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Problem/Issue: Patients presenting to the Emergency Department (ED) often require peripheral intravenous (IV) access to collect blood samples and administer IV medications and fluids. Inadequate IV access can lead to delays in treatment, possible increased length of stay, and patient dissatisfaction.
Background: Although ED nurses are generally accustomed in obtaining peripheral IV access, there are a number of patients who are difficult to cannulate. Difficult intravenous access may include patients with chronic illness such as sickle cell, renal failure, cancer, history of intravenous drug abuse, obesity, extremes of age, and hypovolemia. UGPIV access may be an alternative to blind insertion to establish early IV access, start infusion therapy, perform blood withdrawal, and administer medications. Purpose: The purpose of this project was to implement an evidence-based practice (EBP) guideline for difficult IV access (DIVA) through the use of ultrasound guided IV (USGIV) access techniques. Methods: |
An evidence-based USGIV access policy/procedure was developed and approved by the Nursing Practice Council. Two unit champions and 6 ED staff nurses completed training which involved didactic educational session, pretest/posttests and return demonstrations. The practice change was implemented and monitored over a 6-month period. USGIV access procedures were documented on data collection forms identifying reason for the difficult stick, number of attempts, time to successful cannulation, site of insertion, and complications. Evaluation of the practice change was conducted during a 3-week period to assess impact on DIVA patient outcomes (number of IV attempts and time to successful cannulation).
Results:
Findings showed significant differences in nurses’ knowledge regarding DIVA and USGIV access techniques - pretest mean score of 9.6 vs. posttest mean score 16.2 (p value 0.0004). Significant reduction in the number of IV attempts and time to successful cannulation were also observed for USGIV access compared to traditional blind sticks. Average number of IV attempts using USGIV access was 1.11 compared to 4.75 for blind sticks (p value – 0.0001).Average time to successful cannulation for USGIV access was 9.53 min. compared to 46.8 min. for blind sticks (p value – 0.0001). ED nurse feedback was positive, average of 3.4 out of 5 on the level of cannulation difficulty.
Discussion:
Implementation of an evidence-based policy and procedure for DIVA involving USGIV access techniques can facilitate successful cannulation and impact quality of care by decreasing number of attempts and time required. This can lead to greater patient and nurse satisfaction, reduced length of stay, and lower hospital costs.