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Quality Improvement: Using Ultrasound-Guided Cannulation for Difficult IV Access in Medical-Surgical Patients: A
Odaro Owen1, David C Mulkey, Aldrin Nieves
1Odaro Owen is an administrator at Zuckerberg San Francisco General Hospital and Trauma Center, David C. Mulkey is an associate professor at Grand Canyon University, Phoenix, and Aldrin Nieves is an NP at University Medical Partners/Stanford Medicine. Contact author: Odaro Owen, oeowen2016@icloud.com. The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.
Background:
Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA.
Purpose:
The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center.
Methods:
The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record.
Results:
A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate.
Conclusion:
Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA.
