{"title":"Quality Improvement: Using Ultrasound-Guided Cannulation for Difficult IV Access in Medical-Surgical Patients: A Quality Improvement Project.","authors":"Odaro Owen, David C Mulkey, Aldrin Nieves","doi":"10.1097/AJN.0000000000000016","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA.</p><p><strong>Purpose: </strong>The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center.</p><p><strong>Methods: </strong>The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record.</p><p><strong>Results: </strong>A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate.</p><p><strong>Conclusion: </strong>Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA.</p>","PeriodicalId":7622,"journal":{"name":"American Journal of Nursing","volume":"125 2","pages":"30-35"},"PeriodicalIF":2.5000,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"American Journal of Nursing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/AJN.0000000000000016","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/23 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"NURSING","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Based on a chart review of 164 patients admitted to our medical-surgical unit over 2 months and who underwent peripheral intravenous (PIV) cannula insertion, difficult intravenous access (DIVA) was found in 35% (57) of patients. Similarly, the first-attempt PIV cannula insertion failure rate was 43% (70 of 164 patients) when nurses used the traditional landmark method of visual inspection and palpation in patients with DIVA.
Purpose: The purpose of this evidence-based quality improvement (QI) project was to determine if the use of ultrasound-guided peripheral intravenous (USGPIV) cannulation would impact the rate of first-attempt PIV access among acute care adult patients with DIVA in the medical-surgical unit of an urban level 1 trauma center.
Methods: The timeline for this pilot project was 8 weeks (May 25, 2023, to July 20, 2023). The DIVA Clinical Predictor Tool was used to identify patients at risk for DIVA. Nurses used USGPIV cannulation on eligible patients. Data on first-attempt PIV access were collected from the electronic health record.
Results: A total of 46 patients (14 in the comparison group and 32 in the implementation group) participated in the project. Results showed a statistically significant improvement in first-attempt success rates from 64.3% (9 out of 14 participants) in the comparison group to 87.5% (28 out of 32 participants) in the implementation group; χ2 (1 df) = 3.34, P = 0.048. This represents a 23.2% improvement in the first-attempt success rate.
Conclusion: Based on these results, USGPIV cannulation improves the likelihood of first-attempt insertion success in patients with DIVA.
期刊介绍：
The American Journal of Nursing is the oldest and most honored broad-based nursing journal in the world. Peer reviewed and evidence-based, it is considered the profession’s premier journal. AJN adheres to journalistic standards that require transparency of real and potential conflicts of interests that authors,editors and reviewers may have. It follows publishing standards set by the International Committee of Medical Journal Editors (ICMJE; www.icmje.org), the World Association of Medical Editors (WAME; www.wame.org), and the Committee on Publication Ethics (COPE; http://publicationethics.org/).
AJN welcomes submissions of evidence-based clinical application papers and descriptions of best clinical practices, original research and QI reports, case studies, narratives, commentaries, and other manuscripts on a variety of clinical and professional topics. The journal also welcomes submissions for its various departments and columns, including artwork and poetry that is relevant to nursing or health care. Guidelines on writing for specific departments—Art of Nursing, Viewpoint, Policy and Politics, and Reflections—are available at http://AJN.edmgr.com.
AJN''s mission is to promote excellence in nursing and health care through the dissemination of evidence-based, peer-reviewed clinical information and original research, discussion of relevant and controversial professional issues, adherence to the standards of journalistic integrity and excellence, and promotion of nursing perspectives to the health care community and the public.
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