494 - Successful Implementation of Utilizing Long Umbilical Cord for Initial Blood Work Sampling in the Neonatal Intensive Care Unit

Publication Number: 494.6770

Kirsten Sorum, Loyola University Chicago Stritch School of Medicine, Oak Park, IL, United States; Pamela Nicoski, Loyola University Medical Center, Brookfield, IL, United States; Lindsey Young, Loyola University Chicago Stritch School of Medicine, Addison, IL, United States; Marc G. Weiss, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States; Sachin Amin, Loyola University Chicago Stritch School of Medicine, Maywood, IL, United States

Background: Most neonates require laboratory testing upon Neonatal Intensive Care Unit (NICU) admission. This generally entails a painful procedure, and phlebotomy blood loss from patients who already have relatively low blood volumes. One underutilized resource is the use of umbilical cord blood. Umbilical cord blood is readily available and an abundant source of neonate-derived blood, and can be obtained without any painful procedures inflicted on the neonate.

Objective: To improve the success rates of umbilical cord blood draw upon in neonates on NICU admission.

Design/Methods: NICU and obstetrical staff were educated on the protocol of utilizing long umbilical cord blood sampling for inborn NICU admissions. Cord blood was used to obtain blood culture, type and screen, newborn state screen, and complete blood count. Patient charts were retrospectively reviewed for auditing and subsequently following each quality improvement cycle. Data collection is ongoing. Neonates less than 35 weeks gestation admitted directly to the NICU, and requiring admission labs are included. We also examined factors leading to unsuccessful long umbilical cord sampling. Interventions including periodic reinstruction of obstetric and NICU staff and consistent reminders during daily huddles were used to sustain our success rates.

Results: Our team was able to increase and sustain the percent of babies admitted to our NICU with successful umbilical cord blood draws using various Plan-Do-Study-Act (PDSA) cycles. Before initiation of this project in 2017, no babies were admitted with long cords. Throughout the tracking process from 2022, we have successfully increased the long cord rate from 80 to 94% and improved the rate of successful blood sampling from those cord segments from 75 to 94 %. Consequently, we have decreased the need for phlebotomy on admission in these patients, increased the percentage of blood cultures obtained within one hour, and improved the percent of patients receiving antibiotics within one hour of birth.

Conclusion(s): Our unit has successfully implemented a protocol of utilizing long umbilical cord for initial blood work sampling. Through this project, we have decreased blood loss from phlebotomy, minimized painful procedures, and expedited time for blood culture thereby improving time to first antibiotic dose.

Patients Less than 35 Weeks Gestational Age with Long Cords from Delivery Room


Successful Blood Draw from Cord


Sucessful Blood Culture Draw from Long Umbilical Cord and Time to First Antibiotic Dose