Peripheral Intravenous Insertion Research Articles

Establishing a plan to improve pediatric patient comfort during PIV insertions and blood specimen collection: a quality improvement effort.

Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (eg peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24 134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Establishing a Plan to Improve Pediatric Patient Comfort during PIV Insertions and Blood Specimen Collection: A Quality Improvement Effort

Highlights Patient comfort during peripheral intravenous (PIV) insertion and specimen collection was increased. The authors extended the contingency plan implemented for PICC insertion to include PIV insertion and specimen collection. The authors met their goals by using quality improvement methodology. Prioritizing patient comfort often requires institutional culture change. Abstract Background: Needle procedures can cause pain and distress, especially in pediatric patients.1 Retrospective data collected at a freestanding pediatric facility revealed that approximately 30% of pediatric patients were not demonstrating sufficient levels of comfort during peripheral intravenous (PIV) catheter insertion and specimen collection (lab draws) even after successful implementation of comfort measures by the vascular access team (VAT) in an adjacent procedure (i.e., peripherally inserted central catheter placement). The current quality improvement project was implemented to support adaptation and expansion of previous lessons learned to PIVs and lab draws specifically. Design and Methods: The VAT used the Pediatric Sedation State Scale,2 a standardized assessment tool integrated into the electronic medical record, to assess procedural comfort during PIVs and lab draws from February 2021 through April 2023. A total of 24,134 patients aged 0 to 18 years were included in the data collection. Interventions were delivered concurrently and included (1) reeducation/ongoing support for implementation of the Comfort Promise3 measures, (2) the creation and implementation of advanced comfort options, and (3) culture change. Aims and Objectives: The goal of the interventions was to improve the percentage of pediatric patients achieving adequate levels of comfort beginning at 68% in year 1 to 90% in year 2. Results: From February 2021 to April 2023, the VAT team was able to improve procedural comfort scores from 68% to 90% of pediatric patients with adequate comfort for lab draws and/or PIV insertions. Conclusions: While standard comfort measures are a good first step in pain management during needle procedures, they are not sufficient for every pediatric patient. Nitrous, sedation, and the use of anxiolytics and analgesics can play an important role in reducing pain and anxiety during needle procedures and should be considered for patients not achieving adequate levels of comfort with standard comfort measures.

Outcomes of a Comprehensive Ultrasound Guided Peripheral IV Insertion (USGPIV) Training Program in a Pediatric Emergency Department

IntroductionTimely and reliable peripheral intravenous cannulation is an imperative skill in a pediatric emergency department. Utilization of point-of-care ultrasound guidance has proven to significantly improve first-attempt peripheral intravenous cannulation insertion rates in pediatric patients. We sought to develop, implement, and evaluate an ultrasound-guided peripheral intravenous training program for emergency nurses in a tertiary care pediatric center. MethodsTwelve emergency nurses underwent a training program that consisted of an interactive asynchronous learning module followed by 8 hours of training by a vascular access clinical instructor. Data was collected on each ultrasound-guided peripheral intravenous insertion via survey methodology. ResultsComplete data for a total of 210 ultrasound-guided peripheral intravenous were recorded over the 9-month period. A total of 65.2% (137/210) of patients who received an ultrasound-guided peripheral intravenous had known difficult intravenous access on history. A total of 89.5% (188/210) of patients had a difficult intravenous access of ≥4. The mean difficult intravenous access score for the patients in which ultrasound-guided peripheral intravenous insertions were attempted was 4.78 (95% confidence interval, 4.55-5.01). A total of 193 of 210 (91.9%) of ultrasound-guided peripheral intravenous were attained successfully. On the first attempt, 86.5% (167/193) ultrasound-guided peripheral intravenous were attained, and 98.96% (191/193) were attained within the first 2 attempts. ConclusionWe found that implementing a comprehensive ultrasound-guided peripheral intravenous training program for emergency nurses in a pediatric tertiary care center led to a high first-pass success rate in attaining peripheral intravenous cannulations. It also facilitates vascular access in patients with known difficult intravenous access. Consideration should be made to implementing point-of-care ultrasound intravenous training programs to improve pediatric vascular access in the emergency department, particularly in patients with known difficult intravenous access.

