The practical integration of a hybrid model of ultrasound‐guided peripheral venous access in a large apheresis center

Abstract

Background Apheresis treatments require adequate venous access using peripheral intravenous (PIV) catheterization or central venous catheters (CVC). Ultrasound‐guided PIV (USGPIV) can be used to decrease the need of CVC insertions for apheresis procedures. Method A hybrid model of USGPIV and standard of care (SOC) for PIV access was developed. Nurses performed USGPIV on all patients considered for PIV access if felt SOC PIV access was not possible. Information was collected regarding nurses’ confidence with access, number of attempts required, site of access, complications, and need for CVC. Results In all, 226 PIV access attempts were made during a 2‐month period. All apheresis procedure types were represented. A total 65% were accessed by SOC and 35% by USGPIV. USGPIV was successful on first try on 90% draw/inlet access and 87% successful on first try on return access. Access above the antecubital fossa was required in 31% of USGPIV for draw/inlet veins, and 22% of return veins. Nurses’ confidence with accessing PIV was increased by USGPIV, based on 7‐point Likert scale assessments. During the recording period, 2/226 (0.9%) apheresis procedures required a CVC. In a separate cohort of only hematopoietic progenitor cell collections, CVC insertion was required in 44/238 (18.5%) patients, in 7 months prior to adoption of USGPIV and 5/152 (3.3%) patients in 7 months following adoption of USGPIV. Conclusion A hybrid model of using SOC and USGPIV for PIV access for apheresis procedures resulted in decreased need for CVC access, high levels of successful initial access attempts, and increased nursing confidence in PIV access.

Vascular access in therapeutic apheresis: One size does not fit all

“…In a separate cohort study on HPC patients, in 7 months, only 18.5% of patients required a CVC insertion in the absence of USGPVA. This decreased to 3.3% using ultrasonography for finding the vessel [50]. Using USGPVA combined with SOC could increase the success of PVA and decrease the need for CVC.…”

“…In 2019, Barth et al [50] conducted a study in which they reported their practical experience using USGPVA for their patients undergoing TA. A total of 226 peripheral catheterizations were performed by USGPVA trained nurses.…”

Point-of-care hand-held ultrasound for peripheral intravenous cannulation: a scoping review protocol

“…39 Many clinicians have resorted to ad hoc training and education on ultrasound use for PIVC insertion as expectations for professional development and learning become more self-directed. 40 Standardised ultrasound training programs and clinical guidelines are lacking, and their development has been overtaken by the implementation and integration of these devices into clinical practice. 31,41 POCUS was listed as the second health technology hazard for 2020 as safeguards, training, experience, and skill has been outpaced by its adoption.…”