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.
Boyar V, Galiczewski C. Reducing Peripheral Intravenous Catheter Extravasation in Neonates: A Quality Improvement Project. J Wound Ostomy Continence Nurs. 2021 Jan-Feb 01;48(1):31-38. doi: 10.1097/WON.0000000000000728. PMID: 33427807.