Content validity and inter-rater reliability of procedural skill checklists used in the online OSCE scoring management system

Introduction: The use of online Objective Structured Clinical Examination (OSCE) scoring system in medical and nursing education is emerging. To ensure valid student’ score, the OSCE check lists need to be assessed for its validity and reliability. This study aims to test the validity and reliability of several procedural check lists commonly used in nursing profession such as peripheral intravenous insertion, electrocardiogram placement, nasogastric tube insertion, urinary catheter insertion and oxygenation procedure. Methods: The expert consensus was used to generate items, content validity index and inter-rater reliability was used to evaluate the validity and reliability of the check lists. Five experts assessed the content validity of the checklists and five raters used the check list to evaluate performance of 11 students. Data were collected from April to May 2022. The panel experts rated the content relevance of each instrument using a four-point rating scale. Item level and scale level content validity index were calculated. Inter-rater reliability was calculated using Fleiss Kappa. Results: The item validity index for the five check lists reviewed showed relatively high content validity among experts. I-CVI for each tool was very good, ranging from 0.8 to 1. The average content agreement (S-CVI/Ave) and the universal agreement (S-CVI/UA) for each check list were also very good. The inter-rater reliability results indicated that the agreement among raters was ranged from moderate to very good/excellent. The lowest Kappa value was for the nasogastric insertion check list (0.40, 95%CI 0.40 – 0.41) and the highest Kappa value was for the oxygenation check list (1, 95% CI 0.99 – 1). Conclusion: The face validity was reported as easy to understand and presented logically. Nonetheless, re-formatting of some items and addition of details in the checklists are needed to avoid ambiguity, which could lead to confusion for the examiner and examinee.

President’S Message

2022…WOW! We have come so far and progressed, or should we say regressed? We were finally able to have an in-person face to face conference (664) with virtual attendance (366) too!!! (Excitement and shouts of joy!!!). We started the conference with a great poem written by my nephew Mikey Stevens, (a vascular need patient): To live is to grow, to grow is to learn.As we grow and learn, we must lead so they know.AVA will grow as members align; together we will say “We can save that line!”We raise our flag on the mountain of knowledge, wage war against naivety so they must acknowledge.Needle or catheter, our practice matters.Preserve the vein, is the name of the game.Some growth to improve and ignorance to be pruned.Our research the shears to stop the assume.AVA’s mission is the vessel that maintains our course.The knowledge we gain, is meant to align.Till we all yell together “We can save that line!”This reminds us, as we progress through our careers, we need to make sure we are addressing the problems AND saving the line/Vein. We all read research, but do we all do our diligence to research what we could do better? The AVA Foundation has implemented a program to enable all clinicians to bring their research to JAVA. If you didn’t reply to the foundations survey, it is not too late to reach out to them to apply for a mentor to guide you through the process to become an author of a journal article in JAVA.Although COVID has changed many of our practices is has also provided focus on some of our long-term issues. AVA has partnered with BBraun to develop a comprehensive eLearning module that provides a certification. This curriculum was developed to elevate the knowledge and skill of learners and is offered FREE to universities and colleges. This means your alma mater could now improve vascular access with your help of instituting the PIV curriculum into their current education.Intravascular Quarterly and JAVA continue to offer our members articles of interest, as well as peer-reviewed articles related to care and management of our patients. CE options are offered in the journal and on our website through webinars with additional learning with our podcast.ACE by AVA was offered at our Scientific Meeting Pre-Conference session, to provide education on Ultrasound Guided Peripheral Intravenous Insertions. This is an eLearning module offered to hospitals and individuals to develop a foundation of knowledge and validation of competency to support the placement of ultrasound-guided PIVs.The Resource Guide that was released in 2021 was updated this year and released during our AVASM 2022, along with our PediNeoSIG who published a digital resource for Insertion, Care and Maintenance of PICCs for our youngest of patients.The Education Department is diligently working on our Clinical Practice Guidelines. These comprehensive guidelines will include Patient Assessment and Device Selection, Pre-insertion, Insertion, Complications Management, Device Maintenance and Removal and Administrative Considerations.As we move to the end of a year and beginning of a new year, we have the opportunity to grow, expand, and mentor. Let’s take the knowledge we learned from the year and years passed, to educate our new nurses and inspire all to Save That Line!!!

