Development of an algorithm using ultrasonography-assisted peripheral intravenous catheter placement for reducing catheter failure

Abstract

Up to 50% peripheral intravenous catheters (PIVs) are removed prematurely because of failures. Catheter failure (CF) leads to replacement and is a great concern for patients and medical staff. It is known that visualization of catheters and vessels with ultrasonography (US) during placement prevents CF. However, US is not a common technique for general nurses. In order to standardize US-assisted PIV placement techniques, an algorithm is needed. This study aimed to develop an algorithm using US-assisted PIV placement to reduce CF rate. Furthermore, to evaluate the effectiveness of the algorithm, CF rates were compared before and after intervention. A pretestposttest study was performed. The intervention was PIV placement by 23 nurses undergoing training sessions for the algorithm. Intention to treat, per protocol analyses were applied. Logistic regression analysis was used for factor analysis. The CF rate in the pre-intervention group 35.2% (19/54) did not significantly differ from post-intervention group 33.6% (48/143) (p = 0.831), yet significantly differ from complete algorithm-use group 8.7% (2/23; p = 0.017). In factor analysis, compliance to the algorithm was significantly correlated with CF (p = 0.032). The compliance rate was low 16.1% (23/143). Algorithm compliance reduced CF by confirming appropriate catheter tip position from the insertion to the securement phase. This algorithm effectively reduced CF, however, the compliance rate was unacceptable. In order to increase the compliance rate, modified algorithm and new visualizing technology is required.

Effectiveness of ultrasonography for peripheral catheter insertion and catheter failure prevention in visible and palpable veins

“…In one of our previous studies, we used ultrasonography to the veins, including visible and/or palpable veins, to select the vein with larger diameter before puncture and confirming the position of the catheter tip after catheter insertion and modified the catheter tip in the event that it mechanically stimulates the vessel wall. 19 Consequently, CF incidence decreased (8.9%); however, the SR of the first attempt (74.0%) was similar as other previous study (73.0%), which rarely used ultrasonography. 3 The cross-sectional area size of the vessel lumen might affect the results.…”

“…We also used this because we estimated that our method of using ultrasonography for catheterization provides approximately 15% higher success rate, and then we selected 0.85 as a population proportion based on the report of a previous study. 19…”

“…We also used this because we estimated that our method of using ultrasonography for catheterization provides approximately 15% higher success rate, and then we selected 0.85 as a population proportion based on the report of a previous study. 19 In this study, DIVA was operationally defined as the invisible and/or non-palpable vein as referred to other previous studies. 20,21 The primary outcome evaluated in this study is the SR of the catheter insertion at the first attempts.…”

Aplicaciones en Terapia Intravenosa Y Prevención De Infecciones Del Torrente Sanguíneo Asociadas a Catéteres: Prospección Tecnológica

“…El uso de apps que ayuden a visualizar las venas puede ser una estrategia adecuada y asequible para ser implementada en la rutina del equipo de enfermería, ya que la ecografía no es una tecnología comúnmente utilizada por las enfermeras 21 . Las aplicaciones afirman utilizar rayos infrarrojos a través del flash de la cámara del dispositivo móvil, pero cabe destacar que no existen estudios que demuestren su aplicabilidad.…”

Applications on Intravenous Therapy and Catheter-Associated Bloodstream Infection Prevention: Technology Prospection

“…The use of applications that help visualize veins may be an appropriate and affordable strategy to be implemented in the nursing staff routine, since the ultrasound is not a technology commonly used by nurses 21 . The applications claim to use infrared rays through the camera flash of the mobile device, but it is worth emphasizing that there are no studies that prove its applicability.…”