Implementation of Ultrasound Use for Vascular Access in the Newborn ICU

Background: Peripheral intravascular access (PIV) is one of the most common procedures in the Newborn Intensive Care Unit (NICU). However, it is common for neonates to undergo multiple attempts before successful PIV placement can be achieved. Ultrasound-Guided intravenous placement (USG-IV) has been shown to reduce pokes, increase the success rate, reduce complications, and shorten procedural times. Despite these benefits, the technology is not widely utilized in the NICU setting, in part, due to lack of training. The objective of this project was to implement a USG-IV training program in the NICU to expand the clinical usage of such technology. Methods: A quality improvement project was developed and implemented to train nurses from 3 different NICUs in Salt Lake and Davis counties to use USG for PIV placement in a three-phase training program. System Usability Surveys (SUS) were completed before and after training to measure the perceived usability of the technology and identify implementation barriers. Results: Six nurses were trained and completed the SUS. The mean usability scores increased from 55 (low marginal acceptable) before training to 68 (high marginal acceptable) after training. The positive attitude towards USG-IV was not sustainable, as the SUS decreased to 61 after one month. After training, nurses tended to agree more that they wanted to use ultrasound frequently, that it was easy to use, and that the various functions were well integrated. After training, nurses tended to disagree that the system was unnecessarily complex, that they would need the support of a technical person, that there was too much inconsistency in the system, and that the system was cumbersome. However, one-month follow-up surveys showed that scores tended to more closely resemble pre-training values, except for ease of use which fell below pre-training scores. USG-IV training is a time-consuming and labor-intensive process that requires PIV insertion opportunities and mentor support for mastery of the skill. Other implementation barriers included nurses' clinical experience, the size of the patient's vein, ultrasound equipment availability, and administrative system support. Conclusions: This quality improvement project offered an initial training pathway for NICU nurses to perform USG-IV. Although only a limited number of nurses were trained, they would continue foster, develop, and pass on their knowledge to others in their respective units; thus, the USG-IV program is anticipated to expand in times. While the perception of ultrasound as a tool to assist with vascular access improved after training, continued time and practice are needed for mastering the skill. Future projects should include ways to address implementation barriers and post-training USG-IV usage data.