Development and Implementation of an Ultrasound-Guided Peripheral Intravenous Catheter Education Program for Critical Care Nurses.

Ultrasound-guided (US-guided) peripheral intravenous (PIV) insertion is a skill used by specially trained nurses for patients with difficult vascular access. It can result in potential complications such as occlusive thrombus, phlebitis, infiltration, and pain. Complications can be prevented or minimized with clinical training to achieve competency. Current research shows that the most effective approach to US-guided PIV training consists of a comprehensive structured educational program that includes didactic, hands-on training and skills application. This study aimed to develop and implement a US-guided PIV education program for critical care nurses. Structured education was developed using a step-wise method. Critical care nurse practitioners in the intensive care unit (ICU) developed training materials including hands-on training, ultrasound reference material, and supervised skills application. Afterward, US-guided PIV-trained critical care nurses were enabled to train other nurses in the ICU. The total number of US-guided PIV-trained registered nurses in the ICU increased from 5.8% to 26% of staff, but represents only 20% of those trained at current staffing levels. The percentage of US-guided PIV-trained nightshift/weekend staff increased from 3.9% to 24%, but represents 14% at current staffing levels. One hundred five US-guided PIVs showed a 97% success rate of US-guided PIV placement during an 11-month timeframe, similar to success rates published in the literature that ranged from 86% to 100%. There was 1.9% complication rate for occlusive thrombus, which is below published rates ranging up to 10%. Critical care nurse practitioners in the ICU collaborated with vascular nursing and hospital clinical education to successfully develop and implement a US-guided PIV training program to meet patient needs within a growing community facility. The results of the training program yielded similar success and complication rates as those reported in the literature. Ongoing training is essential for program sustainability. Critical care nurse practitioners training registered nurses in US-guided PIV placement is an effective approach to training. Critical care nurses trained in US-guided PIV insertion can safely and effectively train other critical care nurses in US-guided PIV insertion.

Swaddling to Overcome the Challenges of Peripheral Venous Access in Infants: A Pilot Study

Peripheral intravenous catheter insertion in children in the emergency room has a number of risks, and these increase while the infusion is given to infants. Health personnel attempt to cope with several difficulties in this situation. This study aimed to describe the difficulty of peripheral intravenous insertion factors as well as the interventions implemented to overcome these challenges. This study used a quantitative design with descriptive analysis. 34 nurses and four midwives participated in this study by filling out a questionnaire. According to the findings, the average respondent had four years of work experience and all respondents had infused infant patients in the emergency room in the previous two months. 44.7% of health workers identified venous characteristics of patients as a challenge and 44.1% identified active children as a challenge. Emergency room personnel use a venous viewer 50% of the time and a swaddle 44.7% of the time to overcome infusion difficulties. Due to the challenges of deep palpable veins and small veins, nurses use a vein viewer, whereas for active babies, nurses use the swaddling method.
 Keywords: difficulty factors of venous insertion, swaddling, infants

Improving Vascular Access Dressing Integrity in the Acute Care Setting: A Quality Improvement Project.

