Can Non-Physician Providers Use Ultrasound to Aid in Establishing Peripheral IV Access in Patients Who are Difficult to Cannulate? A Scoping Review

Abstract

Introduction: Non-physician performed point-of-care ultrasound (POCUS) is emerging as a diagnostic adjunct with the potential to enhance current practice. The scope of POCUS utility is broad and well-established in-hospital, yet limited research has occurred in the out-of-hospital environment. Many physician-based studies expound the value of POCUS in the acute setting as a therapeutic and diagnostic tool. This study utilized a scoping review methodology to map the literature pertaining to non-physician use of POCUS to improve success of peripheral intravenous access (PIVA), especially in patients predicted to be difficult to cannulate. Methods: Ovid MEDLINE, CINAHL Plus, EMBASE, and PubMed were searched from January 1, 1990 through April 15, 2021. A thorough search of the grey literature and reference lists of relevant articles was also performed to identify additional studies. Articles were included if they examined non-physician utilization of ultrasound-guided PIVA (USGPIVA) for patients anticipated to be difficult to cannulate. Results: A total of 158 articles were identified. A total of 16 articles met the inclusion criteria. The majority of participants had varied experience with ultrasound, making accurate comparison difficult. Training and education were non-standardized, as was the approach to determining difficult intravenous access (DIVA). Despite this, the majority of the studies demonstrated high first attempt and overall success rates for PIVA performed by non-physicians. Conclusion: Non-physician USGPIVA appears to be a superior method for PIVA when difficulty is anticipated. Additional benefits include reduced requirement for central venous catheter (CVC) or intraosseous (IO) needle placement. Paramedics, nurses, and emergency department (ED) technicians are able to achieve competence in this skill with relatively little training. Further research is required to explore the utility of this practice in the out-of-hospital environment.

Home Ultrasound: A Contemporary and Valuable Tool for Palliative Medicine

“…A recent review has provided evidence that non-physician medical personnel, such as paramedics and nurses, can attain proficiency in the placement of peripheral venous access using ultrasound guidance with relatively little training. This finding suggests that this technique is readily accessible and has the potential for widespread use [ 117 ].…”

Handheld Ultrasound (HHUS): Potential for Home Palliative Care

“…Recently, a review demonstrated that non-physician medical personnel (paramedics, nurses, emergency department technicians) are able to achieve competence in ultrasound-guided peripheral venous access placement in patients with anticipated cannulation difficulties with relatively little training [62].…”

Smart Glasses to Facilitate Ultrasound Guided Peripheral Intravenous Access in the Simulation Setting for Thai Emergency Medical Service Providers

“…The development of Ultrasound-Guided Peripheral Intravenous (USGPIV) cannulation has improved the procedure's overall success rate in a host of different situations. [3][4][5][6][7][8] However, effective ultrasound-guided venous cannulation might also be challenged by the type of ultrasound equipment available, procedure field, knowledge of anatomy, and hand-eye coordination skills which are necessitated by training. 8 Smart glasses are a type of wearable computer that includes a small camera for live streaming.…”

“…[3][4][5][6][7][8] However, effective ultrasound-guided venous cannulation might also be challenged by the type of ultrasound equipment available, procedure field, knowledge of anatomy, and hand-eye coordination skills which are necessitated by training. 8 Smart glasses are a type of wearable computer that includes a small camera for live streaming. Smart glasses innovation has been deployed and examined across various clinical settings and healthcare facilities over the past ten years including PIVC and EMS settings.…”

“… 3–8 However, effective ultrasound-guided venous cannulation might also be challenged by the type of ultrasound equipment available, procedure field, knowledge of anatomy, and hand-eye coordination skills which are necessitated by training. 8 …”