Ultrasound guided peripheral IV placement: An observational study of the learning curve in pediatric patients

Ultrasound guided peripheral intravenous catheter placement (USGPIV) has demonstrated benefits in children including higher success rates and fewer attempts compared to the traditional technique. Little is known about the experience needed to establish competence with USGPIV in children. In adult patients, nurses with four USGPIV attempts had a subsequent 70% probability of success after training. The objective of this study is to measure the competency of nurses with USGPIV in children after training.

Pediatric nurses completed 2 h of training on USGPIV, after which they used ultrasound at their discretion for children with difficult access. Data was collected prospectively via study forms and retrospectively from medical records. Mixed effects logistic regression models were used to estimate the probability of successful USGPIV placement.

Thirty-five nurses underwent training from the pediatric emergency department and intravenous access team. The overall USGPIV success rate was 70%. Participants with less nursing experience made more USGPIV attempts than those with more experience, but had similar success rates. Forty percent of participants performed ten or more attempts during the study period. Mixed effects logistic regression estimated that it took nine USGPIV attempts after training for learners to achieve a 70% probability of success for the subsequent attempt.

After training, 40% of participants adopted USGPIV into their practice. When developing training programs for USGPIV for children with difficult access, trainers can anticipate the experience needed to acquire this skill and the fact that not everyone trained will use this skill in their daily practice.