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Training the Trainers in Ultrasound-guided Access to Improve Peripheral Intravenous Catheter Placement among Children
Vikas N O'Reilly-Shah1, Amber Franz1, Cornelius B Groenewald1
1Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Wash.
Insights
Training pediatric anesthesiologists in ultrasound-guided peripheral intravenous (PIV) catheter placement reduced the number of attempts needed. However, the time to establish PIV access remained unchanged.
Area of Science:
- Pediatric Anesthesiology
- Medical Education
- Ultrasound Technology
Background:
- Difficult peripheral intravenous (PIV) catheter placement is a common challenge in pediatric patients.
- Ultrasound guidance is known to decrease PIV placement attempts, but its adoption by attending anesthesiologists was low.
- A need existed to improve PIV placement success rates and efficiency in pediatric anesthesiology.
Purpose of the Study:
- To reduce the incidence of PIV placement requiring more than 3 attempts in pediatric patients.
- To decrease the time required for PIV placement through targeted training.
- To evaluate the effectiveness of an ultrasound-guided PIV placement training program.
Main Methods:
- An evidence-based difficult IV algorithm and ultrasound-guided PIV placement training were implemented for attending pediatric anesthesiologists.
- Training included group sessions with simulation and individual operating room practice, monitored via a punch card system.
- A cross-sectional analysis compared baseline data with post-training periods (December 2015–September 2019).
Main Results:
- Cases requiring more than 3 PIV attempts decreased from 4.0% to 2.7% overall.
- For patients 24 months or younger, attempts >3 decreased from 10% to 6.2%.
- The time required to establish PIV access did not change significantly.
Conclusions:
- Implementing a difficult IV algorithm and ultrasound training for pediatric anesthesiologists effectively reduced the number of PIV placement attempts.
- The intervention did not significantly alter the time needed for PIV access.
- Further strategies may be needed to address the time component of difficult PIV placement.
Abstract:
Factors predicting difficult peripheral intravenous (PIV) catheter placement in children are known. Ultrasound guidance can decrease the number of attempts required for difficult PIV placement. However, the uptake of this technique among attending anesthesiologists at our institution remained low. This study aimed to reduce the incidence of PIV placement requiring greater than 3 attempts and reduce time to PIV placement by providing training in ultrasound guidance.
Methods:
We implemented an evidence-based difficult IV algorithm and ultrasound-guided PIV placement training for attending pediatric anesthesiologists at a tertiary academic pediatric institution. The algorithm outlined risk factors for difficult IV access, established a goal of 3 or fewer attempts, and recommended early ultrasound use after 1 unanticipated attempt and the first attempt for anticipated difficult IV. Group sessions, including instruction and simulated practice, preceded a period of individual training in the operating room using a punch card to monitor each trainee's progress while also serving to motivate continued engagement.
Results:
We performed a cross-sectional analysis of consecutive cases from December 1, 2015, to September 30, 2019, comparing a 22-month baseline period (n = 12,581) with the training period (n = 6,725) and the following year (n = 6,557). Cases requiring more than 3 attempts decreased from 4.0% to 2.7% overall and from 10% to 6.2% among patients 24 months or less of age. The time required to establish PIV access was unchanged. Factors associated with increased attempts were identified.
Conclusions:
Implementing a difficult IV algorithm and training among attending pediatric anesthesiologists in ultrasound-guided PIV placement reduced attempts but not the time required to establish PIV access.
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