Ultrasound-guided Intravenous Catheter Insertion Research Articles

Use of an ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum to improve paediatric anaesthesia care.

We previously showed that an ultrasound-guided i.v. catheter insertion (USGIV) simulation-based mastery learning (SBML) curriculum improves the simulated USGIV skills of paediatric anaesthesiologists. It remains unclear if improvements in simulated USGIV skills translate to improved patient care. A cohort study was conducted from August 2018 to August 2020 to evaluate paediatric anaesthesiologists' USGIV performance in the operating theatre before and after they participated in the USGIV SBML curriculum. Paediatric anaesthesiologists' use of ultrasound for successful i.v. insertion and first-attempt i.v. insertion success rate with ultrasound were compared before and after training. Twenty-nine paediatric anaesthesiologists completed training. Unadjusted analysis showed a significant increase in the percentage of i.v. catheters inserted with ultrasound for successful i.v. catheter insertion (9.5-14.5%; P<0.001) and first i.v. catheter insertion attempt success with ultrasound (5.5-8.9%; P<0.001) from before to after training. Multivariable regression analysis showed higher odds of ultrasound use for a successful i.v. catheter attempt (1.79; 95% confidence interval [CI]: 1.11-2.90; P=0.018) and first-attempt success with ultrasound (4.11; 95% CI: 2.02-8.37; P<0.001) after training. After completing the USGIV SBML curriculum, paediatric anaesthesiologists increased their ultrasound use for successful i.v. catheter insertion and first-attempt success rate with ultrasound for patients in the operating theatre.

Training Program for Ultrasound-Guided Intravenous Catheter Insertion.

Ultrasound guidance is now widely available in military treatment facilities and civilian hospitals alike, both in the USA and in forward-deployed military environments. Technical mastery of ultrasound-guided peripheral intravenous (USGPIV) catheter insertion can be easily achieved through a short training course. Mastery can be achieved even when trainees have a limited medical background before course attendance. An evidence-based practice project team sought to improve the knowledge, confidence, and skills in the placement of USGPIV catheters by clinicians at Naval Hospital Jacksonville. Completion of an USGPIV training program can equip healthcare providers with knowledge and confidence for placement of peripheral access necessary in critical situations such as those requiring medications or blood products. The project team conducted a literature review to evaluate the appropriateness of USGPIV training for the nurses and military medical technicians in this setting. The team developed and delivered a USGPIV training program based on adaptations from the literature. During the training period, knowledge and confidence scores were reported by each trainee to evaluate the perceptions of the quality of training. The number of attempted catheter placements and ultrasound utilization was recorded in the pre- and post-implementation periods to evaluate the project's effect on the delivery of patient care. Statistical analysis was conducted to evaluate project outcomes. In the pre-intervention period, none of the 252 intravenous catheters were placed with the USGPIV technique, compared to 50 of 267 in the post-intervention period. These results demonstrate an 18.7% increase in the USGPIV access approach by nursing staff. Mean knowledge scores significantly increased following the delivery of the training, 60% versus 80% in the pre- and post-training assessments, respectively (P < .001). Mean self-reported skill confidence scores also significantly improved (P < .001). Knowledge and self-reported confidence in USGPIV access improved for the trainees. Mean knowledge improved from 60% to 80%, while mean confidence scores increased from 2.74 to 3.79 for corpsman and from 3.0 to 3.88 for nurses. Utilization of the USGPIV technique increased by 18.7% in the post-intervention period. These results demonstrate that implementing this training program can improve knowledge, confidence, and use of ultrasound during the placement of PIV catheters.

Use of a simulation-based mastery learning curriculum to improve ultrasound-guided vascular access skills of pediatric anesthesiologists.

