Reducing peripherally inserted central catheters and midline catheters by training nurses in ultrasound-guided peripheral intravenous catheter placement

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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Real-time ultrasound-guided placement of peripherally inserted central venous catheter without fluoroscopy

The Journal of Vascular Access ◽

10.1177/1129729818765057 ◽

2018 ◽

Vol 19 (6) ◽

pp. 609-614 ◽

Cited By ~ 6

Author(s):

Soshi Nakamuta ◽

Toshihiro Nishizawa ◽

Shiori Matsuhashi ◽

Arata Shimizu ◽

Toshio Uraoka ◽

...

Keyword(s):

Success Rate ◽

Detection Rate ◽

Ultrasound Guidance ◽

Catheter Placement ◽

Peripherally Inserted Central Catheter ◽

Central Catheter ◽

Ultrasound Guided ◽

Peripherally Inserted Central Catheters ◽

X Ray ◽

Central Catheters

Background and aim: Malposition of peripherally inserted central catheters placed at the bedside is a well-recognized phenomenon. We report the success rate of the placement of peripherally inserted central catheters with ultrasound guidance for tip positioning and describe the knacks and pitfalls. Materials and methods: We retrospectively reviewed the medical case charts of 954 patients who received peripherally inserted central catheter procedure. Patient clinical data included success rate of puncture, detection rate of tip malposition with ultrasonography, adjustment rate after X-ray, and success rate of peripherally inserted central catheter placement. Results: The success rate of puncture was 100% (954/954). Detection rate of tip malposition with ultrasonography was 82.1% (78/95). The success rate of ultrasound-guided tip navigation was 98.2% (937/954). The success rate of ultrasound-guided tip location was 98.0% (935/954). Adjustment rate after X-ray was 1.79% (17/952). The final success rate of peripherally inserted central catheter placement was 99.8% (952/954). Conclusion: Ultrasound guidance for puncturing and tip positioning is a promising option for the placement of peripherally inserted central catheters. Ultrasound guidance could dispense with radiation exposure and the transfer of patients to the X-ray department.

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