Initiative leads to vein preservation for hospitalized children who may require dialysis
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A quality improvement initiative resulted in increased frequency of peripheral IV placement in the dominant arm for hospitalized children with kidney disease.
According to the researchers, the improvements seen were partially due to education and increased awareness regarding the importance vein preservation for this patient population.
“An arteriovenous fistula (AVF) in the non-dominant arm is the preferred access for hemodialysis (HD) patients,” Nisha S. Singh, MD, of the division of pediatric nephrology at Children’s Mercy Kansas City, and colleagues, wrote. “Prior peripheral intravenous (PIV) line placement can lead to vascular injury and limit options for AVF placement, a particular problem for children with the potential need for HD over a lifetime. We instituted an initiative to increase the frequency of PIV placement in the dominant arm for hospitalized pediatric patients with advanced chronic kidney disease.”
The initiative consisted of the following four components:
- education of health care team, parents and patients on the importance of vein preservation;
- individualized notes in the electronic health record identifying the preferred arm for PIV placement;
- use of restricted extremity arm bands; and
- participation from a vascular access team to reduce attempts for PIV placement.
Participants included children who had stage 3-5 chronic kidney disease, were on dialysis or who had undergone kidney transplantation. All were hospitalized between September 2018 and August 2020.
Researchers compared data on PIV location for patients from 2017 to that following the initiative.
They found that, prior to implementation of the initiative, 47% of PIVs were placed in patients’ dominant arms; for children younger than 5 years only, 25% were placed in the dominant arm.
After the initiative, 93% of PIVs were placed in the dominant arm; for children younger than 5 years, 94% were now placed in the dominant arm.
“Our [quality improvement] QI initiative has been able to dramatically improve the use of the dominant arm for PIV placement for hospitalized patients, so as to potentially preserve veins in the non-dominant arm for future AVF placement,” Singh and colleagues concluded of the findings, adding “pediatric nephrology teams caring for children with CKD need to advocate for vessel preservation as part of everyday patient management.
This advocacy can be achieved by using a multidisciplinary team approach and by providing education and various vein preservation strategies to mitigate vascular injury. The institution of this type of initiative has the potential to significantly lessen the disease burden for the children we care for as they transition through pediatric and into adult [end-stage kidney disease] ESKD care.”
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