The learning curve for ultrasound-guided peripheral intravenous cannulation in adults: a multicenter study.

Abstract

To lower the threshold for applying ultrasound (US) guidance during peripheral intravenous cannulation, nurses need to be trained and gain experience in using this technique. The primary outcome was to quantify the number of procedures novices require to perform before competency in US-guided peripheral intravenous cannulation was achieved. A multicenter prospective observational study, divided into two phases after a theoretical training session: a hands-on training session and a supervised life-case training session. The number of US-guided peripheral intravenous cannulations a participant needed to perform in the life-case setting to become competent was the outcome of interest. Cusum analysis was used to determine the learning curve of each individual participant. Forty-nine practitioners participated and performed 1855 procedures. First attempt cannulation success was 73% during the first procedure, but increased to 98% on the fortieth attempt (p<0.001). The overall first attempt success rate during this study was 93%. The cusum learning curve for each practitioner showed that a mean number of 34 procedures was required to achieve competency. Time needed to perform a procedure successfully decreased when more experience was achieved by the practitioner, from 14±3 minutes on first proce-dure to 3±1 minutes during the fortieth procedure (p<0.001). Competency in US-guided peripheral intravenous cannulation can be gained after following a fixed educational curriculum, resulting in an increased first attempt cannulation success as the number of performed procedures increased.