Impact of a care bundle on short peripheral catheter-associated complications in a resource-limited neonatal unit.

Abstract

Short peripheral catheter (SPC)-associated complications occur frequently in hospitalised neonates. Few studies have reported the use of SPC care bundles in resource-limited neonatal units. To evaluate the impact of a SPC care bundle on SPC associated complications (infiltration, dislodgement, phlebitis) and catheter dwell time. We conducted a quasi-experimental study comparing neonatal SPC complications during a 2-month baseline and a 2-month intervention period, where a SPC care bundle was introduced including hand hygiene, insertion site antisepsis, nurse assistance during cannulation, IV insertion carts and IV securement dressings. A total of 459 SPC days were observed in 223 neonates: 111 pre-intervention and 112 post-intervention (after SPC bundle implementation). Most neonates were preterm (208, 93.3%) with very or extremely low birth weight (133, 59.6%). SPC care bundle compliance was 43.8% for five bundle elements and 83.9% for four bundle elements. Most SPCs had unplanned removal within 48 h of insertion owing to infiltration or dislodgement (89/111 pre-intervention (80.2%) vs 90/112 post-intervention (80.4%); 0.974). No phlebitis was documented. The mean SPC dwell time was unchanged following bundle implementation (32.9 vs 34.2 h; p = 0.376). Infiltration and dislodgement occurred frequently necessitating replacement of four of every five SPCs. Despite moderate compliance with the SPC care bundle, the high rates of unplanned SPC removal and short duration of catheter dwell time were unchanged. The SPC care bundle did not improve catheter dwell time; further research is needed to identify strategies to reduce unplanned SPC removal and extend catheter dwell time in hospitalised neonates.