Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients With Difficult Intravenous Access

Abstract

ObjectivesDifficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients.MethodsWe performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period.ResultsOne hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period.ConclusionsA hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.

Educating health professionals in ultrasound guided peripheral intravenous cannulation: A systematic review of teaching methods, competence assessment, and patient outcomes

“…Study design and demographic data for the 35 included articles can be seen in Table 1 . Of these studies, 8.6% (n = 3) were randomized controlled trials, [ 59 , 63 , 72 ] 22.9% (n = 8) were non-randomized interventional studies (pre/post studies), [ 41 , 42 , 53 , 54 , 56 , 57 , 64 , 66 ] 45.7% (n = 16) were longitudinal observational studies (of which 13 were prospective [ 10 , 40 , 43 – 45 , 47 – 49 , 55 , 58 , 62 , 69 , 71 ] and three were retrospective [ 51 , 67 , 68 ] ), 5.7% (n = 2) were cross-sectional observational studies [ 50 , 52 ] and 14.3% (n = 5) were quality improvement projects with methodology otherwise unspecified. [ 46 , 61 , 65 , 70 , 73 ] The vast majority of included studies described predominantly quantitative outcomes (97.1%, n = 34), with just one included study describing purely qualitative outcomes.…”

“…[ 56 , 68 ] Some necessitated an attempt to be successful to count towards the quota for competency. [ 40 , 41 , 43 , 53 , 60 , 61 , 65 ]…”

“…Comparison to baseline data or pre-implementation audit data showed multiple improvements to patient and organizational outcomes among included studies. These included significantly reduced midline insertion rates, [ 41 ] central venous catheter insertion rates, [ 56 , 64 , 66 , 67 ] central venous catheter-associated bacteremia and sepsis, [ 66 ] self-reported difficulty of cannulation, [ 45 ] need for specialist vascular access team input, [ 57 , 58 , 61 ] therapy delays [ 65 ] and premature catheter failure rates. [ 66 ] They also described significantly improved procedural confidence, [ 10 , 40 , 42 , 54 , 63 ] knowledge [ 54 , 71 ] and competence, as evidenced by improved cannulation insertion attempts, success rate and first-time success.…”

“…[ 40 , 59 ] Given the risk of complications to patients from invasive procedure such as PIVC insertion, it is a logical step to include this minimum passing standard in teaching sessions. A series of recent studies by Amick et al [ 40 , 41 ] described use of this method for training nurses in ultrasound guided PIVC, midline and peripherally inserted central catheter insertion. They reported encouraging results, including a successful PIVC insertion rate of 89.5% from a mean of 35.6 insertions at 3 months post intervention.…”

Therapeutic Effect of Ultrasound-Guided Peripherally Inserted Central Catheter Combined with Predictive Nursing in Patients with Large-Area Severe Burns

“…However, burn patients generally have scarred skin, which makes the veins difficult to find, greatly increasing the difficulty of venipuncture. In addition, conventional puncture or central venous catheter requires repeated alternation and replacement in a short time period [ 18 ]. These problems and shortcomings often bring pain to patients and increase the difficulty of clinical nursing.…”