Improving the longevity of intravenous cannulas in sick neonates admitted to NICU in a tertiary care centre: a quality improvement project

BACKGROUND: Neonatal intravenous cannulation, especially in preterms, is more challenging than in children or adults. Placement of an intravenous cannula is painful and many cannulas need frequent changing due to complications. Each attempt at cannulation creates an entry for skin flora to cause systemic bacteraemia. This study was undertaken at a level III NICU. The team attempted to prolong the existing cannula longevity to reduce the frequency of intravenous cannulation thereby reducing handling and pain. OBJECTIVES: To improve the longevity of peripherally inserted intravenous cannula in sick neonates in NICU from the current 25.7 hours to 36 hours or more, over a span of 6 weeks. MATERIALS AND METHODS: The quality improvement (QI) team comprised resident doctors and staff nurses. A fishbone analysis was used to identify factors that affected the longevity of intravenous cannulas. Five WHYs technique was used to identify the cause behind early cannula removal. Both techniques identified the fixation technique used at the study centre for target intervention. Plan-Do-Study-Act cycles were planned to explore different fixation techniques to improve cannula longevity. The unpaired t-test and the χ(2) tests were applied to analyse statistical significance. RESULTS: We achieved significant improvement in cannula longevity from 25.7 hours to 39.6 hours just by improving the fixation technique over 6 weeks with a p=0.0006. CONCLUSIONS: The QI study was successful and is adopted for routine practice. Such initiatives would greatly impact babies in low-resource settings and in transit.