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已发表论文
基于循证的持续质量改进在中国早产儿外周置入中心静脉导管并发症减少中的有效性：一项为期四年的回顾性研究
Authors Zhu P, Xu X, Zhang X, He X, Jiao J
Received 8 July 2025
Accepted for publication 1 December 2025
Published 21 December 2025 Volume 2025:18 Pages 8153—8167
DOI https://doi.org/10.2147/JMDH.S552393
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jacqueline Dunbar-Jacob
Panru Zhu, Xingpu Xu, Xiaoman Zhang, Xiangfei He, Jiancheng Jiao
Neonatal Department, Hebei Children’s Hospital, Hebei Provincial Clinical Research Center for Child Health and Disease, Shijiazhuang, Hebei, 050031, People’s Republic of China
Correspondence: Jiancheng Jiao, Neonatal Department, Hebei Children’s Hospital, Hebei Provincial Clinical Research Center for Child Health and Disease, No. 133, Jianhua South Street, Yuhua District, Shijiazhuang, Hebei, 050031, People’s Republic of China, Email 18032806902@163.com
Purpose: This study evaluated the effectiveness of evidence-based continuous quality improvement strategies in reducing peripherally inserted central catheter complications among premature infants in a tertiary neonatal intensive care unit.
Patients and Methods: A retrospective cohort analysis was conducted on 722 premature infants requiring peripherally inserted central catheter placement from January 2020 to December 2023. The control group (n=154, January-December 2020) received routine bundle care, while a multidisciplinary evidence-based nursing team implemented continuous quality improvement protocols across three intervention periods: first-year implementation (n=147, 2021), second-year refinement (n=201, 2022), and third-year optimization (n=220, 2023). Primary outcomes included total complication rates and unplanned catheter removal. Multivariate logistic regression identified independent risk factors for complications.
Results: Baseline characteristics showed comparable gestational age (31.32± 4.05 to 31.98± 4.21 weeks, P=0.419) and insertion timing across groups. Total complication rates demonstrated progressive reduction from 46.10% in controls to 32.65% in year 1, 19.90% in year 2, and 15.45% in year 3 (χ2=51.214, P< 0.001), representing a 66.5% overall reduction. Unplanned removal rates decreased from 24.03% to 11.82% (χ2=13.128, P=0.004). Multivariate logistic regression analysis revealed routine care (adjusted OR=4.707, 95% CI: 2.861– 7.742, P< 0.001) and first-year implementation (adjusted OR=2.672, 95% CI: 1.595– 4.477, P< 0.001) as independent risk factors, while higher gestational age was protective (adjusted OR=0.876, 95% CI: 0.837– 0.916, P< 0.001).
Conclusion: Implementation of evidence-based continuous quality improvement strategies achieved substantial and sustained reductions in peripherally inserted central catheter complications among premature infants, supporting systematic adoption of multidisciplinary approaches to optimize vascular access outcomes in vulnerable neonatal populations.
Keywords: evidence-based practice, quality improvement, infant, premature, central venous catheters, postoperative complications, intensive care, neonatal
Neonatal Department, Hebei Children’s Hospital, Hebei Provincial Clinical Research Center for Child Health and Disease, Shijiazhuang, Hebei, 050031, People’s Republic of China
Correspondence: Jiancheng Jiao, Neonatal Department, Hebei Children’s Hospital, Hebei Provincial Clinical Research Center for Child Health and Disease, No. 133, Jianhua South Street, Yuhua District, Shijiazhuang, Hebei, 050031, People’s Republic of China, Email 18032806902@163.com
Purpose: This study evaluated the effectiveness of evidence-based continuous quality improvement strategies in reducing peripherally inserted central catheter complications among premature infants in a tertiary neonatal intensive care unit.
Patients and Methods: A retrospective cohort analysis was conducted on 722 premature infants requiring peripherally inserted central catheter placement from January 2020 to December 2023. The control group (n=154, January-December 2020) received routine bundle care, while a multidisciplinary evidence-based nursing team implemented continuous quality improvement protocols across three intervention periods: first-year implementation (n=147, 2021), second-year refinement (n=201, 2022), and third-year optimization (n=220, 2023). Primary outcomes included total complication rates and unplanned catheter removal. Multivariate logistic regression identified independent risk factors for complications.
Results: Baseline characteristics showed comparable gestational age (31.32± 4.05 to 31.98± 4.21 weeks, P=0.419) and insertion timing across groups. Total complication rates demonstrated progressive reduction from 46.10% in controls to 32.65% in year 1, 19.90% in year 2, and 15.45% in year 3 (χ2=51.214, P< 0.001), representing a 66.5% overall reduction. Unplanned removal rates decreased from 24.03% to 11.82% (χ2=13.128, P=0.004). Multivariate logistic regression analysis revealed routine care (adjusted OR=4.707, 95% CI: 2.861– 7.742, P< 0.001) and first-year implementation (adjusted OR=2.672, 95% CI: 1.595– 4.477, P< 0.001) as independent risk factors, while higher gestational age was protective (adjusted OR=0.876, 95% CI: 0.837– 0.916, P< 0.001).
Conclusion: Implementation of evidence-based continuous quality improvement strategies achieved substantial and sustained reductions in peripherally inserted central catheter complications among premature infants, supporting systematic adoption of multidisciplinary approaches to optimize vascular access outcomes in vulnerable neonatal populations.
Keywords: evidence-based practice, quality improvement, infant, premature, central venous catheters, postoperative complications, intensive care, neonatal