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Quality improvement measures for early detection of severe intravenous infiltration in infants
  1. Subhasri Lakshmi Sangam1,2
  1. 1Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
  2. 2Robert Wood Johnson University Medical Center, New Brunswick, New Jersey, USA
  1. Correspondence to Dr Subhasri Lakshmi Sangam; subhasri_s{at}yahoo.com

Abstract

Intravenous infiltration is one of the most commonly seen morbidity in infants admitted to the neonatal intensive care unit (NICU). The risk of intravenous infiltration in preterm infants is probably due to prolonged peripheral intravenous access requirement for nutritional support and usage of other intravenous medications to support their growth. Infants are more likely to develop intravenous infiltrations due to the increased fragility of their blood vessels, deficient subcutaneous tissue and inability to express pain. As a result, the intravenous infiltrates in infants can rapidly progress to severe stage 3 and stage 4 infiltrates with necrosis if timely intervention is not provided. Also, factors obscuring to identify stage 1 and stage 2 infiltrates, may lead their progression to severe infiltration. Root cause analysis was performed following two severe intravenous infiltrates that required plastic surgery intervention in our level III NICU. Quality improvement measures were implemented. We developed a unique intravenous securing method, conducted educational programmes for NICU staff, increased intravenous site surveillance and ascertained to maintain the intravenous pump pressures in the reference range. The hospital NICU intravenous care policy was updated with quality improvement measures. Data were collected preintervention and postintervention. The incidence of intravenous infiltration in preterm infants varies widely in different places. This may be due to under-reporting of these relatively rare adverse events, but may also be due to the fact that the preterm infants represent a small portion of the patient population. The present study has shown that severe infiltration was associated with an increase in intravenous days. Following the quality improvement measures, there were no reported cases of severe intravenous infiltration. In conclusion, the awareness of the problem with evidence-based quality improvement measures may help in early detection of intravenous infiltrates and decrease the severe intravenous infiltration in infants.

  • preterm infants
  • neonates
  • iv infiltration

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Footnotes

  • Contributors Contributions to the design of the work, collection, interpretation of data and drafting is solely by SLS.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • IRB approval The changes in intravenous protocol were implemented as quality improvement measures and mandated through NICU intravenous care policy following two severe intravenous infiltrations. IRB review was not obtained prior to implementing policy changes as this study met the criteria for exemption from such review according to the institutional policy.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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