Implementation of an Ultrasound-Guided Peripheral Access Training Program in a Pediatric Emergency Department
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Introduction:
Pediatric patients in the emergency department, especially those considered to have difficult intravenous access (DIVA), experience an increase in the overall number of intravenous (IV) attempts and IV-related complications.
Methods:
The Johns Hopkins Evidence-Based Practice model guided this evidence-based practice project. A nurse-led ultrasound-guided intravenous (USGIV) training program was developed in collaboration with the Vascular Access Team. The training included a didactic session, a simulation session using a training mold, and a precepted training period during which learners completed at least 20 precepted USGIV placements. Key patient USGIV-related outcomes, such as the first-stick success rate, were tracked after implementation of the training program using a chart audit.
Results:
Three training sessions were held, and the number of ultrasound nurses within the emergency department doubled to 24. The average monthly number of USGIV insertions increased from 84 to 138 after implementation while maintaining a first-stick success rate above 90%.
Discussion:
An emergency department-specific ultrasound-guided intravenous training program can be successful with structured training, performance surveillance, and educational remediation as necessary. This training program can serve as a framework for other hospitals hoping to expand the use of USGIV in the emergency department.
