WIP 3 - Implementation of Ultrasound-Guided Approach to Peripheral Intravenous Catheter Placements

Poster Number: WIP 3
Publication Number: WIP 3.2639

Background: Peripheral intravenous (PIV) access is critical for fluid and drug administration in paediatric patients (Takeshita et al. 2019). However, PIV catheter placement is often more challenging in children due to smaller vein size (Schindler et al. 2012). Ultrasound (US) has shown its utility in paediatric PIV catheterization. In a sample of paediatric emergency department patients with difficult venous access, Doniger et al. (2009) found that US-guided (USg) PIV catheters required fewer attempts and less time compared to traditional landmarking methods. Vinograd et al. (2019) also reported higher first-attempt success rate, improved efficiency, and greater longevity for PIV catheters placed under USg.

Objective: The goal of our quality improvement project was to increase PIV catheterization success rates and dwell times by implementing the USg approach. By December 2022, we aimed to increase first-attempt placement success rates and dwell times for PIV catheters placed in large veins by 15% and 0.5 days, respectively, through use of USg methodology. Process measure was the percent of PIV lines placed under USg. Outcome measures were first-attempt success rate and dwell time. This study received IRB exemption and received QI approval.

Design/Methods: Change ideas included US technique standardization, identification of qualifying patients, implementation of the eligibility algorithm, and daily identification of USg providers. Large vein PIV catheters were placed in 632 patients, where most lines were placed in the arm (70.6%). Process measure showed the first shift in May 2021 from 6.4% to 15.4%. Another shift to 41.4% occurred in October 2022 and was sustained until study end date in April 2023. Preliminary analysis of the first-attempt success rate did not reveal special cause variation during the study period. Dwell times showed special cause variation with a shift noted in June 2021 from 1.5 to 2.1 days. We are conducting further analysis based on mode of PIV insertion, patient diagnosis, and administered medications. We plan to finish the analysis by February 2024.