Ultrasound-Guided Peripheral Intravenous Catheter Insertion Training Reduces Use of Midline Catheters in Hospitalized Patients with Difficult Intravenous Access

Ashley E. Amick*, Sarah E. Feinsmith, Jordan Sell, Evan M. Davis, Diane B. Wayne, Joseph Feinglass, Jeffrey H. Barsuk

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract

Objectives Difficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients. Methods We performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period. Results One hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period. Conclusions A hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.

Original languageEnglish (US)
Pages (from-to)E697-E703
JournalJournal of Patient Safety
Volume18
Issue number3
DOIs
StatePublished - Apr 1 2022

Keywords

  • difficult IV access
  • hospital medicine
  • nursing education
  • simulation-based mastery learning
  • ultrasound-guided peripheral IV insertion

ASJC Scopus subject areas

  • Leadership and Management
  • Public Health, Environmental and Occupational Health

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