Ultrasound‐Guided Peripheral Intravenous Catheter Training Results in Physician‐Level Success for Emergency Department Technicians

Duran‐Gehring, Petra; Bryant, Laurie; Reynolds, James M.; Aldridge, Petra; Kalynych, Colleen; Guirgis, Faheem W.

doi:10.7863/ultra.15.11059

Cited by 61 publications

(85 citation statements)

References 25 publications

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“…While the traditional method of vein palpation for cannulation is effective in the majority of patients, those with difficult vascular access (DVA) present a daily challenge to hospital staff. There are approximately 150 million IVs placed annually in the US [1], with 10-30% of Emergency Department (ED) patients classified as DVA [2]. In these patients, placement of an ultrasound (US) guided IV catheter is a viable and safe option, and has been shown to increase patient satisfaction [3].…”

Section: Introductionmentioning

confidence: 99%

Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival

Bahl

Hang

Brackney

et al. 2019

The American Journal of Emergency Medicine

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Section: Introductionmentioning

confidence: 99%

Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival

Bahl

Hang

Brackney

et al. 2019

The American Journal of Emergency Medicine

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“…This, in turn, suggests that POCUS promotes indirect cost savings (eg, reducing patient discomfort, saving time for patients and providers), especially in the context of procedures. At least 1 study from 2016 has drawn a parallel conclusion about indirect savings: ultrasound‐trained ED technicians were able to place intravenous (IV) lines with ultrasound guidance in fewer attempts (1.15 attempts, on average), in patients classified as difficult by access criteria, than published studies indicated to be the case for nontrained technicians (1.27–1.70 attempts) . Furthermore, this 2016 study showed that ultrasound‐trained technicians placing IV lines with ultrasound guidance reached first‐attempt success rates of 97%, nearly equivalent to published success rates for nurses and physicians .…”

Section: Discussionmentioning

confidence: 75%

“…At least 1 study from 2016 has drawn a parallel conclusion about indirect savings: ultrasound-trained ED technicians were able to place intravenous (IV) lines with ultrasound guidance in fewer attempts (1.15 attempts, on average), in patients classified as difficult by access criteria, than published studies indicated to be the case for nontrained technicians (1.27-1.70 attempts). 29 Furthermore, this 2016 study showed that ultrasound-trained technicians placing IV lines with ultrasound guidance reached first-attempt success rates of 97%, nearly equivalent to published success rates for nurses and physicians. 29 Although the present work does not specifically assess the indirect cost savings associated with ED physicians using POCUS for IV access, it does suggest that POCUS can allow technicians to reach physician-level proficiency at IV placements, sparing patients discomfort and hastening their time in the ED, and facilitating providers' treatment and throughput of patients.…”

Section: Indirect Cost and Patient Carementioning

confidence: 83%

“…29 Furthermore, this 2016 study showed that ultrasound-trained technicians placing IV lines with ultrasound guidance reached first-attempt success rates of 97%, nearly equivalent to published success rates for nurses and physicians. 29 Although the present work does not specifically assess the indirect cost savings associated with ED physicians using POCUS for IV access, it does suggest that POCUS can allow technicians to reach physician-level proficiency at IV placements, sparing patients discomfort and hastening their time in the ED, and facilitating providers' treatment and throughput of patients.…”

Section: Indirect Cost and Patient Carementioning

confidence: 83%

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Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

Schaik

Murphy

2018

J of Ultrasound Medicine

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Objectives Point‐of‐care ultrasonography (POCUS) is an increasingly integral part of emergency medicine. This study investigated community emergency department physicians’ choices regarding ultrasonography as a branch point in clinical decision making. Methods During shifts covering all days of the week and all time‐spans over a 3‐month period, emergency department physicians were interviewed whenever POCUS was used. Questions focused on the role of POCUS in clinical management and on tests avoided because of ultrasonography use. Cost savings attributable to POCUS were calculated using Center for Medicare and Medicaid Services and FairHealth data. Anonymization of data precluded follow‐up testing to account for misdiagnosis. Results On average, POCUS use eliminated $1134.31 of additional testing for privately insured patients, $2826.31 for out‐of‐network or uninsured patients, and $181.63 for Center for Medicare and Medicaid Services patients. Differences were significant when the total cost of eliminated additional testing was compared to a baseline of no savings (p < .001). Aggregate cost savings remained significant when analyses were broadened to include POCUS encounters that did not yield changes in management (p < .001). Conclusions When physicians’ clinical expertise suggests that POCUS may be indicated, its use results in significant cost savings, even in encounters in which management is not directly impacted. POCUS, when incorporated earlier and more frequently into community hospital emergency medicine diagnostic protocols, can lower direct and indirect costs associated with diagnostic workups. Community emergency departments, in particular, would benefit from additional investigation informing specific guidelines for the integration of POCUS into clinical management and the role that this has in cost savings.

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“…Only one randomised study conducted in selected trained emergency nurses has demonstrated that, in anticipated difficult intravenous access patients, an ultrasound-guided method was associated with a higher success rate compared with the LM. Vascular access in ICU is, on the other hand, a specific condition which cannot be compared with the emergency department setting [5][6][7]. B-ultrasound guided indwelling needle puncture of external jugular vein achieved satisfactory results in establishing fast venous access for critical patients with microcirculation failure before setting up CVC access from September 2018 to June 2019.…”

Section: Introductionmentioning

confidence: 99%

Advantage of B-ultrasound Guidance in Indwelling Needle Puncture of External Jugular Vein for Patients in General ICU

Su¹,

Guo²,

Weitao³

et al. 2019

AJIM

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The paper aims to investigate the advantage of B-ultrasound guidance in indwelling needle puncture of external jugular vein in the emergency treatment for critical patients with microcirculation failure. We included 70 microcirculation failure patients induced by different factors and with unclear external jugular veins that were admitted to the general ICU from September 2018 to June 2019 and performed indwelling needle puncture on them. We used random number table to divide the patients into control group and observation group with 35 patients in each group. The control group received traditional indwelling needle puncture and the observation group was given B-ultrasound guided indwelling needle puncture. The success rate, time and cost of indwelling needle puncture of two groups were compared. In the control group, 31 out of 35 cases of indwelling needle puncture were successful. The success rate was 88.6% and the average time consumed in each case was (9.09±2.35) min; in the observation group, 35 out of 35 cases of indwelling needle puncture were successful. The success rate was 100% and the average time consumed in each case was (2.13±0.52) minutes. Statistically, the results of observation group were significantly better than those of the control group (P<0.01). In the emergency treatment for critical patients with microcirculation failure, compared with the doctor-guided central venous catheterization, B-ultrasound guided indwelling needle puncture of the external jugular vein has the advantages of high success rate and time efficiency so as to open the vein access for critical patients quickly and help them take the medicine timely, which reduces the pressure of nurses and is well worth clinical application.

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Ultrasound‐Guided Peripheral Intravenous Catheter Training Results in Physician‐Level Success for Emergency Department Technicians

Abstract: With brief but comprehensive training, ED technicians can successfully obtain US-guided peripheral IV catheter access in patients with difficult IV access.

Cited by 61 publications

References 25 publications

Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival

Standard long IV catheters versus extended dwell catheters: A randomized comparison of ultrasound-guided catheter survival

Point‐of‐Care Ultrasonography (POCUS) in a Community Emergency Department: An Analysis of Decision Making and Cost Savings Associated With POCUS

Advantage of B-ultrasound Guidance in Indwelling Needle Puncture of External Jugular Vein for Patients in General ICU

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