Neonatologist University of Utah University of Utah Salt Lake City, Utah, United States
Background: The majority of neonates in the Neonatal Intensive Care Unit (NICU) require vascular access. Traditionally, peripherally inserted central catheters (PICC) and peripheral IV catheters have been the only options. The extended dwell peripheral intravenous (EPIV) catheter has recently been introduced to the NICU population. Recent evidence suggests benefit and safety in the NICU population, however there is limited data in the use of EPIV in low birth weight infants. In 2012, the Intermountain Medical Center NICU implemented EPIV catheters as an alternative to PICC for providing prolonged nutritional support and route for medication administration in infants ≥1500 g. Infants <1500 g were excluded due to a high rate (59%) of unintended discontinuation (UD).
Objective: To review baseline usage of the EPIV catheter and share our experience with a change in patient selection criteria in the Intermountain Medical Center NICU
Design/Methods: A retrospective review of our EPIV catheter practice from 2017 through 2020 was conducted. Drivers of safety and reliability for placement of EPIV in the smaller population were identified and in 2019, the patient selection criteria were adjusted to include infants 1000-1500 g. Infants ≥1500 g were compared to infants 1000-1500 g for rates of UD (defined as infiltrate, cording, or early removal before the completion of intravenous therapy). In patients <1500 g, a process measure of placement radiographs was adopted in 2020.
Results: In patients ≥1500 g, 763 EPIV catheters were placed over the 4-year period. After selection criteria were broadened, 48 EPIV catheters were placed in babies weighing 1000-1500 g. The UD rate in these smaller patients was 21% (10/48) as compared to 79/763 (10%) in infants ≥1500 g (p=0.02). No placement radiographs prompted repositioning or discontinuing the EPIV catheter. Conclusion(s): Since initial implementation in our unit, EPIV catheters have been used reliably with our in-unit protocol and without adverse events beyond UD. Inclusion of smaller patients showed an increased rate of UD of 21% versus 10% in the baseline group. This is lower than the previously published UD rate of 59%. In our unit, this increase in rate of UD is considered acceptable in the smaller weight patients. Our next steps include discontinuing routine imaging for placement and operationalizing fluid orders to facilitate routine placement of EPIV catheters in patients that do not meet criteria for routine umbilical venous catheter or PICC lines.
Authors/Institutions: Alicia M. Sainsbury, Intermountain Medical Center, Murray, Utah, United States; Melissa Willden, Intermountain Medical Center, Murray, Utah, United States; Tara DuPont, University of Utah, Salt Lake City, Utah, United States; Jessica Davidson, University of Utah, Salt Lake City, Utah, United States