WIP 125 - Increasing Utilization and Level of Comfort with Ultrasound for Peripheral Intravenous Access Placement at a Large Tertiary Pediatric Emergency Department

Poster Number: WIP 125
Publication Number: WIP 125.719

Background: Ultrasound (US) is a valuable tool to improve success rates in obtaining peripheral intravenous access (PIV), with few complications and a long PIV survival time. It has been shown to improve cannulation rates for pediatric patients with difficult access and to decrease time spent, number of needle redirections, and number of attempts. Nurses can reliably place US-guided PIVs at a high success and low complication rate after an initial training period.

Objective: The aim of this study was to increase utilization and level of comfort with US-guided PIVs by core nursing staff at a large tertiary Pediatric Emergency Department (PED). The primary objective was to perform a needs assessment and implement a tailored curriculum. The secondary objective was to increase the frequency of use and expertise in US-guided PIVs by the trained nursing staff.

Design/Methods: The study was a Quality Improvement project. Core nursing staff of the PED were recruited to participate, with inclusion criteria being at least 6 months of experience in nursing and obtaining PIVs as part of clinical practice. A total of 18 voluntary subjects engaged in the study, most of which (72.2%) had over 3 years of experience.
The needs assessment revealed most subjects (89.5%) had no formal US training, and only 15.7% had previously used US to guide PIV placement. While only 11.1% of the participants reported feeling very comfortable with US use, 83.3% believed it is very helpful. We also assessed the average time spent obtaining PIVs and the number of failed attempts per patient prior to requesting US IV team assistance.
A tailored curriculum was implemented by a POCUS-trained attending and two PED fellows. Training consisted of a lecture, a hands-on session, and the performance of 3 supervised and 10 total US-guided PIVs. Options for charting the PIV modality (US-guided vs not) were added to the electronic medical records. Participants were sent a post-completion survey.
As of October 2023, 8 participants have completed all requirements. The project is expected to be completed by December 2023.