Implementation and evaluation of a quality improvement initiative for central venous catheter management in neonates undergoing therapeutic hypothermia for perinatal asphyxia

OBJECTIVES: Therapeutic hypothermia (TH) is an effective treatment for hypoxic-ischaemic encephalopathy in infants following perinatal asphyxia, reducing mortality and morbidity when initiated within 6 hours after birth. Both perinatal asphyxia and TH require intensive management and therefore central venous access, such as umbilical venous catheters (UVC) or peripherally inserted central catheters (PICC). Placement of these catheters can lead to a delay in initiating TH. This study evaluated a potential quality improvement using subclavian vein catheters (SVCs) in TH patients, focusing on time to initiation, integration into routine practice and safety. METHODS: We conducted a retrospective study including all neonates treated with TH between July 2017 and April 2025 at a level IV neonatal intensive care unit. Data included catheter type, placement success, adverse events and relation to TH initiation time. RESULTS: A total of 219 patients were included: 160 prior and 59 after SVC implementation. Between 2017 and 2022, UVC was the most used (50.6%), followed by PICC (21.3%), while 12.5% had unsuccessful catheter placement. Catheter-related difficulties occurred in 51.6% overall and in 46/56 (82.1%) with delayed TH initiation beyond 6 hours. The introduction of the SVC led to an increase in its use up to 69.5% of patients and an overall 100% central catheter success rate. Mean time to initiate TH was 39.4 min shorter when SVC was chosen as the primary catheter (p=0.003), and delayed initiation decreased from 25.6% to 13.6%. No SVC-related adverse events were reported. CONCLUSIONS: Since introducing SVCs, catheter placement success improved and TH initiation was faster, indicating that SVCs are clinically feasible and safe. This quality improvement initiative represents a step forward toward optimising care for neonates undergoing TH. Further prospective studies are needed to confirm these findings and assess long-term outcomes. IMPLICATIONS FOR CLINICAL PRACTICE: Implementing SVCs as primary central access in neonates undergoing TH can reduce delays and improve care without increasing adverse events.