571 - An Ultrasound-Guided Intravenous Program Improves First Stick Success and Longevity in Critically Ill Children.
Wednesday, May 13, 2020
Location: Majestic Ballroom: Majestic
Background and Objectives: Ultrasound guidance has been shown to improve the first stick success in obtaining peripheral (PIV) intravenous access. However, widespread implementation in the critical care setting remains low. We hypothesized that the implementation of a nursing education curriculum would result in increased first stick and overall PIV placement success rates compared to conventional landmark-based methods.
Methods: This is a pre-post intervention study of ultrasound guidance for PIV placement with data from a landmark guided (LM) PIV epoch from April until December 2018 and an Ultrasound guided (US) epoch starting in December 2018 until October 2019. Pediatric intensive care unit (PICU) Registered Nurses (RNs) at a quaternary medical-surgical referral institution were enrolled. Each RN attempted placement of 10 PIVs by using the LM methods. The RNs were then individually coached through a one-hour education session that involved a presentation and hands on ultrasound practice. The education was consolidated by placement of 5 proctored US PIVs. Lastly, each RN attempted 10 PIVs using US guidance. First stick success, overall success and longevity of PIV placement were compared using the LM vs. US methods. Fisher’s exact test was used to compare categorical data. Kaplan-Meier survival analysis was performed to compare longevity of PIVs placed.
Results: A total of 15 RNs in the LM group attempted placement of 150 PIVs. In the US guided placement group 15 RNs attempted placement of 143 PIVs. The first stick success in the US group was 87.9% compared to 47.3% in the LM group (p value < 0.001). Overall success was also superior in the US group compared to the LM group (93.1% vs. 57.3%, respectively) (p value < 0.001). A Kaplan Meier survival analysis demonstrated that PIVs placed by US lasted longer than LM ones (p value < 0.050, log-rank).
Conclusion: Ultrasound guidance measurably improves first-stick success and catheter longevity in critically ill children. A one-hour standardized curriculum with a 5 PIV credentialing requirement is readily sufficient to establish a program.