Outcomes of a simplified ultrasound-guided intravenous program for emergency nurses
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Session E presented Friday, September 15, 2017
Purpose: The purpose of this study was to produce an applicable and economical model of Ultrasound-Guided Intravenous access (USGIV) training and competency for emergency nurses and examine emergency nurse skill acquisition and the impact of this program on all Emergency Department (ED) patients requiring IV access.
Design: The study design was a translational research, quality improvement, prospective single arm pre-post study.
Setting: The study took place at an urban, academic teaching hospital and Level I Trauma Center with over 86,000 Emergency Department visits annually.
Participants/ Subjects: The study was offered to all emergency nurses regardless of skill and experience levels. Thirty-four emergency nurse volunteers with experience levels from 1 year to 30 years enrolled in this IRB approved study over the 7 months it was offered.
Methods: Emergency nurses completed a 4-hour, continuing education (CE) approved USGIV taught by ED resident physicians. Emergency nurses were deemed competent after successful completion of 10 supervised USGIV insertions on patients. Data was collected from a nurse completed USGIV log identifying date, successfulness, procedure time and difficulty levels on a 1-5 Likert scale, IV attempts from the electronic medical record (EMR), post training questionnaires and focus groups. This study analyzes emergency experience levels, course completion rates, USGIV procedure times, difficulty levels, success rates, utilization and the effects on overall IV attempts in the emergency department.
Results/Outcomes: Thirty-four emergency nurses with experience levels of under 1 year to 30 years enrolled in the study, logging 280 USGIV attempts over 7 months. Twelve (35%) of the emergency nurses who attended the training class developed competency in the procedure. The greatest number of successful participants came from the 3-10 years of experience group. Successful cannulation rates were 81% in attempts 1-10, 84% for attempts 11-20, and 96% for attempts 21-30. USGIV procedure times and successfulness varied from 4.74 ± 1.75 minutes and 100% successful when appraised as “very easy” to 15.53 ± 8.18 minutes and 55% successful when assessed as “very difficult.” All patient IV attempts pre and post intervention were examined using two tailed T test (n=24471). The mean number of IV attempts per IV site decreased by 2%, P=0.013. DIVA patients with ≥ 2 failed IV attempts experienced a 7% decrease in IV attempts, P=0.003. Patients with an USGIV placed by an emergency nurse experienced a 28.02% reduction in IV attempts compared to physician placed USGIVs (P=< 0.0001). Qualitative data from focus groups and surveys will be described in a follow-up paper.
Implications: An emergency nurse USGIV training program can decrease total number of IV attempts, especially for DIVA patients, and decrease cost of IV supplies. A simplified and economical USGIV training program for emergency nurses can be successful and completion outcomes are dependent on level of prior nursing experience and individual emergency nurse motivation. Training environment with high demand for IV placement would benefit rapid skill acquisition. A randomized controlled study could more accurately assess emergency nurse versus physician skill in placing USGIVs.