PURPOSE:The purpose of this quality improvement project was to evaluate transparent vascular access dressings and the use of a liquid gum mastic adhesive on improving dressing integrity over peripheral intravenous (PIV) insertion sites without increasing medical adhesive-related skin injuries (MARSIs) such as tears.PARTICIPANTS AND SETTING:A multidisciplinary team consisting of specialists in infection prevention, vascular access, nursing professional development, materials management, and WOC nurses met to review current audit data and available products to trial on 2 intermediate care units in our 2 hospitals in Indiana with a combined average daily unit census of 35 patients.APPROACH:Four dressing protocols—including our existing dressing with education, and an updated dressing with education, and the updated and new dressing, both with education and the addition of a gum mastic adhesive agent—were sequentially implemented by nurses on the units, each over a 2-week period. The goal was for 80% of the dressings to remain with all 4 corners fully intact without reinforcement at day 7, or sooner if PIV was discontinued before day 7. Data were reported as frequencies for intact dressings and skin complications.OUTCOMES:Education combined with the original dressing and the updated dressing did not achieve the goal of 80% fully intact dressings in the samples evaluated. The addition of the adhesive agent to the updated and new dressings with education exceeded the 80% goal. In addition, there were zero exposed PIV insertion sites and no documented MARSI in any of the 4 protocols.IMPLICATIONS FOR PRACTICE:We continued to collect postproject data of 30,049 vascular access sites including central line catheters and observed the same effectiveness of incorporating a gum mastic adhesive on dressing integrity. This practice change has now become standard of care in our institution.

Peripheral intravenous catheters in hospitalized patients: Practice, Dwell times, and factors impacting the dwell times: A single center retrospective study.

Despite being the most common hospital procedure, limited information is available on the peripheral intravenous (PIV) catheter insertion practices. This study was designed to evaluate the contemporary PIV insertion practice (all age groups), and to identify the patient and device-related factors influencing the dwell times (<18 years). Single Center Retrospective study. Patients of all age groups admitted to the hospital for >4 midnights, from 01/2015 to 12/2019. Data extracted by automated EMR audits. Variables included patient demographics, number of PIVs inserted, PIV size, location, dwell time, and length of stay. Standard comparative analysis, including multivariable linear regression for dwell time performed for patients <18 years. A total of 44,198 (39,341 (89%) adults and 4857 (11%) children) PIVs on unique patients met study criteria, with mean duration of 2.8 ± 2.4 days in children and 2.6 ± 1.3 days in adults (p < 0.001). Pediatric PIV had more dwell time variation, with a higher proportion lasting <1-day and also >2 SD of the age-specific mean, compared to adults. Adults had significantly higher number of PIVs placed/week compared to children. The failure rate for PIV was 56% in children and 76% in adults (p < 0.001). 1 out of 5 adults required >5 PIV/admission. Forty-five percent of children requiring only one PIV versus 21.8% of seniors. Discharge department, body part, and PIV size were independently associated with the dwell duration in children. No PIV size, however, had an independent increase in dwell duration over the reference of the 24 Ga cannula in children. PIVs placed in ante cubital vein and upper arm had dwell duration 26% and 20% longer than PIVs placed in the hand. The failure rate of PIV is high, and patients are subjected to multiple insertions during hospitalization. Hospital unit, body part, and PIV size are associated with the dwell duration in children.

Using Ultrasound-guided PIV Insertion in the Pediatric Population to Decrease Insertion Attempts

Intravenous (IV) therapy using a peripheral IV (PIV) in children is a medical intervention frequently used in hospitals. Current evidence supports ultrasound-guided PIV placement in the adult patient population. The purpose of this study was to implement an evidence-based practice approach to determine if ultrasound-guided IV insertion decreased the number of attempts for successful cannulation and improved staff and patient satisfaction with the treatment in the pediatric inpatient population. Data collection was conducted in a pediatric medical surgical unit and pediatric intensive care unit (PICU). After the implementation of ultrasound-guided IV insertion, the average number of attempts necessary for successful insertion decreased from 2 to 1.37. Findings support the integration of ultrasound-guided IV insertion into the standard of care on pediatric medical surgical units and PICUs.

