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.

中文翻译：

---

在新生儿重症监护病房提供及时中央血管通路的质量改进计划

背景： 

及时的中心静脉通路对于危重新生儿的护理至关重要。当无法放置或停用脐静脉导管时，外周插入中心导管 (PICC) 是中心静脉通路的首选形式。然而，时间延迟会增加外周静脉输液管损伤的风险，并可能导致必要的液体和药物输送不一致。

目的： 

该质量改进项目的目的是减少 PICC 在新生儿重症监护室 (NICU) 的等待时间。

方法： 

建立了一个由 NICU 护士和主治新生儿科医生组成的以单位为基础的 PICC 团队，并分两个阶段实施。数据是在团队实施之前、期间和之后从图表审查中收集的。我们跟踪了 PICC 订单和放置之间的时间以及尝试次数。还监测了外周静脉导管浸润和中心导管相关血流感染的医院指标。在项目结束时，我们继续跟踪结果以确定收益是否会持续到项目期之后。

结果： 

基于单位的跨学科专业团队的实施导致 PICC 平均等待时间从 1.2 天减少 50% 至 0.58 天。该倡议的好处在项目的初始阶段之后得以维持。

对实践的影响： 

一个专门的本地团队的发展在改善新生儿重症监护室的血管通路方面发挥了关键作用。

对研究的影响： 

专业团队的接近提供了解决 NICU 护理差距的解决方案。