Reducing Ischemic Injury From Indwelling Peripheral Arterial Catheters in a Pediatric Cardiac ICU: A Quality Improvement Initiative*

Abstract

Our project included 1,945 arterial catheters encompassing 7,197 catheter days. During the preintervention period, on average, 3.1 patients per month experienced an arterial catheter-related injury compared with 1.9 patients per month following intervention, a reduction of 38.7% (3.1 vs 1.9; p = 0.01). The rate of injury per 1,000 arterial catheter days was reduced from 16.7 pre intervention to 7.52 post intervention, a 55% overall reduction (16.7 vs 7.52; p = 0.0001). The rate of concerning arterial catheter nursing assessment based on our definition was reduced by 18.0% following our intervention cycles (25.5% vs 20.9%; p = 0.001) CONCLUSIONS:: Implementation of a quality improvement initiative and changing local practices reduced arterial catheter-associated harm in children with congenital and acquired heart disease requiring care in a cardiac ICU.

Nutrition association with skin integrity and pressure injury in critically ill pediatric patients

“…Additional sources of skin injury include irritant dermatitis exposures, such as stool, urine, saliva or respiratory secretions, the effluent of digestive excretions, or wound drainage. Surgical wounds, use of vascular access devices, vasoconstriction resulting from fluid and medication extravasation, and medical adhesive–related skin injury are also potential additional sources for skin injury in the critically ill child 21,22 . Medical devices necessary during illness such as noninvasive positive‐pressure ventilation appliances, endotracheal tubes and securing apparatuses, tracheostomy tubes and ties, pulse oximetry probes, and other medically necessary tools with skin failure (as described) increase the risk for breakdown of skin integrity and occurrence of PIs 23 .…”

“…Surgical wounds, use of vascular access devices, vasoconstriction resulting from fluid and medication extravasation, and medical adhesive-related skin injury are also potential additional sources for skin injury in the critically ill child. 21,22 Medical devices necessary during illness such as noninvasive positive-pressure ventilation appliances, endotracheal tubes and securing apparatuses, tracheostomy tubes and ties, pulse oximetry probes, and other medically necessary tools with skin failure (as described) increase the risk for breakdown of skin integrity and occurrence of PIs. 23 The incidence of skin injury in critically ill children is reported to be between 10% and 27%, with prevalence described up to 43%.…”

Quality Improvement Studies in Pediatric Critical Care Medicine

“…Several elements make a QI report good and useful. Table 1 provides a summary, with excerpts from exemplary publications (18)(19)(20)(21)(22)(23), to support each description below.…”

Intraarterial papaverine for relief of catheter‐induced peripheral arterial vasospasm during pediatric cardiac surgery: A randomized double‐blind controlled trial

“…Some of these are the site of arterial cannulation, size of artery cannulated, number of attempts, the type of arterial catheter, and fidelity of transducer-flush system. [1][2][3][4] Also, maintaining the patency of pediatric peripheral arterial catheters during complex surgeries can be challenging due to lengthy surgical procedures, temperature instability, inotropic medications, and frequent sampling compounding the effects on suboptimal arterial waveforms. [2][3][4] Arterial vasospasm around the catheter site is a potentially modifiable factor that significantly impacts peripheral arterial line patency.…”

“…[1][2][3][4] Also, maintaining the patency of pediatric peripheral arterial catheters during complex surgeries can be challenging due to lengthy surgical procedures, temperature instability, inotropic medications, and frequent sampling compounding the effects on suboptimal arterial waveforms. [2][3][4] Arterial vasospasm around the catheter site is a potentially modifiable factor that significantly impacts peripheral arterial line patency. Papaverine is known to cause relaxation of arterial smooth muscle when spasmodically contracted and, therefore, offers a potential solution to arterial vasospasm-related variability.…”