title: Reducing peripherally inserted central catheters in the neonatal intensive care unit.
abstract: Our objective was to safely reduce the number of peripherally inserted central catheters (PICCs) inserted in infants with umbilical venous catheter using quality improvement methods.
  
  
  
  In a tertiary neonatal intensive care unit, a questionnaire designed to prompt critical thinking around the decision to place a PICC, along with an updated standardized feeding guideline was introduced. PICC insertion in 86 infants with umbilical venous catheter (pre intervention) with birth weight 1000-1500 g were compared with 115 infants (post intervention) using Fisher's exact test.
  
  
  
  PICC lines inserted after the intervention decreased by 37.5% (67/86; 77.9% vs 56/115; 48.7%; P<0.001). The proportion of central line-associated blood stream infection were 2.49 vs 2.82/1000 umbilical venous catheter days; P=0.91 in the two epochs, respectively.
  
  
  
  Quality improvement methodology was successful in significantly reducing the number of PICCs inserted without an increase in central line-associated blood stream infection.
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: A J
authors.initials: AJ
authors.lastname: Vachharajani
authors.affiliation: Department of Surgery, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: N A
authors.initials: NA
authors.lastname: Vachharajani
authors.affiliation: St Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: H
authors.initials: H
authors.lastname: Morris
authors.affiliation: St Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Niesen
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: A
authors.initials: A
authors.lastname: Elward
authors.affiliation: St Louis Children's Hospital, St. Louis, MO, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Linck
authors.affiliation: Department of Pediatrics, Washington University in St. Louis, St. Louis, MO, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Mathur
mesh_terms: D055499:Catheter-Related Infections / Q000209:etiology; D002406:Catheterization, Peripheral / Q000706:statistics & numerical data*; D062905:Central Venous Catheters / Q000009:adverse effects*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000592:standards* / Q000706:statistics & numerical data; D008297:Male; D008923:Missouri; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D014471:Umbilical Veins