Preventing Hypothermia in NICU Infants Undergoing Cardiac Catheterization

Purpose/Objectives: A quality gap involving thermoregulation of patients in the neonatal intensive care unit (NICU) undergoing cardiac catheterization was observed in our institution. It is well known that infants, especially premature infants, are at increased risk of developing hypothermia. Hypothermia may occur from heat loss via radiation, convection, conduction, or evaporation. Thermoregulation is immensely important in this patient population, as hypothermia can increase the risk of morbidity and mortality. The increased metabolic demand during hypothermia can lead to hypoglycemia, hypoxia, metabolic acidosis, and other adverse outcomes.

Design/Methods: Upon retrospective review, we identified that >75% of NICU infants were intermittently hypothermic during cardiac catheterization from 2018-2020. After defining the quality gap, we assessed causes contributing to hypothermia by utilizing a fish bone diagram and 5 Whys chart. Stakeholder input was acquired by interviews with NICU physicians, NICU nurse practitioners, NICU nursing staff, pediatric respiratory therapists, cardiology physicians, anesthesia physicians, anesthesia CRNAs and cardiology lab technicians. An effort-impact grid was utilized to prioritize implementation of potential interventions.

Results: Once the quality gap and possible causes had been identified, a multidisciplinary team including pediatric cardiology, neonatology, clinical nurse specialists, and pediatric anesthesiology began this QI project’s first PDSA cycle. Our goal was to create a standard approach to not only prevent hypothermia, but also avoid hyperthermia during cardiac catheterization. With the team’s input, an upgraded thermostat was placed in the cardiac catheterization suite, and thermoregulation during cardiac catheterization procedures was standardized with a procedural and supply checklist. In addition, a standard process for continuous temperature monitoring was implemented.

Conclusion/Discussion: With ongoing PDSA cycles, we aim to eliminate the quality gap in patient care. This is relevant to patient safety, particularly in the neonatal population. Recent advances in devices and technique allow for ever smaller infants to receive care with cardiac catheterization. With protocols in place that address the root causes of infant procedural hypothermia, patients will be safer. Thus far, we have observed that this project has already had the additional benefit of improved communication among care teams. We are currently in our first PDSA cycle and are actively reassessing the data on a 2-month basis utilizing run and control charts.