6.00
Hdl Handle:
http://hdl.handle.net/10755/162422
Type:
Presentation
Title:
"Decreasing Cannulation IV Time for Difficult Access via Ultrasound"
Abstract:
"Decreasing Cannulation IV Time for Difficult Access via Ultrasound"
Conference Sponsor:Emergency Nurses Association
Conference Year:2011
Author:Booth, Phil, RN, MSN, CEN, MICN
P.I. Institution Name:Cedars-Sinai Medical Center
Title:Clinical Nurse IV Clinical Educator
Contact Address:8700 Beverly Blvd., Los Angeles, CA, 90048, USA
Contact Telephone:310-423-8774
Co-Authors:EunJoo An, RN, BSN, CEN
[ENA Leadership Conference] Evidence-based Practice Presentation: "Decreasing Cannulation IV Time for Difficult Access via Ultrasound"

Purpose: Emergency room nurses encounter many patients who require IV intervention whose underlying conditions make for difficult and/or delayed access using traditional methods. The purpose of this research project is to determine if the use of ultrasound decreases the time for successful IV cannulations.

Design: This performance improvement project was designed to utilize ultrasound guided IVs as an alternative to the traditional method of starting IVs by use of palpation and sight. A 4 hour class was held in the use of ultrasound. The 4 hour class included a lecture component, a hand on demonstration, and practice on a Blue Phantom practice arm with simulated peripheral and deep veins.

Setting: A Los Angeles based level 1 trauma center having approximately 80,000 patient visits each year, with an average stay time of 4 hours per visit.

Participants/Subjects: Patients with chronic conditions, peripheral obesity, IV drug abusers, and those with unusual landmarks are considered "difficult sticks." Most often these patients go through painful multiple unsuccessful attempts at phlebotomy. 17 Register Nurses self-selected into this performance improvement project. After the 4 hour training, each RN completed 3 successful IVs starts before being considered independent. The first 3 attempts were monitored and coached by pre-selected proctors who included Nurse Educators and Emergency Room Doctors. Once the nurse identified a "difficult stick," the same nurse explained the alternative method and received verbal consent from the patient before attempting IV insertion via ultrasound.

Methods: Prior to staff training in this project, 11 patients were identified as "difficult sticks." Using conventional techniques, peripheral IVs were started in 10 of the 11 patients at which the mean start time was measured.
Post staff training, 19 patients were identified as "difficult sticks" in which RNs were unable to find a peripheral vein using conventional techniques or had at least 2 unsuccessful attempts. Mean start time was measured for this group as well
.
Results/Outcomes: In the conventional IV Group the mean time to IV cannulation was 48 minutes and the median time was 45 minutes. In the ultrasound guided IV Group, the mean time to IV cannulation was 12.3 minutes and median time was 14 minutes. An equal variance t test revealed a statistically reliable difference between the mean time of IV starts using traditional methods (M=35.75, s=5.119) and ultrasound guided venipuncture (M=35.75, s=4.912), t(19)=6.982, p =.000, alpha = .05.

Implications: Ultrasound-guided vascular access demonstrates significant paired t-test results in reducing the number of venipuncture attempts and shortening the intervention time to a functional peripheral IV access. The success of this performance improvement project resulted in increasing the number of core nurses trained in this procedure, further study in using a longer angiocath for deeper veins, broadening the training to other departments including phlebotomy, and conducting research on nursing satisfaction related to this approach.

Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.title"Decreasing Cannulation IV Time for Difficult Access via Ultrasound"en_GB
dc.identifier.urihttp://hdl.handle.net/10755/162422-
dc.description.abstract<table><tr><td colspan="2" class="item-title">&quot;Decreasing Cannulation IV Time for Difficult Access via Ultrasound&quot;</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2011</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Booth, Phil, RN, MSN, CEN, MICN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cedars-Sinai Medical Center</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse IV Clinical Educator</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">8700 Beverly Blvd., Los Angeles, CA, 90048, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">310-423-8774</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">phil.booth@cshs.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">EunJoo An, RN, BSN, CEN</td></tr><tr><td colspan="2" class="item-abstract">[ENA Leadership Conference] Evidence-based Practice Presentation: &quot;Decreasing Cannulation IV Time for Difficult Access via Ultrasound&quot;<br/><br/>Purpose: Emergency room nurses encounter many patients who require IV intervention whose underlying conditions make for difficult and/or delayed access using traditional methods. The purpose of this research project is to determine if the use of ultrasound decreases the time for successful IV cannulations. <br/><br/>Design: This performance improvement project was designed to utilize ultrasound guided IVs as an alternative to the traditional method of starting IVs by use of palpation and sight. A 4 hour class was held in the use of ultrasound. The 4 hour class included a lecture component, a hand on demonstration, and practice on a Blue Phantom practice arm with simulated peripheral and deep veins. <br/><br/>Setting: A Los Angeles based level 1 trauma center having approximately 80,000 patient visits each year, with an average stay time of 4 hours per visit. <br/><br/>Participants/Subjects: Patients with chronic conditions, peripheral obesity, IV drug abusers, and those with unusual landmarks are considered &quot;difficult sticks.&quot; Most often these patients go through painful multiple unsuccessful attempts at phlebotomy. 17 Register Nurses self-selected into this performance improvement project. After the 4 hour training, each RN completed 3 successful IVs starts before being considered independent. The first 3 attempts were monitored and coached by pre-selected proctors who included Nurse Educators and Emergency Room Doctors. Once the nurse identified a &quot;difficult stick,&quot; the same nurse explained the alternative method and received verbal consent from the patient before attempting IV insertion via ultrasound. <br/><br/>Methods: Prior to staff training in this project, 11 patients were identified as &quot;difficult sticks.&quot; Using conventional techniques, peripheral IVs were started in 10 of the 11 patients at which the mean start time was measured.<br/>Post staff training, 19 patients were identified as &quot;difficult sticks&quot; in which RNs were unable to find a peripheral vein using conventional techniques or had at least 2 unsuccessful attempts. Mean start time was measured for this group as well<br/>. <br/>Results/Outcomes: In the conventional IV Group the mean time to IV cannulation was 48 minutes and the median time was 45 minutes. In the ultrasound guided IV Group, the mean time to IV cannulation was 12.3 minutes and median time was 14 minutes. An equal variance t test revealed a statistically reliable difference between the mean time of IV starts using traditional methods (M=35.75, s=5.119) and ultrasound guided venipuncture (M=35.75, s=4.912), t(19)=6.982, p =.000, alpha = .05.<br/><br/>Implications: Ultrasound-guided vascular access demonstrates significant paired t-test results in reducing the number of venipuncture attempts and shortening the intervention time to a functional peripheral IV access. The success of this performance improvement project resulted in increasing the number of core nurses trained in this procedure, further study in using a longer angiocath for deeper veins, broadening the training to other departments including phlebotomy, and conducting research on nursing satisfaction related to this approach. <br/><br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:57Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:57Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
All Items in this repository are protected by copyright, with all rights reserved, unless otherwise indicated.