143 - Reducing PIVIE in the NICU: 6 Years of Improvement and Sustainability

Publication Number: 3137.143

Sonia K. Chandi, New York University Long Island School of Medicine, Mineola, NY, United States; Leticia Rios, NYU Langone Long Island, Mineola, NY, United States; Ashley Noiman, New York University Long Island School of Medicine, Valley Stream, NY, United States; Dinah Thomas, NYU Langone Hospital- Long Island, Levittown, NY, United States; Jennifer Landaverde, NYU Langone Long Island, Mineola, NY, United States; LaShon Pitter, NYU Langone-Long Island, Mineola, NY, United States; Tara A. Schepis, The Children’s Medical Center at NYU Winthrop Hospital, East Rockaway, NY, United States; Maria Lyn Quintos-Alagheband, NYU Langone Hospital Long Island, Mineola, NY, United States; Zeyar Htun, The Children’s Medical Center at NYU Winthrop Hospital, Mineola, NY, United States

Background: Neonates admitted to the neonatal intensive care unit (NICU) need peripherally inserted venous (PIV) catheters to administer fluids, parenteral nutrition and medications. One complication that can occur from PIVs are peripheral intravenous infiltrations and extravasations (PIVIE). PIVIEs can result in further complications such as tissue necrosis, ulcerations, and compartment syndromes. Early recognition and prevention are key to reducing PIVIEs and their associated harm. At our level III NICU, the two-year baseline data showed a rate (per 1000 patient days) of 1.71 for all PIVIEs, 1.17 for mild PIVIEs, and 0.67 for moderate/severe PIVIEs.

Objective: Our SMART AIM is to decrease the incidence of PIVIE by 10% each year to improve quality of care, decrease hospital-related complications, and reduce harm in this vulnerable population.

Design/Methods: Baseline data were collected over a two-year period (2018-2019). Foundational work included forming a multidisciplinary team, creating a PIVIE reference card, and developing a standardized algorithm for assessment and management. Between 2020 and 2025, the following key interventions were implemented: standardization of PIV securement techniques; adoption of a "Touch-Look-Compare" model for assessment; formal case reviews; introduction of a protocol for high-risk extravasations; implementation of bundle audits and job instruction tools; recruitment of frontline champions; and regular monthly Plan-Do-Study-Act (PDSA) cycles with detailed review of each event.

Results: The annual mean rate for all types of PIVIEs per 1000 patient days decreased from baseline of 1.71 to 0.79 in Q2 2025 - a 54% reduction over 6-years (Figure 1). The annual mean rate for mild cases per 1000 patient days decreased from baseline of 1.17 to 0.60 in 2024 - a 49% reduction over 6-years (Figure 2). The annual mean rate for moderate/severe cases per 1000 patient days decreased from baseline of 0.97 to 0.20 in 2024 - a 79% reduction over 6-years (Figure 3).

Conclusion(s): Implementation of a structured, multidisciplinary quality improvement initiative led to a sustained reduction in PIVIE rates over a six-year period. The next phase toward achieving zero harm will focus on the introduction of proactive safety tools and predictive monitoring strategies.

Total PIVIEs from 2018-2025
Figure 1.jpeg(A) Q1 2018: Multi-disciplinary team formed, standardized assessment, Key card, education, and algorithm for evaluation/treatment of PIVIE, (B) QI 2019: PIVIE kits, bundle audits started, simulation used for education, (C) Q1 2020: Standardized securement and improved review process, (D) QI 2021: Introduction of IV infiltration/extravasation risk list based on medications, (E) Q2 2021: Algorithm for evaluation and treatment created, (F) Q2 2022: Scoring tool created; further recruitment of champions, (G) Q1 2023: Tip sheet for prevention/positioning, and securement created, (H) Q2 2023: Use of EMR for recording PIV history, (I) Q1 2024: Job instruction tool (documentation, photography, measurement) created; including specialists for treatment; further education of staff, (J) Q4 2024: Recreating key driver diagram to include proactive safety tools.

Trend of mild PIVIEs from 2018-2025
Figure 2.jpeg(A) Q1 2018: Multi-disciplinary team formed, standardized assessment, Key card, education, and algorithm for evaluation/treatment of PIVIE, (B) QI 2019: PIVIE kits, bundle audits started, simulation used for education, (C) Q1 2020: Standardized securement and improved review process, (D) QI 2021: Introduction of IV infiltration/extravasation risk list based on medications, (E) Q2 2021: Algorithm for evaluation and treatment created, (F) Q2 2022: Scoring tool created; further recruitment of champions, (G) Q1 2023: Tip sheet for prevention/positioning, and securement created, (H) Q2 2023: Use of EMR for recording PIV history, (I) Q1 2024: Job instruction tool (documentation, photography, measurement) created; including specialists for treatment; further education of staff, (J) Q4 2024: Recreating key driver diagram to include proactive safety tools.

Trend of moderate and severe PIVIEs from 2018-2025
(A) Q1 2018: Multi-disciplinary team formed, standardized assessment, Key card, education, and algorithm for evaluation/treatment of PIVIE, (B) QI 2019: PIVIE kits, bundle audits started, simulation used for education, (C) Q1 2020: Standardized securement and improved review process, (D) QI 2021: Introduction of IV infiltration/extravasation risk list based on medications, (E) Q2 2021: Algorithm for evaluation and treatment created, (F) Q2 2022: Scoring tool created; further recruitment of champions, (G) Q1 2023: Tip sheet for prevention/positioning, and securement created, (H) Q2 2023: Use of EMR for recording PIV history, (I) Q1 2024: Job instruction tool (documentation, photography, measurement) created; including specialists for treatment; further education of staff, (J) Q4 2024: Recreating key driver diagram to include proactive safety tools.