Central vascular catheter insertion in the NICU: A lean approach

Purpose: To apply Lean principles to the process of inserting central lines into neonates in the NICU. Design: The authors used standard interviews and live observations to obtain concrete data on the current process of central line insertions. Recommendations for improvement were then suggested based on Lean principles. Sample: NICU care providers. Main Outcome Variable: Non-value-added time (waste), provider confidence, and variation in placing central lines. Results: There was large variation in how providers inserted central lines, and providers were least confident with placing peripherally inserted central catheter lines (55 percent confident). Live observations showed that 53 percent of the current process consisted of waste, with the line insertion and radiography phases of the process as the most wasteful. Lean principles can be applied to a neonatal clinical setting and can be an effective methodology for NICU care providers to improve the way that we care for our patients.