Training Program for Ultrasound-Guided Intravenous Catheter Insertion

Abstract

Introduction Ultrasound guidance is now widely available in military treatment facilities and civilian hospitals alike, both in the USA and in forward-deployed military environments. Technical mastery of ultrasound-guided peripheral intravenous (USGPIV) catheter insertion can be easily achieved through a short training course. Mastery can be achieved even when trainees have a limited medical background before course attendance. An evidence-based practice project team sought to improve the knowledge, confidence, and skills in the placement of USGPIV catheters by clinicians at Naval Hospital Jacksonville. Completion of an USGPIV training program can equip healthcare providers with knowledge and confidence for placement of peripheral access necessary in critical situations such as those requiring medications or blood products. Materials and Methods The project team conducted a literature review to evaluate the appropriateness of USGPIV training for the nurses and military medical technicians in this setting. The team developed and delivered a USGPIV training program based on adaptations from the literature. During the training period, knowledge and confidence scores were reported by each trainee to evaluate the perceptions of the quality of training. The number of attempted catheter placements and ultrasound utilization was recorded in the pre- and post-implementation periods to evaluate the project’s effect on the delivery of patient care. Statistical analysis was conducted to evaluate project outcomes. Results In the pre-intervention period, none of the 252 intravenous catheters were placed with the USGPIV technique, compared to 50 of 267 in the post-intervention period. These results demonstrate an 18.7% increase in the USGPIV access approach by nursing staff. Mean knowledge scores significantly increased following the delivery of the training, 60% versus 80% in the pre- and post-training assessments, respectively (P < .001). Mean self-reported skill confidence scores also significantly improved (P < .001). Conclusion Knowledge and self-reported confidence in USGPIV access improved for the trainees. Mean knowledge improved from 60% to 80%, while mean confidence scores increased from 2.74 to 3.79 for corpsman and from 3.0 to 3.88 for nurses. Utilization of the USGPIV technique increased by 18.7% in the post-intervention period. These results demonstrate that implementing this training program can improve knowledge, confidence, and use of ultrasound during the placement of PIV catheters.

Educating health professionals in ultrasound guided peripheral intravenous cannulation: A systematic review of teaching methods, competence assessment, and patient outcomes

“…Study design and demographic data for the 35 included articles can be seen in Table 1 . Of these studies, 8.6% (n = 3) were randomized controlled trials, [ 59 , 63 , 72 ] 22.9% (n = 8) were non-randomized interventional studies (pre/post studies), [ 41 , 42 , 53 , 54 , 56 , 57 , 64 , 66 ] 45.7% (n = 16) were longitudinal observational studies (of which 13 were prospective [ 10 , 40 , 43 – 45 , 47 – 49 , 55 , 58 , 62 , 69 , 71 ] and three were retrospective [ 51 , 67 , 68 ] ), 5.7% (n = 2) were cross-sectional observational studies [ 50 , 52 ] and 14.3% (n = 5) were quality improvement projects with methodology otherwise unspecified. [ 46 , 61 , 65 , 70 , 73 ] The vast majority of included studies described predominantly quantitative outcomes (97.1%, n = 34), with just one included study describing purely qualitative outcomes.…”

“…These included significantly reduced midline insertion rates, [ 41 ] central venous catheter insertion rates, [ 56 , 64 , 66 , 67 ] central venous catheter-associated bacteremia and sepsis, [ 66 ] self-reported difficulty of cannulation, [ 45 ] need for specialist vascular access team input, [ 57 , 58 , 61 ] therapy delays [ 65 ] and premature catheter failure rates. [ 66 ] They also described significantly improved procedural confidence, [ 10 , 40 , 42 , 54 , 63 ] knowledge [ 54 , 71 ] and competence, as evidenced by improved cannulation insertion attempts, success rate and first-time success.…”

“…In total, 88.6% (n = 31) articles described teaching of nurses, and of these 51.6% (n = 16) specified teaching of nurses from an emergency department (ED). [10,42,[44][45][46][47][52][53][54][55]58,[60][61][62]69,73] Only 8.6% (n = 3) included teaching of doctors, [42,48,62] and the same proportion (8.6%, n = 3) described teaching of medical students. [42,59,63] Finally, 5.7% (n = 2) of articles discussed the teaching of military medics, [54,62] and a single study (2.9%) discussed teaching of ED technicians.…”

“…[63] Some articles (28.6%, n = 10) noted the use of online learning resources prior to in-person session(s). [51,[54][55][56][57]61,62,66,68,71] Of the 22 included studies that detailed total training time, there was a median of 2.5 hours of education per participant (IQR = 2.38 hours). However, this ranged widely from 1.5 hours [49,65] to 91.5 hours.…”

Conduct of nursing technician in primary health care: integrative review / Condutas do técnico em enfermagem na atenção primária à saúde: revisão integrativa

“…The personification of the activities of this worker in PHC should not be limited to checking vital signs, performing dressings, applying vaccines and medications, as already discussed, and should have procedural autonomy, greater theoretical detention and representativeness in the planning and execution of care with the health team and community. 22,24 As emphasized by Law² 7498 of 1986 that establishes the Professional Exercise of Nursing in Brazil, the nursing technician is part of the health team, participates in the planning of care, performs care actions, except those exclusive to nurses. About 15 (15.6%) studies of the sample emphasize that the care of the nursing technician considers physical, social, psychic, spiritual and cultural aspects, being performed with a general evaluation of the patient, with the aid of materials and the use of sense organs such as hearing, sight, smell and touch that compose the primary evaluation of the first instance of care, allowing the collection of patient data.…”