117 - Reducing the Incidence of PIV Infiltration and Extravasation in the Neonatal Intensive Care Unit (NICU): A Quality Improvement Initiative.

Publication Number: 4115.117

Nikhitha Kotha, Albert Einstein College of Medicine, Bronx, NY, United States; Nadia Nazir Jatoi, Jacobi Medical Center, Bronx, NY, United States; Mahmoud A. Taha, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States; chidinma I. Ododo, Jacobi medical center, Bronx, NY, United States; Temitope Olayinka, Jacobi Medical Center, Bronx, NY, United States; Enoch Tettey, Jacobi Medical Center, BRONX, NY, United States; Samantha Angeles Perez, Jacobi Medical Center/Albert Einstein College of Medicine, Bronx, NY, United States; Babina K. nayak, Jacobi Medical Center, Dix HIlls, NY, United States

Background: Peripheral IVs (PIV's) are routinely performed procedures in NICUs. Complications of PIV placement may present in the form of phlebitis, infiltration, occlusion/mechanical failure, dislodgement, and infection. Such complication may require treatments including administration of drugs-hyaluronidase, skin grafts or PT and OT causing emotional burden on the parent and overall financial burden on the unit. The baseline incidence of PIV infiltration in the unit prior to start of interventions were- 9 cases in the month of October 2023 and 7 cases in the month of Nov 2023.

Objective: The aim of the project was to reduce the incidence of PIV infiltrates/extravasation/phlebitis to zero in the period of Nov'23 to Oct'24. Each PDSA cycle was aimed at reducing the incidence by 25%.

Design/Methods: The QI project was conducted in a level III NICU of an urban teaching hospital with approximately 1800 births annually and 300 admissions. IHI's PDSA model was adapted. Over a period of 12-month we carried multiple PDSA cycles each lasting 3-4 months. In Jan'24, rebound incidence was noted so 4th PDSA cycle was restarted. Data was collected from EMR and the institution's safety event reporting system.

Four main causes identified: 1. Cannulation by inexperienced staff, 2. Inappropriate disinfection of the site before insertion, 3. Multiple insertion attempts 4. Administration of drugs and IV fluids with low pH, higher concentrations, high Calcium using high flow rates.
PDSA Cycles: 1. Nov'23 to Feb'24 Aimed at educating proper IV insertion technique; aseptic precautions, using the right device for the right vein; selecting the most distal and least restrictive site 2. March'24 to June'24 Ensuring only 2 attempts by one provider, reinforcing extremity boards for stabilization 3. July'24 to October'24 Avoidance of high concentrated IV fluids solution and TPN through PIV and early central line access in qualified infants 4. Jan'25 to March'25 Improving motivation by visual display of the VIP score for phlebitis and diagram 'Let's go back to Zeros!'

Results: Attempted to detect early-stage infiltrations and also improved surveillance with educational interventions for the staff. This showed improvement in IV infiltrates rates in the unit. There were 100% results achieved in 2 of the PDSA cycles with zero incidence in two consecutive months.

Conclusion(s): Use of extremity stabilizing methods, compliance of "Touch, Look, Compare"(TLC) assessments of site every hour and real time documentation of VIP (Visual Infusion Phlebitis) scores along with timely placement of central lines helped in reducing the incidence of PIV infiltration.

PDSA cycles
PDSA cycles targeting 4 main problems identified for the high incidence of PIV infiltrations and phlebitis

Incidence of PIV related infiltration and phlebitis in the unit
Showcasing the remarkable decrease in the incidence of PIV infiltration and phlebitis to 0% over two consecutive months in March'24-April'24 and Feb'25-March'25.