Positive effects of ultrasound-guided peripheral IV insertion on pediatric sickle cell anemia/thalassemia patients receiving automated red cell exchange procedures or chronic transfusion therapy.

Peripheral vascular access and venipuncture are major causes of distress and anxiety for children and their parents. This is especially difficult for patients with hemoglobinopathies (thalassemia major and sickle cell disease) who require chronic blood transfusions. These patients require peripheral venous access for regular blood transfusions and (in the case of sickle cell disease) for automated red cell exchange procedures. Peripheral intravenous (PIV) catheters are much preferred to central venous lines as they carry far fewer risks. However, when patients experience multiple unsuccessful attempts to initiate a PIV, it can be traumatizing and cause anxiety for future visits. Establishing therapeutic trust and ensuring a smooth experience are of paramount importance for these chronic patients who require regular blood transfusions. The purpose of this study was to determine whether ultrasound-guided PIV insertion decreases PIV-associated pain and anxiety, and whether the number of attempts and amount of time spent accessing PIVs in children with difficult peripheral intravenous (DPIV) access is reduced. This was a pilot study with both retrospective and prospective components. Hemoglobinopathies are relatively rare in our population and our study cohort was small (N = 18). We identified four DPIV access patients. We recorded each time these patients had a PIV inserted as an encounter. We found that while there was a small amount of time gained by using ultrasound-guided PIV insertion, patient and parent satisfaction was significantly improved.

Structured Educational Program and Peripheral Intravenous First-Time Insertion Rate in Saudi Arabia

Peripheral intravenous insertion (PIV) is one of the most common clinical procedures which nurses receive little formal training. It is said that more than a quarter of first-time insertion rate (FTIR) fail (Hess 2010), thus, patient experience is at risk if this is not performed by a trained staff. This study aimed to explore if a Structured Educational Program (SEP) was effective to increase a hospital’s FTIR which has a failing international benchmark scores. It used a quasi-experimental design and pre-experimental one-group pretest post-test to examine the pre and post-test data set among 160 respondents. It was found out that the most of respondents are Filipinos in their 30’s who have bachelor’s degree. They have a decade or less of experience; have had no PIV training in their home country; and have less than five daily insertions. It was revealed that the SEP was effective knowledge and skills improvement. Ages, nationality, years of experience, and specialization were found to be related to improve knowledge; while nationality, licensure exam ratings, frequency of PIV insertions, and relevant trainings were associated on an enhanced skill.

Procedural Interventions and Stabilization Times During Interfacility Neonatal Transport

ObjectiveTransport teams perform multiple procedural interventions during the stabilization of critically ill neonates. The setting of this study was a national cohort of interfacility neonatal transports from nontertiary centers. MethodsA retrospective cohort study of neonatal transports having interventional procedures using the Canadian Neonatal Transport Network database during 2014 to 2016. Demographics and procedures associated with stabilization times ≤ 120 versus > 120 minutes were analyzed. Predictors of stabilization time were evaluated using multivariable logistic regression analysis. ResultsAmong 3,350 neonatal transports analyzed, the 3 most frequently performed procedures were peripheral intravenous insertion, arterial blood gas sampling, and endotracheal tube insertion, with success rates of 85.2%, 89.1%, and 95.3%, respectively. The frequency of procedures varied across gestational age subgroups, and success rates were lower for umbilical arterial catheter insertions. After adjustment for confounders, more invasive procedures and a higher number of interventions were associated with longer stabilization times. ConclusionThe type and frequency of procedures performed had a significant impact on stabilization time. Any procedures that are nonessential for stabilization at the nontertiary center, such as umbilical arterial catheter insertion, could be minimized to promote timely admission to tertiary centers. The demonstrated variations in procedural success among teams provide useful information for benchmarking and promote the sharing of training practices.