Pediatric vascular access is inherently challenging due to the small caliber of children's vessels. Ultrasound-guided intravenous catheter insertion has been shown to increase success rates and decrease time to cannulation in patients with difficult intravenous access. Although proficiency in ultrasound-guided intravenous catheter insertion is a critical skill in pediatric anesthesia, there are no published competency-based training curricula. The objective of this study was to evaluate the performance of pediatric anesthesiologists who participated in a novel ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum. Pediatric anesthesia attendings, fellows, and rotating residents participated in the ultrasound-guided intravenous catheter insertion simulation-based mastery learning curriculum from August 2019 to February 2020. The 2-hour curriculum consisted of participants first undergoing a simulated skills pretest followed by watching a video on ultrasound-guided intravenous catheter insertion and deliberate practice on a simulator. Subsequently, all participants took a post-test and were required to meet or exceed a minimum passing standard. Those who were unable to meet the minimum passing standard participated in further practice until they could be retested and met this standard. We compared pre to post-test ultrasound-guided intravenous catheter insertion skills and self-confidence before and after participation in the curriculum. Twenty-six pediatric anesthesia attendings, 12 fellows, and 38 residents participated in the curriculum. At pretest, 16/76 (21%) participants were able to meet or exceed the minimum passing standard. The median score on the pretest was 21/25 skills checklist items correct and improved to 24/25 at post-test (95% CI 3.0-4.0, P<.01). Self-confidence significantly improved after the course from an average of 3.2 before the course to a postcourse score of 3.9 (95% CI 0.5-0.9, P<.01; 1=Not all confident, 5=Very confident). Simulation-based mastery learning significantly improved anesthesiologists' ultrasound-guided intravenous catheter insertion performance in a simulated setting.

Ultrasound Guidance for Peripheral Venous Access

Asheville Surgery Center, Asheville, North Carolina. stonemd@charter.netThank you for your interest in ultrasound-guided peripheral venous access. My intent in reporting this series1was to demonstrate to anesthesiologists that ultrasound-guided peripheral venous access using a simplified Seldinger technique has a good success rate and is not time-consuming. The simplified Seldinger approach facilitates the use of the longer catheters that the deeper veins may require but does not require the gown, large drape, and extra table required by a standard Seldinger technique.I agree that defining difficult venous access is subjective. Costantino et al. 2defined difficult intravenous access as failure with at least three attempts. His study of emergency department patients with difficult intravenous access demonstrated that ultrasound-guided intravenous catheter insertion (when compared with further standard approach) increased success rates, required less time, and increased patient satisfaction. I find, in most cases, when the surface veins are difficult to see and feel, the deeper veins of the antecubital fossa and upper arm remain large and easy to cannulate with ultrasound guidance. Even in patients with a history of intravenous drug abuse, the basilic vein is usually accessible and is not thrombosed. I believe the success I demonstrated was not exaggerated by the use of a more liberal definition of difficult intravenous access.I can further define the cost of ultrasound-guided peripheral venous access using a simplified Seldinger technique. The technique requires the 20-gauge, 10.8-cm arterial catheterization set (FA-0420; Arrow International, Reading, PA) costing $11.24 and the occlusive dressing to cover the ultrasound probe (Tegaderm 10 × 12 cm; 3M, St. Paul, MN) costing $0.71. The cost of the ultrasound gel is negligible. The ultrasound unit was purchased previously for regional anesthesia and therefore did not add to the cost of the procedure. Our standard safety intravenous catheter (ProtectIV Plus-W 20-gauge 1¼-inch; Medex Inc., Carlsbad, CA) costs $1.77. The added cost of the ultrasound-guided technique is therefore $10.38. One must weigh this cost against the cost of continuing a standard approach: additional intravenous catheters, increased time to cannulation, and increased patient discomfort. Different practitioners will likely have different thresholds for changing to an alternative insertion site (leg, external jugular, central vein) or technique (ultrasound) based on the specifics of the patient and the type of surgery.I agree that assistance may be hard to find in a busy ambulatory surgery center. I have been able to perform the procedure alone in many cases. If the needle tip is well visualized in a vein, one can drop the ultrasound probe to advance the integral wire. If the wire advances easily, it is likely in the vein, and the catheter should advance easily. If the wire does not advance easily, the ultrasound should be used again to place the needle tip into the vein.I believe the ultrasound-guided technique has been demonstrated by others to improve success rates in patients with difficult intravenous access. I believe the simplified Seldinger technique I describe facilitates cannulation of the deeper veins at a relatively low cost, in a time-efficient manner and usually by a single practitioner.Asheville Surgery Center, Asheville, North Carolina. stonemd@charter.net