Extended Dwell Catheters in the NICU

Most infants in the newborn intensive care unit (NICU) require insertion of a device to acquire vascular access during hospitalization and this is the most common procedure in the NICU. New devices are met with uncertainty due to lack of evidence for their use. Extended dwell catheters (EDC) are new devices that offer long-term vascular access for infants. An EDC is a deep line that is inserted peripherally, terminating in the upper arm or leg and is designed to stay in place for up to 29 days. The product is intended to decrease multiple intravenous entries. The purpose of this project was to analyze data on EDC use in infants as a quality improvement project. The objectives included, 1) analyzing 4 years of data about various vascular devices' longevity and reasons for termination, 2) analyze the data to determine the effectiveness of EDC use in infants, 3) present the results to clinicians using the devices so that they can decide about future use, 4) disseminate the findings to other institutions where use of EDCs is limited. Peripherally inserted venous catheters (PIV) have poor longevity in the NICU. Approximately 95% of PIVs in the NICU are removed prior to the completion of therapy and the average PIV in the NICU stays in for 37 hours before various complications require replacement. Peripherally inserted central catheters (PICC) are also used in the NICU, and although they remain in place longer then PIVs and have less complications, PICCs are expensive and the complications can be life threatening. Limited research points to the benefit of EDCs over conventional PIVs for infants because of the increased dwell time and efficacy. Extended dwell catheters have advantages over PICCs because they are less expensive and avoid the life-threatening complications associated with PICCs. The project was implemented after IRB approval and began with a thorough literature review that compared various devices. Extended dwell catheter data from 432 NICU charts was collected and analyzed statistically using independent T-tests and chi-square tests. Results showed that 71.70% of EDC remained in place until therapy was no longer needed and the average line days were 4.02 +/- 2. Analysis also revealed that the reasons for discontinuation of EDCs prior to the end of treatment were similar to those of PIVs and PICCs. During the same time PICC data from 202 NICU charts was collected and analyzed using T-tests and chi-square tests. Results showed that 84% of PICCs remained in place until therapy was no longer needed and the average line days were 7.31 +/-4.35. Although the PICCs remained in place longer and were more reliable, there were 4 potentially life-threatening complications recorded. A cost analysis also showed EDCs to be the least expensive option. The findings were presented locally and feedback from attendees was used to modify and improve the presentation for the NICU Developmental Meeting, which is attended by the NICU and special care nursery directors and managers from 8 different hospitals throughout Utah. The information was also prepared for future publication in a peer-reviewed journal. This project has achieved the goal of presenting EDC data so that local clinicians have findings on which to base their practice. The results indicated that EDCs offer a safe, effective, and cost saving alternative to PIVs and PICCs for infants. The benefits of using this device will decrease interventions to the patient, while saving staff time and resources.