Utility of the DIVA score for experienced emergency department technicians.

The DIVA score is validated for predicting success of the initial attempt at peripheral intravenous insertion by nurses and physicians. A score of 4 or greater is 50% to 60% likely to have a failed first attempt. The study objective was to assess the validity of this score for emergency department technicians. This study used a prospective convenience sample of 181 children presenting to the emergency department with intravenous access attempt by one of 29 emergency department technicians. DIVA score, total number of attempts, and median time to successful intravenous cannulation were obtained. Comparing patients with a DIVA score <4 to ≥4, first-time IV placement failure rates were lower (9% [95% CI, 3-24] vs. 41% [95% CI, 33-49]) and median time to IV placement was shorter (75 [interquartile range (IQR) 42-157] vs. 254 [IQR 91-806]) seconds. In patients with scores ≥4, emergency department technicians with ≥5 years of experience were significantly more likely to be successful on the first attempt (OR 2.8; 95% CI, 1.03-7.63). For every year of technician experience, the time to catheter placement, adjusted for DIVA score, decreased by 25 minutes (P≤0.05, R2=0.05). Comparing our receiver operating curve to the derivation study, the areas were similar (0.67 vs. 0.65). This study provides preliminary evidence for the validity of the DIVA score when applied to IVs placed by emergency department technicians. For patients with high DIVA scores, ≥5 years of IV experience was associated with higher odds of successful first-time IV placement and shorter time to placement. HIGHLIGHTS The difficult intravenous access (DIVA) score may be generalizable to IVs placed by experienced emergency department technicians (EDTs) Higher odds of first-time success in difficult patients with ≥5 years EDT experience Early identification of difficult access may allow for aid of alternative technology Likely first study to evaluate EDTs IV skills in patients with varying DIVA scores.

Psychometric testing of a checklist for procedural training of peripheral intravenous insertion

BackgroundNurses, medical technologists, nuclear medicine technologists, pre-hospital providers, and medical students are a few groups of healthcare learners asked to learn intravenous (IV) cannulation in their training (J Surg Educ. 69:536–43, 2012). Despite the fact that IV cannulation has been taught to several health professions, it is difficult to find a psychometrically validated checklist to guide teaching this skill in the simulated procedural training (Pediatrics 124: 610-9, 2009, J Assoc Vasc Access 21: 196-204, 2016). In the absence of a pragmatic, valid checklist for the initial teaching of peripheral IV skills in the simulation procedural skills lab, this investigation sought to describe the process and create a psychometrically valid checklist.MethodsExpert raters used Lawshe’s method for identifying valid items from the universe of items for IV insertion. Gwet’s AC2 and generalizability (G) theory was used assess inter-rater reliability.ResultsThe literature and in-house IV checklists were examined for steps to inserting a peripheral IV, and the steps were compiled into a survey and sent to experts who rated each item. Of the 37 potential steps, 16 steps were identified as being psychometrically valid. The checklist content validity index was .82. Inter-rater reliability was .94 (95% CI .91–.98). Good inter-rater reliability was confirmed using generalizability theory.ConclusionsThis study created and provided evidence of content validity and reliability for this checklist using Lawshe’s methodology. As such, this method of evaluating a checklist for validity and reliability evidence can be followed for other healthcare checklists. This checklist can be used for teaching IV placement in healthcare students in the simulation procedural training lab.

