291 Effect of Ultrasound-Guided Peripheral Intravenous Catheter Placement by Nurses and Paramedics on Central Line Placement in the Emergency Department

BackgroundTraining nurses in ultrasound-guided peripheral intravenous catheter placement might reduce the use of more invasive venous access devices (peripherally inserted central catheters (PICC) and midline catheters).MethodsWe implemented an abbreviated training in ultrasound-guided peripheral intravenous catheter placement for nurses on an inpatient medical unit and provided a portable ultrasound device for 10 months.ResultsNurses on this unit placed 99 ultrasound-guided peripheral intravenous catheters with a high level of success. During the implementation period, PICC and midline catheter placement decreased from a mean 4.8 to 2.5 per month, meeting criteria for special cause variation. In the postimplementation period, the average catheter use reverted to 4.3 per month on the intervention unit. A comparison inpatient medical unit without training or access to a portable ultrasound device experienced no significant change in PICC and midline catheter use throughout the study period (mean of 6.0 per month).ConclusionsThese results suggest that an abbreviated training in ultrasound-guided peripheral intravenous catheter placement for nurses on an inpatient medical unit is sufficient to reduce PICC and midline catheters.

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Ultrasound-Guided Peripheral Intravenous Catheter Insertion: The Nurse’s Manual

Critical Care Nurse ◽

10.4037/ccn2020240 ◽

2020 ◽

Vol 40 (5) ◽

pp. 38-46

Author(s):

Lauren Morata ◽

Mark Bowers

Keyword(s):

Acute Care ◽

Venous Access ◽

Catheter Placement ◽

Ultrasound Guided ◽

Intravenous Catheter ◽

Peripheral Intravenous Catheter ◽

Acute Care Nursing ◽

Intravenous Catheters ◽

Difficult Venous Access ◽

Central Catheters

Peripheral intravenous catheter placement is a skill that is used daily in the hospital. However, many nurses face the challenge of cannulating increasingly complex and difficult-to-access vasculature. Although emergency department clinicians have been using ultrasound to facilitate this procedure for the last 18 years, ultrasound-guided peripheral intravenous catheter placement has not been as rapidly adopted in the critical and acute care nursing realms. Given the benefits of this procedure, including increased patient satisfaction and reduced use of central catheters, its use should be encouraged among all acute care clinicians. The aim of this article is to provide the bedside nurse with a basic understanding of the techniques involved in placing ultrasound-guided peripheral intravenous catheters in patients with difficult venous access.

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32: A Randomized Controlled Trial Comparing Ultrasound, Veinviewer and Standard Approach to Peripheral Intravenous Catheter Placement in the Pediatric Emergency Department

Paediatrics & Child Health ◽

10.1093/pch/19.6.e35-31 ◽

2014 ◽

Vol 19 (6) ◽

pp. e46-e47 ◽

Cited By ~ 1

Author(s):

SJ Curtis ◽

W Craig ◽

L Erin ◽

B Vandermeer ◽

A Hanson ◽

...

Keyword(s):

Emergency Department ◽

Randomized Controlled Trial ◽

Controlled Trial ◽

Pediatric Emergency ◽

Catheter Placement ◽

Standard Approach ◽

Pediatric Emergency Department ◽

Intravenous Catheter ◽

Randomized Controlled ◽

Peripheral Intravenous Catheter

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Procedural competency for ultrasound-guided peripheral intravenous catheter insertion for nurses in a pediatric emergency department

The Journal of Vascular Access ◽

10.1177/1129729820937131 ◽

2020 ◽

pp. 112972982093713

Author(s):

Carly Blick ◽

Alexandra Vinograd ◽

Jamie Chung ◽

Elizabeth Nguyen ◽

Mary Kate F Abbadessa ◽

...

Keyword(s):

Emergency Department ◽

Training Program ◽

Success Rate ◽

Training Period ◽

Complication Rates ◽

Initial Training ◽

Ultrasound Guided ◽

Intravenous Catheter ◽

Peripheral Intravenous Catheter ◽

Intravenous Catheters

Objectives: To evaluate if nurses can reliably perform ultrasound-guided peripheral intravenous catheter placement in children with a high success rate after an initial training period. A secondary aim was to analyze complication rates of ultrasound-guided peripheral intravenous catheters. Methods: A database recorded all ultrasound-guided peripheral intravenous catheter encounters in the emergency department from November 2013 to April 2019 including the emergency department nurse attempting placement, number of attempts, and whether it was successful. Patient electronic medical records were reviewed for the time of and reason for intravenous removal. The probabilities of first-attempt successful intravenous placement and complication at successive encounters after an initial training period were calculated. These probabilities were plotted versus encounter number to graph best-fit logarithmic regressions. Results: A total of 83 nurses completed a standardized training program in ultrasound-guided peripheral intravenous catheter placement including 10 supervised ultrasound-guided peripheral intravenous catheter placements. In total, 87% (3513/4053) of the ultrasound-guided peripheral intravenous catheter placed after the training program were successful on the first attempt. The probability of successfully placing an ultrasound-guided peripheral intravenous catheter increased as nurses had more experience placing ultrasound-guided peripheral intravenous catheters (R2 = 0.18) and was 83% at 10 encounters. Twenty-five percent (904/3646) of ultrasound-guided peripheral intravenous catheters had complications, and there was no statistically significant relationship between the number of encounters per nurse and complication rates (R2 < 0.001). Conclusion: Nurses can reliably place ultrasound-guided peripheral intravenous catheters at a high success rate after an initial training period. First-attempt success rates were high and increased from 67% to 83% for the first 10 unsupervised encounters after training and remained high. The complication rate was low and did not change as nurses gained more experience.

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