2.50
Hdl Handle:
http://hdl.handle.net/10755/162553
Type:
Presentation
Title:
Ultrasound-Guided Venous Cannulation by the Emergency Nurse
Abstract:
Ultrasound-Guided Venous Cannulation by the Emergency Nurse
Conference Sponsor:Emergency Nurses Association
Conference Year:2009
Author:White, Ann, RN, MSN, CCNS, CEN
P.I. Institution Name:Duke University Hospital
Title:Emergency Services Clinical Nurse Specialist, Clinical Associate Faculty
Contact Address:7304 Pulley Town Road, Wake Forest, NC, 27587, USA
Contact Telephone:919-681-0352
Co-Authors:Phillip Stone, RN; Fernando Lopez, MD
[Annual Conference] Clinical topic: Even the most experienced emergency nurse has difficulty in obtaining intravenous (IV) access in patients with conditions like obesity, chronic illness, hypovolemia, intravenous drug abuse, vasculopathy and others. These patients lack easy access to peripheral venous sites using the traditional anatomic landmark and palpation methods of venous cannulation. While these patients require timely peripheral venous access, their condition may not be so acute as to require emergent central venous or intraosseous access, invasive techniques not without risks. An evolving option for the emergency nurse is to gain venous access under ultrasound (US) guidance. The benefits of using this technique are multiple; decreasing patient throughput due to less time spent in obtaining venous access, cost reduction, decreasing complications of traditional insertion which include pain, arterial puncture, nerve damage, and paresthesias. Other added benefits are increased patient and emergency medicine physician satisfaction and increased emergency nurse autonomy. The use of US is advantageous due to its lack of biological effects and it provides real-time images. Venous access with US is a relatively new skill for the emergency nurse. The literature provides varied information about formal research findings and clinical experience. Only two observational, descriptive studies exist about the EN experience and both are from the same healthcare institution.

Implementation: After consulting the state nursing practice act and securing support from the ED and organizational leadership, a training program was developed to help the emergency nurse become proficient in US-guided venous cannulation. Organizational experts who assisted with the training included an Ultrasound Fellowship trained Emergency Medicine Physician, clinicians from the IV Therapy Department who use bedside US for peripherally inserted central catheters, and a representative from SonoSite Inc. (manufacturer of the portable US machine). Four senior staff nurses received training which included didactic, simulation and hands-on practice. Ten proctored attempts were selected as the benchmark for competency before the emergency nurse could perform US independently.

Outcomes: Patients who failed initial traditional venous cannulation, or who had history of or suspicion of difficult IV cannulation were selected to receive venous access under US guidance. No adverse patient outcomes have occurred. It has become common that patients with chronic conditions, who visit the ED frequently, ask for their IV to be started initially with the US technique. Being able to provide that service leads to increased patient satisfaction and improved rapport with the healthcare team. Future goals include increasing the number of nurses trained to perform US-guided venous cannulation, collecting data on the emergency nurses' experience in developing their skill, investigating the patient's experience with the procedure and elucidating the potential benefits and complications of ultrasound guidance in IV access.

Recommendations: Developing a program to train emergency nurses in US-guided venous cannulation is viable, easy and safe.
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.titleUltrasound-Guided Venous Cannulation by the Emergency Nurseen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162553-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Ultrasound-Guided Venous Cannulation by the Emergency Nurse</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">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">White, Ann, RN, MSN, CCNS, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Duke University Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Emergency Services Clinical Nurse Specialist, Clinical Associate Faculty</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">7304 Pulley Town Road, Wake Forest, NC, 27587, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">919-681-0352</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">ann.white@duke.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Phillip Stone, RN; Fernando Lopez, MD</td></tr><tr><td colspan="2" class="item-abstract">[Annual Conference] Clinical topic: Even the most experienced emergency nurse has difficulty in obtaining intravenous (IV) access in patients with conditions like obesity, chronic illness, hypovolemia, intravenous drug abuse, vasculopathy and others. These patients lack easy access to peripheral venous sites using the traditional anatomic landmark and palpation methods of venous cannulation. While these patients require timely peripheral venous access, their condition may not be so acute as to require emergent central venous or intraosseous access, invasive techniques not without risks. An evolving option for the emergency nurse is to gain venous access under ultrasound (US) guidance. The benefits of using this technique are multiple; decreasing patient throughput due to less time spent in obtaining venous access, cost reduction, decreasing complications of traditional insertion which include pain, arterial puncture, nerve damage, and paresthesias. Other added benefits are increased patient and emergency medicine physician satisfaction and increased emergency nurse autonomy. The use of US is advantageous due to its lack of biological effects and it provides real-time images. Venous access with US is a relatively new skill for the emergency nurse. The literature provides varied information about formal research findings and clinical experience. Only two observational, descriptive studies exist about the EN experience and both are from the same healthcare institution. <br/><br/>Implementation: After consulting the state nursing practice act and securing support from the ED and organizational leadership, a training program was developed to help the emergency nurse become proficient in US-guided venous cannulation. Organizational experts who assisted with the training included an Ultrasound Fellowship trained Emergency Medicine Physician, clinicians from the IV Therapy Department who use bedside US for peripherally inserted central catheters, and a representative from SonoSite Inc. (manufacturer of the portable US machine). Four senior staff nurses received training which included didactic, simulation and hands-on practice. Ten proctored attempts were selected as the benchmark for competency before the emergency nurse could perform US independently. <br/><br/>Outcomes: Patients who failed initial traditional venous cannulation, or who had history of or suspicion of difficult IV cannulation were selected to receive venous access under US guidance. No adverse patient outcomes have occurred. It has become common that patients with chronic conditions, who visit the ED frequently, ask for their IV to be started initially with the US technique. Being able to provide that service leads to increased patient satisfaction and improved rapport with the healthcare team. Future goals include increasing the number of nurses trained to perform US-guided venous cannulation, collecting data on the emergency nurses' experience in developing their skill, investigating the patient's experience with the procedure and elucidating the potential benefits and complications of ultrasound guidance in IV access. <br/><br/>Recommendations: Developing a program to train emergency nurses in US-guided venous cannulation is viable, easy and safe.</td></tr></table>en_GB
dc.date.available2011-10-27T10:30:08Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:30:08Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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