Ultrasound Guided Peripheral Intravenous Catheter Placement Implementation in a Community Hospital

Abstract

Problem: At a community hospital, patients were having venipuncture attempted on them, on average, every day of their hospital stay. More attempts mean more nursing time and more patient discomfort. Furthermore, according to a 2022 internal survey, the mean dwell time of peripheral intravenous catheters (PIVC) was just two days. When PIVC cannot be placed or maintained, providers then order a central line to be placed, and there are multiple initiatives in place to reduce the number of central lines placed. Purpose: The purpose of this project was to implement nurse placed ultrasound guided PIVCs in critical care and to implement the adult difficult venous access (A-DIVA) tool to decide which patients would benefit from the placement of an ultrasound-guided PIVC (USGPIVC). Methods: Eleven bedside RNs were trained to place USGPIVC by a professional trainer during 6–8-hour training sessions. The training sessions included a didactic section, practice on a vein block, and time to place USGPIVCs on patients. All staff who trained were deemed competent if they placed three USGPIVCs independently. All ICU nurses were trained to use the A-DIVA to determine which PIVC placement method should be attempted first on a patient. Higher A-DIVA scores indicate a patient will have more difficult veins to access. Scores greater than two received an USGPIVC as their first attempt. Results: 1.625 USGPIVCS were placed on average. 29 percent of PIVCs were USGPIVCs. Only 10 percent of patients who had access placed in the ICU had A-DIVA documentation. Of the 11 nurses trained the majority of the USGPIVCS were placed by four nurses. Conclusions: The interventions increased USGPIVC from none placed to a significant part of the PIVCS placed. Most studies on USGPIVC placement are set in the emergency room. This study shows USGPIVCs can be implemented in the ICU as well.