Effectiveness of Evidence-Based Continuous Quality Improvement in Reducing Peripherally Inserted Central Catheter Complications Among Premature Infants in China: A Four-Year Retrospective Study.

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.