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VOLUME 25 , ISSUE 5 ( May, 2021 ) > List of Articles

Pediatric Critical Care

Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room

Neelima Singh, Geetanjli Kalyan, Sukhwinder Kaur, Muralidharan Jayashree, Sandhya Ghai

Keywords : Infiltration, Pediatric emergency, Phlebitis, Quality improvement

Citation Information : Singh N, Kalyan G, Kaur S, Jayashree M, Ghai S. Quality Improvement Initiative to Reduce Intravenous Line-related Infiltration and Phlebitis Incidence in Pediatric Emergency Room. Indian J Crit Care Med 2021; 25 (5):557-565.

DOI: 10.5005/jp-journals-10071-23818

License: CC BY-NC 4.0

Published Online: 01-05-2021

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Aim and objective: To reduce the incidence of infiltration and phlebitis by 50% over 2 months among children admitted to the emergency room (ER) of a tertiary care hospital. Materials and methods: The study was conducted in the pediatric ER of a tertiary care hospital in North India. All children aged >28 days, receiving intravenous (IV) medication and/or fluids, were enrolled between June (2017) and September (2017). Existing practices of IV line insertion and maintenance were observed and recorded. The visual infusion phlebitis score and infiltration assessment scale used to grade the extent of the two. The intervention classified as “IV line insertion and maintenance bundle” included the introduction of low-cost mobile sterile compartment trays, audit and feedback, organizational change and introduction of infection control nurse. These interventions were implemented in sequential Plan-Do-Study-Act (PDSA) cycles. Reduction in the “incidence of phlebitis and infiltration” were the outcome measures while “scores on checklist of IV line insertion and IV line maintenance and administration of drugs” were the process measures. Result: The process measures, for IV line insertion, maintenance and administration of drugs through IV line, revealed an increase in scores on the checklist. There was a significant decrease in the incidence of infiltration and phlebitis from 82.9% and 96.1% to 45% and 55%, respectively, after implementation of all PDSA cycles. Conclusion: Multifaceted QI IV line insertion and maintenance bundle reduced the incidence of infiltration and phlebitis. These interventions when integrated into daily work bundles along with continuous education and motivation helped in sustaining the goal and attaining long-term success.


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