Ultrasound-guided IV Insertion in the Emergency Department

Background: Intravenous (IV) access is a critical component of patient care in the emergency department as it facilitates the diagnosis and treatment of many conditions. Delays in diagnosis and treatment due to difficult IV access can be fatal, particularly in myocardial infarction, stroke, trauma, and sepsis. Ultra-sound guided IV access bridges the practice gap between traditional IV access and central venous access for patients with difficult IV access. Purpose: Implement an evidence based difficult IV access practice guideline and ultrasound-guided IV (USGIV) training program in the emergency department to reduce the time to IV placement and allow for improved timeliness of diagnosis and treatment. Methods: Pre-intervention data (gender, age, number of traditional IV attempts and time to IV establishment) was obtained on 50 difficult to access patients in the emergency department. An evidence based practice guideline and USGIV training program, modeled after that of Laksonen and Gasiewicz, (2015), were then implemented for nurses and emergency medical technicians (EMTs) in the emergency department. The training program consisted of an online module, a hands-on training session with practice guideline instruction, competency demonstrations with a proctor, and a post training survey. Post-intervention data was then collected, with the addition of the number of USGIV attempts, on 50 difficult IV access patients. A comparative analysis of pre- and post-intervention data was performed using descriptive statistics. Results: The training program was provided to 24 registered nurses and five EMTs. A paired two- sample t-test showed a significant increase in participant knowledge from an average pre-test score of 53.4% to a post-test score of 95.4% (p<0.001). An independent t-test showed significant decreases in the average time to IV access (20.5 minutes to 12 minutes, p<0.004), and number of IV attempts (3.06 to 2.22, p<0.001). Ninety-eight percent of IV's placed using the USGIV technique were obtained by the second attempt. Conclusion: The USGIV training program resulted in a significant reduction in the time to IV placement and number of IV attempts, which allowed for improved timeliness of diagnosis and treatment in the emergency department. The program was cost effective and replication would be useful in small community and rural emergency departments that lack access to IV and peripherally inserted central catheter (PICC) line teams, and in an academic setting for nursing students. Future studies should include patient satisfaction scores as a component of measuring program success, and evaluate for changes in length of stay in the emergency department as a result of the practice guideline and training program.