A Quality Improvement Project: Use of Umbilical Cord Blood for NICU Admission Labs
Topic of Interest
Quality Initiatives
Patient Populations
Interprofessional Collaboration
Abstract
Admission bloodwork for newborns in the Neonatal Intensive Care Unit (NICU) is drawn from arterial punctures or umbilical catheter. Phlebotomy loss is 6-8ml, about 10-20 ml/kg. This blood loss can disrupt blood flow, negatively impacting hemodynamic stability thus increasing potential need for vasopressors and blood transfusions. Especially in conjunction with extreme prematurity, the risk of Intraventricular Hemorrhage (IVH) and Necrotizing Enterocolitis (NEC) increases.
Emerging literature suggests use of umbilical cord blood can be used for newborn blood work. This may have numerous positive outcomes, including decreased need for early blood transfusions, timely results, and increased blood volume for cultures.
Neonatal Clinical Nurse in role of Quality Improvement Facilitator, CNS and Medical Director established collaborative plan with Labor & Delivery Clinical Nurse and CNS to expand on the practice of cord blood draws for gases to include NICU admission lab work. Additional collaboration involved leadership of Blood Bank and Laboratory. Planning was put in place to validate results to affirm accuracy like that in the literature. A training program for L&D nurses to reinforce best practices drawing blood cultures, transfer techniques and order of draw was implemented. Blood culture contamination rate and comparison of labs would be considered prior to full implementation.
Outcomes include: 52 blood culture comparisons with 2 from cord blood and 1 from infant draw; 42 CBCD comparisons: 3 platelet count discrepancies.
Implications:
Newborns in NICU will experience:
- Less pain and trauma due to less invasive method of obtaining admission lab work.
- More timely results of blood culture and CBCD
- Less need for blood transfusions
- Less incidence of hemodynamic instability, IVH, NEC, etc..
Consider spread of practice to newborn nursery for infants at high-risk for early onset sepsis despite being asymptomatic which allows for earlier antibiotic administration.