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  • Quality Improvement Article
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Implementation of an ultrasound-guided approach for arterial line placements in neonates—quality improvement project

Journal of Perinatology (2023)Cite this article

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Abstract

Objective

Our goal was to improve placement success rates for peripheral arterial line (PAL) placements by introducing an ultrasound-guided (USg) approach. Our aim was to maintain success rates over 70% within 18 months.

Study design

Interventions included development of a training curriculum, and procedure standardization. Among 302 patients, 115 underwent USg catheter placement; the traditional method was used in 187 patients. Outcome measures were first-attempt and overall success rates. Process measures were proportion of PALs placed under US guidance, trainer availability, and trainee sign-off. Line complications were balancing measures. Statistical process control charts were used to monitor metrics.

Results

Sustained improvement was seen with the USg approach. The USg approach had first and overall attempt success by the trainers (i.e., independent users) of 83.7% (77/92) and 96.5% (111/115), compared to 50.3% (82/163) and 73.8% (138/187) with the traditional approach.

Conclusion

Introducing the USg approach had a significant impact on PAL placement success in neonatal patients.

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Fig. 1: Driver diagram for the implementation of the ultrasound-guided approach for placement of peripheral arterial lines.
Fig. 2: Statistical process control graphs for the outcome, process, and balancing measures.
Fig. 3: Success and complication rates for traditionally-placed and ultrasound-guided peripheral arterial lines.

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Funding

Funding for the purchase of ultrasound machines was obtained through a donation by SickKids Innovators.

Author information

Authors and Affiliations

  1. Division of Neonatology, Department of Paediatrics, The Hospital for Sick Children, Toronto, ON, Canada

    Marko Culjat, Kyong-Soon Lee & Hilary Whyte

  2. Acute Care Transport Services, The Hospital for Sick Children, Toronto, ON, Canada

    Marko Culjat, Heather Colangelo, Jill Gardiner, Kyong-Soon Lee & Hilary Whyte

  3. Department of Anatomy, School of Medicine, University of Zagreb, Zagreb, Croatia

    Domagoj Dzaja

Authors
  1. Marko Culjat
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  2. Domagoj Dzaja
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  3. Heather Colangelo
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  4. Jill Gardiner
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  5. Kyong-Soon Lee
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  6. Hilary Whyte
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Contributions

MC planned, conceptualized, and designed the quality improvement study and data collection instruments, organized and led the team education, collected data, carried out the initial data analyses, drafted the initial manuscript, and critically reviewed and revised the manuscript. DD conceptualized the study, carried out the data analysis, and critically reviewed and revised the manuscript. HC and JG co-led team education, planned the study, collected the data, and critically reviewed and revised the manuscript. K-SL co-designed the study and data collection instruments, provided quality improvement oversight, and critically reviewed and revised the manuscript. HW co-designed the study, provided sponsor-level support for the project, and critically reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.

Corresponding author

Correspondence to Marko Culjat.

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Culjat, M., Dzaja, D., Colangelo, H. et al. Implementation of an ultrasound-guided approach for arterial line placements in neonates—quality improvement project. J Perinatol (2023). https://doi.org/10.1038/s41372-023-01860-9

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  • DOI: https://doi.org/10.1038/s41372-023-01860-9

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