Pediatric Vascular Access Peripheral IV Algorithm Success Rate

PurposeDetermine if the pediatric peripheral vascular access algorithm (PPVAA) led to differences in first-attempt and overall peripheral intravenous (PIV) success, staff attempting PIV access per episode and overall attempts and first PIV attempt success by provider. Design/MethodsA two-cohort pre-/post-implementation comparative design involved pediatric nurses and patients. The PPVAA included four components: a patient comfort plan, PIV grading score, nurses' self-assessed IV access capability and nurse decision to stop-the-line. Two sample t-test or Wilcoxon rank sum test and Pearson's chi-square test were used to evaluate differences between groups and measures. ResultsHealthcare providers (N=96) attempted 721 PIV insertions (pre-PPVAA, n=419 and post-PPVAA, n=302). Of 78 nurse providers, mean (SD) age was 37.4 (11.0) years and 20.0% self-assessed PIV capability as expert. Of children, mean age was 8.3 (7.0) years. Post-PPVAA, first-attempt (p=0.86) and overall (p=0.21) success did not change, though fewer staff were needed per episode to initiate PIV; p=0.017. Overall rate of success after one attempt in the post-PPVAA period compared to pre-PPVAA was reduced (p=0.002), reflecting greater awareness to stop-the-line. Compared to pre-PPVAA, advanced practice nurses and non-clinician providers were more likely to achieve success on first attempt. ConclusionsThe PPVAA did not increase first-attempt or overall PIV success; however, it decreased overall IV attempts and the number of staff attempting access per episode. Practice ImplicationsThe multi-component PPVAA provided a guide for nurses during PIV and assisted decision making to stop attempts in difficult cases.

A Randomized, Double-Blind Trial to Determine if Vapocoolant in the Adult Population Improves Patient Perception of Pain With Peripheral Intravascular Access.

The purpose of this study was to investigate whether the use of a topical anesthetic spray (vapocoolant) at the site of intravenous access reduces pain and anxiety associated with peripheral intravenous (PIV) catheter insertion in an adult emergency department population. A randomized, double-blind, placebo-controlled, single-center trial, conducted from July to August, in an adult emergency department where 72 patients with orders for PIV insertion receiving either topical vapocoolant spray (n = 38) or placebo spray (n = 34). Vapocoolant or placebo was applied to the intravenous site and allowed to evaporate before cleansing and insertion. The primary outcome was patient perception of pain and anxiety with PIV needle insertion using a 0-10 Likert scale. Secondary outcomes included patient/staff preference or desire for vapocoolant/placebo use in future procedures and staff perception of patient pain and anxiety. Patient groups did not vary significantly in the history of intravenous access, nor anxiety preprocedure, and the sprays did not affect ability to obtain intravenous access. Patient perception of pain did not vary significantly between vapocoolant (2) and placebo populations (2.5), nor did the scores vary significantly for patient-forecasted anxiety in future procedures using the same methods (0.5 for vapocoolant, 0 for placebo; p > 0.05). Eighty-nine percent of nurses and patients would use vapocoolant in future procedures, whereas 74% would use placebo; the difference was not significant (p > 0.05). No skin blanching or lesions were noted. Among adult patients in the Parkland Emergency Department receiving PIV access, no significant differences in pain relief or alleviation of anxiety were found between treatment using a topical anesthetic spray or placebo.

Does Test-enhanced Learning Improve Success Rates of Ultrasound-guided Peripheral Intravenous Insertion? A Randomized Controlled Trial.

