Using Ultrasound Guided PIV Insertion in the Pediatric Population

Introduction/background: Intravenous (IV) therapy using a peripheral IV (PIV) in children is one of the most frequent medical interventions in the hospital. Current evidence supports ultrasound guided PIV placement in the adult patient population as it helps improve successful placement and decrease time to successful cannulation with no more risk than the traditional procedure (Constantino, 2005; Crowley, 2012; Gregg, 2009). There is growing body of evidence available that ultrasound guided PIV placement reduces the number of attempts to place a PIV in children (Benkhadra, 2012; Doniger, 2009; Feinsmith, 2018; Leung, 2015; Viongrad, 2018) and the cannulation lasts longer than traditional insertion (Desai, 2018). This was a study conducted as a fellow participant of the Maternal-Child Health Nurse Leadership of Academy (MCHNLA), sponsored by Sigma and Johnson & Johnson.

Aim/Goal/Purpose: Ultrasound guided IV insertion is current standard of care but is not consistently used at the University of Texas Medical Branch (UTMB). The purpose of this study is to implement an ultrasound guided IV insertion team in the Pediatric Medical/Surgical (Med/Surg) and Pediatric Intensive Care Units (PICU) to increase compliance with the standard of care and to improve staff and patient satisfaction with the treatment in the pediatric inpatient population.

Methods: Data was collected during a 6-month period, June 1, 2018, to November 30, 2018, for all pediatric patients that required a peripheral IV be inserted for treatment on the UTMB pediatric med/surg unit or PICU. Data was obtained from EPIC (electronic medical record) documentation and included the number of IV attempts and whether ultrasound was used to assist insertion. Each parent and staff were asked to fill out an anonymous survey regarding their experience of the treatment. The data obtained from the survey was used to measure an aggregate data pool related to staff, patient and parent satisfaction. Following the implementation of the standard of care (ultrasound guided PIV insertion after two failed blind attempts) data was extracted from EPIC from December 1, 2018, to April 2019, to evaluate the implementation of the treatment.

Results: In October and November 2018, four staff attended training to complete competencies in ultrasound guided PIV insertion. Two staff were fully trained and validated. The other two were not able to attend all required elements of the training and were not able to join the treatment group. December 1, 2018, we implemented the usage of the pediatric team to begin the treatment phase. As of April 1, 2019, we have successfully had 10 patients meet criteria for ultrasound use and the treatment was used. Pre and post treatment data, and survey results are currently pending.

Conclusions: Training was successfully completed to integrate ultrasound guided IV insertion into the standard of care being delivered for pediatric patients at UTMB. The staff continue to work on their confidence and efficiency in insertion, which other centers have found challenging in the first 12 months after implementation (Richard, 2105). UTMB policies have been updated to reflect the need for using ultrasound guided IV insertion in all age patients, outside of the neonatal intensive care unit, once two insertion attempts have failed. Findings from both the number of patients receiving treatment and survey results of this study are currently pending conclusion of the treatment period.

References

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Constantino, T., Parikh, A., Satz, W., & Fojtik. J. (2005). Ultrasonography-guided peripheral intravenous access versus traditional approaches in patients with difficult intravenous access. Annals of Emergency Medicine, 46(5), 456-461. doi: 10.1016/j.annemergmed.2004.12.026

Crowely, M., Brim, C., Proehl, J., Barnason, S., Leviner, S., Lindauer, C., Naccarato, M., Storer, A., & Williams, J. (2012). Emergency nursing resource: Difficult intravenous access. Journal of Emergency Nursing, 38(4), 335-343. doi: 10.1016/j.jen.2012.05.010

Doniger, S., Ishimine, P., Fox, J., & Kanegaye, J. (2009). Randomized controlled trial of ultrasound – guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatric Emergency Care, 25(3), 154-159.

Feinsmith, S., Huebinger, R., Pitts, M., Baran, E., & Hass, S. (2018). Outcomes of a simplified ultrasound-guided intravenous training course for emergency nurses. Journal of Emergency Nursing, 44(2), 169-175.

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Vinograd, A., Zorc, J., Dean, A., Abbadessa, M.K., & Chen, A. (2018). First-attempt success, longevity, and complication rates of ultrasound-guided peripheral intravenous catheters in children. Pediatric Emergency Care, 34(6), 376-380. doi.org/10.1097/PEC.0000000000001063