Hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous catheter placement

Abstract

Introduction: Objective measures such as hand motion analysis are needed to assess competency in technical skills, including ultrasound-guided procedures. Ultrasound-guided peripheral intravenous catheter placement has many potential benefits and is a viable skill for nurses to learn. The objective of this study was to demonstrate the feasibility and validity of hand motion analysis for assessment of nursing competence in ultrasound-guided peripheral intravenous placement. Methods: We conducted a prospective cohort study at a tertiary children's hospital. Participants included a convenience sample of nurses with no ultrasound-guided peripheral intravenous experience and experts in ultrasoundguided peripheral intravenous placement. Nurses completed hand motion analysis before and after participating in a simulation-based ultrasound-guided peripheral intravenous placement training program. Experts also completed hand motion analysis to provide benchmark measurements. After training, nurses performed ultrasound-guided peripheral intravenous placement in clinical practice and self-reported details of attempts. Results: A total of 21 nurses and 6 experts participated. Prior to the hands-on training session, experts performed significantly better in all hand motion analysis metrics and procedure time. After completion of the hands-on training session, the nurses showed significant improvement in all hand motion analysis metrics and procedure time. Few nurses achieved hand motion analysis metrics within the expert benchmark after completing the hands-on training session with the exception of angiocatheter motion smoothness. In total, 12 nurses self-reported 38 ultrasound-guided peripheral intravenous placement attempts in clinical practice with a success rate of 60.5%. Discussion: We demonstrated the feasibility and construct validity of hand motion analysis as an objective assessment of nurse competence in ultrasound-guided peripheral intravenous placement. Nurses demonstrated rapid skill acquisition but did not achieve expert-level proficiency.

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

“…Their lower overall success rate may be because their training program only included three proctored attempts, and data were only collected for the first 4 months after training. 8 While acceptable guidelines for success rates are not well known, this study shows that after 10 proctored encounters, reasonably high success rates were achieved and remained stable with further experience.…”

“…These data are consistent with prior data collected at the same institution in 2018 that showed a first-attempt success rate of 68% and a more recent randomized control study in 2019, which showed an overall success rate of 85.4%. 11,1 A recent study of pediatric emergency nurses by Good et al 8 found an overall success rate of 60.5%. Their lower overall success rate may be because their training program only included three proctored attempts, and data were only collected for the first 4 months after training.…”

“…There is little reported data on training programs or competency for USGPIV placement in pediatric patients. In pediatric patients, Good et al 8 found that after a three-step training program consisting of an online module, a 2-hour hands-on simulation session and three proctored attempts, nurses had a success rate of 60.5%. Given the many benefits of USGPIVs in pediatric patients, it is important to establish a level of competency to improve and standardize training across providers.…”

Education in the placement of ultrasound-guided peripheral venous catheters: a systematic review

“…In other studies, the living subjects were healthy persons ( n = 2). The phantoms used in studies were commercially available ( n = 10) [ 13 , 23 , 34 , 35 , 38 , 40 , 44 – 47 ], homemade ( n = 5) [ 26 , 37 , 39 , 48 , 49 ], or a mixture of both types of phantoms [ 50 ]. One study did not specify the type of phantom they used [ 51 ].…”

A short bevel needle with a very thin tip improves vein puncture performance of peripheral intravenous catheters: An experimental study

“…14 Because this needle-steering process requires complex skills and clinical experience, ultrasound guidance has been proposed to improve peripheral intravenous catheter (PIVC) placement success rates in patients with difficult venous access. [15][16][17] However, cannulation into smaller veins remains difficult even with the use of ultrasound-guided cannulation. In an observational study using ultrasound, the success rate was 56% (95% confidence interval (CI) ¼ 40% to 71%) for a vein diameter < 0.3 cm and 92% (95% CI ¼ 62% to 100%) for a diameter > 0.6 cm.…”