Teaching procedural skills in medicine is time- and resource-intensive, and it is therefore important to determine which educational strategies are most effective. Test-enhanced learning (TEL) has been demonstrated to be effective in improving learner retention; however, there is little research evaluating the testing effect on the acquisition of procedural skills in medicine. The objective of this study was to examine the impact of TEL on learning ultrasound-guided intravenous (USG IV) insertion on a simulated model. We conducted a prospective randomized controlled trial of medical students at a single tertiary care academic hospital. Participants were randomized to either the TEL group (TEG) or control group (CG). Each group received an USG peripheral IV teaching session that included a didactic portion and hands-on skills training. The training sessions were identical except that the TEG was informed at the outset that there would be an assessment at the end of the session. The TEG then received a formal assessment of the skill during the last 15 minutes of the session, whereas the CG had continued practice time. Subjects in both groups were evaluated 10-14 days later to compare skill performance using a simulation-based assessment tool consisting of a global rating scale (GRS) and checklist items. Thirty medical students completed the study, 15 in the TEG and 15 in the CG. There were no significant differences between the two groups at baseline based on year of medical training or prior IV or ultrasound experience. The overall procedural success rate was 93.3% (95% CI= 79.0%-100.0%) in the TEG and 80.0% (95% CI= 57.1%-100%) in the CG (p=0.60). The first-attempt failure rate was 13.3% (95% CI= 0.0%-32.8%) in the TEG and 33.3% (95% CI= 6.3%-60.4%) in the CG (p=0.39). There were no statistically significant differences between the means of the GRS (TEG=4.7, CG=4.2; p=0.53, r=0.11) or checklist scores (TEG=78.6%, CG=75.3%; p=0.20, r=0.24). In this study of novice learners, both TEL with structured practice and structured practice alone lead to high success rates performing USG IV insertion on a simulated model. While we noted a trend toward higher procedural success rates and lower first-attempt failure rates in the TEG, these did not meet statistical significance. Further studies with larger sample sizes are required to determine whether the beneficial effects of TEL can be transferred to procedural skills teaching.

Factors affecting Intravenous Infiltration among Hospitalized Children

Peripheral intravenous (PIV) insertion is one of the most common procedures undertaken for pediatric patients requiring short-term infusion therapy. Infiltration, which considered one of the most common complications of PIV insertion, may cause discomfort, pain, inconvenience or delay in treatment due to reinsertion of the IV catheter, or more serious negative consequences, such as tissue ulceration or necrosis. Such complications have not only increased the length of hospital stay and care costs for additional treatments, but also resulted in permanent damage and limitations of physical functions in pediatric patients. Nurses working at the children’ hospitals should consider the risk of IV infiltration for children receiving intravenous infusion therapy and make efforts to identify IV infiltration in high-risk children at an early stage to prevent damage. Therefore, this study aimed, firstly, to investigate the risk factors for intravenous infiltration among hospitalized children and, secondly, to develop clinical guidelines for nurses for early recognition, prevention and management of intravenous infiltration. A descriptive correlative research design was used. The study was conducted at pediatric inpatient medical and surgical wards of Children's University Hospital in Mansoura city, Egypt. The participants werehospitalized children (253) from less than one year to 16 years who received peripheral IV insertions.Interview questionnaire sheet was developed by the researcher to collect relevant data. The results indicated that the infiltration rate was 23.3% and it was from stage 1 and 2. Conclusion: the most important risk factors for infiltration were the child weight, previous experiences of insertion of peripheral catheter, dwell time, site of insertion, catheter size, repeated insertion on the same site, infusion of antibiotics and IV fluids. Recommendation:in future studies, it would be important to account for nurse-associated factors in the study design, including, educational status, experience of the nurses, the nurses' potential preference for a particular insertion site or method and catheter insertion skills.

The Application and Effect of the Nursing Protocol of Pediatric Peripheral Intravenous Infusion

Purpose: The aim of this study was to compare the effect of training and implementation of a pediatric peripheral intravenous infusion protocol on the nurses’ performance and infusion complication rate. Methods: A quasi-experimental study using a posttest comparison of a one group pretest-time series design was utilized. This method was developed to measure nursing knowledge and performance based on a pediatric peripheral intravenous infusion protocol. To calculate the occurrence rate of complications, the number of complications were divided into the number of intravenous insertions. Results: It was shown that the training developed by the study team in 2015 contributed to nurses’ increased knowledge, as well as improved job performance. Furthermore, the implementation of the protocol revealed that the number of peripheral intravenous insertions, an invasive procedure, decreased. Additionally, the nursing workload related to pediatric intravenous infusions was reduced. Conclusion: This protocol may contribute to the improved scientific quality and efficiency of nursing management of peripheral intravenous infusions.