICC order and placement and number of attempts. Hospital metrics on peripheral intravenous line infiltrations and central line-associated blood stream infection were also monitored. At the end of the project, we continued tracking outcomes to determine whether gains would be sustained past the project period. RESULTS: Implementation of a unit-based interdisciplinary specialty team led to a 50% reduction in mean PICC wait times from 1.2 days to 0.58 days. Benefits of the initiative were sustained past the initial project period. IMPLICATIONS FOR PRACTICE: The development of a dedicated, local team played a key role in improving vascular access in the NICU. IMPLICATIONS FOR RESEARCH: Proximity of specialized teams provides a solution to address gaps in care in the NICU.

Having Skin in the Game: A Case Study of Necrotizing Fasciitis in the Neonate Treated With Cultured Epidermal Autografts.

BACKGROUND: Necrotizing fasciitis (NF) is a rare but often fatal bacterial infection of the skin and the soft tissue. CLINICAL FINDINGS: Necrotizing fasciitis occurs mainly in adults and remains relatively uncommon in the neonate. Because the presenting skin and laboratory findings are variable, prompt diagnosis is often difficult. The risk of mortality increases with time to intervention. PRIMARY DIAGNOSIS: This case presents a 4-day old full-term female neonate with NF resulting in a significant scalp defect. INTERVENTIONS: The neonate was successfully treated using a novel approach with a cultured epidermal autograft. OUTCOMES: The treatment period was effective, and the neonate had an excellent clinical outcome. The neonate was discharged home 21 days post graft application. PURPOSE: This case study will highlight the influence of the clinical nurse specialist on care coordination, innovative treatment plans, and resource development for a neonate with NF. PRACTICE RECOMMENDATIONS: Because of the rare but fatal nature of NF, innovative therapies must be considered. Offering a nontraditional treatment can help improve patient recovery and long-term outcomes. The use of cultured epidermal autograft now provides a new treatment option for neonatal patients in the future.