Ultrasound‐guidance of peripheral venous catheterization in apheresis minimizes the need for central venous catheters

Abstract

IntroductionCentral venous catheters (CVC) can facilitate a reliable blood flow for apheresis procedures, but the placement is time‐consuming and costly and the incidence of catheter‐related complications is high. Ultrasound can aid nurses to insert peripheral venous catheters (PVC), which is safer for the patients.Methods and materialsWe evaluated the use of CVC vs PVC for all apheresis procedures 3 years after the implementation of structured training of apheresis nurses to perform ultrasound‐guided PVC. Ultrasound can visualize the needle tip and target vessel dynamically and guide peripheral venous catheterization with an increased success rate. Time consumption for PVC insertion was measured.ResultsIn 10 months, we performed 1294 apheresis procedures on 227 patients, where 97.4% were performed with PVC. Hundred percent of extracorporeal photophoresis (off‐line ECP) and peripheral blood stem cell collections on adults were performed with PVC. Patients who were treated with CVC (n = 8) were either children, had poor peripheral blood flow due to dehydration or admitted to an intensive care unit and had CVC for other reasons. Time consumption for PVC placement with ultrasound was 11 minutes on average.ConclusionTraining of apheresis nurses in ultrasound‐guided peripheral venous catheterization can enable close to 100% of apheresis procedures to be performed by PVC.

Nationwide practices in the use of central venous catheters for therapeutic plasma exchange in the inpatient setting

“…Use of ultrasound guidance significantly improves the success of peripheral vein cannulation and has been shown to result in marked reduction in the need for CVCs. 14,15 Our findings support the recommendations of a recent study that advised prioritizing the use of peripheral venous access over CVCs as a safe and an effective option. 16 This study provides novel information regarding the use of CVCs for inpatient TPE procedures in the United States.…”

The Efficacy of Nurse-Performed Ultrasound Guidance Compared with the Conventional Cannulation Technique in Patients with Difficult Peripheral Intravenous Access: A Systematic Review

“…19 A retrospective observational study was performed on the same Danish hospital ward three years later and showed that the use of nurse-performed UG for the placement of PIVCs continued to have a positive efficacy on the patients where 97,4% of the apheresis procedures were accomplished via peripheral venous access. 25 These studies show that there is strong evidence of the positive efficacy in the use of UG in patients with DIVA.…”

“…As an example, there already exists a Danish e-learning program, which proved to be successful. 15,25 The authors recommend for future research, RCT studies of nurse-performed UG with more participants that also include technical factors such as the use of DNTP technique and focus on catheter length and size. 22,23…”

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.…”