001 – The Effectiveness of Blood Drawing Peripheral Intravenous Lines During Endocrine Fasting Tests in Pediatric Patients

Children with unknown causes of hypoglycemia are admitted to the hospital to perform endocrine fasting tests. Blood drawing peripheral intravenous lines (BDPIVs) are used to obtain blood for laboratory studies. When BDPIVs fail, they have to be replaced or the patient may undergo multiple blood draw attempts. This can lead to inconclusive results and increased length of stay. The aim of this quality improvement (QI) project is to determine which small tests of change are effective in maintaining BDPIVs while pediatric patients are undergoing fasting tests. A review of literature and benchmarking with other hospitals provided little information about the use and management of BDPIVs in children. Retrospective audits were completed on charts of 30 children who had endocrine fasting tests with BDPIVs. Thirteen (43%) subjects had failed BDPIVs, and 17 (57%) had BDPIVs that worked. Failed BDPIVs were those that leaked, fell out, would not flush, clotted and needed to be removed before completion. Five of the 13 patients whose BDPIVs failed required either multiple blood draw attempts at the end of the fast or their BDPIV was replaced. Following the audits, small tests of change were implemented based on best practice and clinical expertise: intravenous hydration, hot packs, and staff education to try to improve the failed BDPIV rate and subsequent blood draw attempts. A post-intervention chart audit is now in process. The goal of this project is to decrease BDPIV failure rate by implementing new tests of change. Data will be reported on both the process (i.e., consistent use of interventions) and outcomes (i.e., BDPIV failure versus test completion) of this QI project after 30 post-intervention audits are completed.