Vachharajani A J, Vachharajani N A, Morris H, Niesen A, Elward A, Linck D A, Mathur A M
Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
J Perinatol. 2017 Apr;37(4):409-413. doi: 10.1038/jp.2016.243. Epub 2017 Jan 12.
Our objective was to safely reduce the number of peripherally inserted central catheters (PICCs) inserted in infants with umbilical venous catheter using quality improvement methods.
In a tertiary neonatal intensive care unit, a questionnaire designed to prompt critical thinking around the decision to place a PICC, along with an updated standardized feeding guideline was introduced. PICC insertion in 86 infants with umbilical venous catheter (pre intervention) with birth weight 1000-1500 g were compared with 115 infants (post intervention) using Fisher's exact test.
PICC lines inserted after the intervention decreased by 37.5% (67/86; 77.9% vs 56/115; 48.7%; P<0.001). The proportion of central line-associated blood stream infection were 2.49 vs 2.82/1000 umbilical venous catheter days; P=0.91 in the two epochs, respectively.
Quality improvement methodology was successful in significantly reducing the number of PICCs inserted without an increase in central line-associated blood stream infection.
我们的目标是采用质量改进方法，安全减少通过脐静脉导管插入中心静脉导管（PICC）的婴儿数量。
在一家三级新生儿重症监护病房，引入了一份旨在促使围绕放置PICC的决策进行批判性思考的问卷，以及一份更新的标准化喂养指南。采用Fisher精确检验，将86例出生体重1000 - 1500 g且带有脐静脉导管的婴儿（干预前）的PICC插入情况与115例婴儿（干预后）进行比较。
干预后插入的PICC数量减少了37.5%（67/86；77.9%对比56/115；48.7%；P<0.001）。两个时期中心静脉导管相关血流感染的比例分别为每1000个脐静脉导管日2.49例和2.82例；P = 0.91。
质量改进方法成功显著减少了PICC的插入数量，且未增加中心静脉导管相关血流感染。
