Implementation and evaluation of a quality improvement initiative for central venous catheter management in neonates undergoing therapeutic hypothermia for perinatal asphyxia.
Koolen-De Koninck M, Ouwehand T, et al. • BMJ paediatrics open • 2026
Implementing subclavian vein catheters (SVCs) as primary central access in neonates undergoing therapeutic hypothermia led to 100% catheter placement success, a mean 39.4-minute reduction in time to initiate treatment, and no SVC-related adverse events.
Key Findings
Results
Catheter-related difficulties were extremely common prior to SVC implementation and were strongly associated with delayed therapeutic hypothermia initiation.
Catheter-related difficulties occurred in 51.6% of all patients overall in the pre-implementation period.
Among the 56 patients with delayed TH initiation beyond 6 hours, 46 (82.1%) had catheter-related difficulties.
Between 2017 and 2022, UVC was the most used catheter type (50.6%), followed by PICC (21.3%).
12.5% of patients had unsuccessful catheter placement prior to SVC implementation.
Results
Introduction of subclavian vein catheters achieved 100% central catheter placement success and became the dominant catheter type used.
After SVC implementation, SVC use increased to 69.5% of patients.
The overall catheter placement success rate reached 100% after SVC introduction, compared to 12.5% failure rate previously.
The study included 219 total patients: 160 prior to and 59 after SVC implementation.
The study was conducted at a level IV neonatal intensive care unit between July 2017 and April 2025.
Results
SVC use as the primary catheter was associated with significantly faster initiation of therapeutic hypothermia.
Mean time to initiate TH was 39.4 minutes shorter when SVC was chosen as the primary catheter (p=0.003).
The rate of delayed TH initiation beyond 6 hours decreased from 25.6% to 13.6% after SVC implementation.
Therapeutic hypothermia must be initiated within 6 hours after birth to reduce mortality and morbidity.
The reduction in delay was evaluated in the context of a retrospective study design.
Results
No adverse events related to subclavian vein catheter placement were reported following implementation.
No SVC-related adverse events were reported in the 59 post-implementation patients.
The authors concluded that SVCs are 'clinically feasible and safe' in this population.
Data collected included catheter type, placement success, and adverse events.
The authors note that further prospective studies are needed to confirm safety findings and assess long-term outcomes.
Methods
The study was a retrospective quality improvement evaluation of neonates with hypoxic-ischaemic encephalopathy treated with therapeutic hypothermia.
All neonates treated with TH between July 2017 and April 2025 at a single level IV NICU were included.
A total of 219 patients were included in the study.
The pre-implementation group comprised 160 patients and the post-implementation group comprised 59 patients.
The study evaluated catheter type, placement success, adverse events, and relation to TH initiation time.
What This Means
This research suggests that switching to a different type of central venous catheter — specifically a subclavian vein catheter (SVC) inserted near the collarbone — can significantly improve care for newborns who need brain-cooling treatment (therapeutic hypothermia) after oxygen deprivation at birth. Before the change, more than half of babies experienced problems getting a catheter placed, and over 80% of those whose treatment was delayed had catheter-related difficulties. Commonly used catheters such as umbilical venous catheters and peripherally inserted central catheters frequently failed or caused delays, with about 1 in 8 placements being unsuccessful.
After the hospital introduced SVCs as the preferred catheter, placement success reached 100%, and the time to start brain-cooling treatment dropped by nearly 40 minutes on average — a clinically meaningful difference given that treatment must begin within 6 hours of birth to be effective. The proportion of babies whose treatment was delayed beyond the 6-hour window also dropped from about 1 in 4 to about 1 in 7. Importantly, no complications related to the new catheter type were recorded.
This research suggests that SVCs represent a practical and safe improvement in how these critically ill newborns are managed, potentially helping more babies receive timely treatment and improving their chances of better outcomes. However, because this was a single-center retrospective study, the authors caution that larger, prospective studies are needed to confirm these findings and evaluate long-term outcomes before broader recommendations can be made.
Koolen-De Koninck M, Ouwehand T, Cassel F, Simons S, van den Bosch G. (2026). Implementation and evaluation of a quality improvement initiative for central venous catheter management in neonates undergoing therapeutic hypothermia for perinatal asphyxia.. BMJ paediatrics open. https://doi.org/10.1136/bmjpo-2026-004817