2.50
Hdl Handle:
http://hdl.handle.net/10755/306598
Category:
Abstract
Type:
Poster
Title:
Ultrasound-Guided Peripheral Intravenous Insertion in the Emergency Department
Author(s):
Ignacio, Alfie; Santiago, Theresa
Lead Author STTI Affiliation:
Non-member
Author Details:
Alfie Ignacio, DNP, MSN, RN, ACNS-BC, FNP-BC, CEN, CCRN, CFRN, PHN, Zulu22373@aol.com; Theresa Santiago, BSN, RN, PHN
Abstract:

Evidence-based Practice Abstract

Purpose: Patients presenting to the Emergency Department (ED) often require peripheral intravenous (IV) access to collect blood samples and administer IV medications and fluids. Although ED nurses are excellent in obtaining peripheral IV access, there are a number of patients who are difficult to cannulate. Inadequate IV access can lead to delays in treatment, possible increased length of stay, and patient dissatisfaction. The purpose of this project was to implement an evidence-based practice (EBP) guideline for difficult IV access (DIVA) based on the literature and the Emergency Nurses Association recommendations (2011) incorporating use of ultrasound guided IV (USGIV) access techniques.

Design: This was an EBP project guided by the steps of the Iowa EBP Model including baseline practice assessment, staff education and hands-on training, pretest-posttest, coaching/mentoring, and outcomes evaluation.

Setting: The practice change project was conducted in a 34-bed ED of a non-profit community hospital with over 60,000 visits per year.

Participants: The participants for this project included 17 DIVA patients to assess baseline practice using traditional blind sticks, 6 ED nurses who completed USGIV access education and training, and an additional 45 DIVA patients who underwent USGIV access to evaluate the impact of the practice change.

Methodology: An evidence-based USGIV access policy/procedure was developed and approved by the Nursing Practice Council. With the guidance of the clinical nurse specialist, two unit champions and 6 ED staff nurses completed training that involved a didactic educational session, pretest/posttests evaluation, and return demonstration of insertion. The practice change was implemented and monitored over a 6-month period. USGIV access procedures were documented on data collection forms identifying reason for the difficult stick, number of attempts, time to successful cannulation, site of insertion, and complications. Adherence to the practice change was monitored by unit champions and recorded on a coaching/mentoring form. ED nurse feedback/suggestions regarding the new policy/procedure were requested. Evaluation of the practice change was conducted during a 3-week period to assess impact on DIVA patient outcomes (number of IV attempts and time to successful cannulation).

Results: Significant differences in nurses’ knowledge regarding DIVA and USGIV access techniques - pretest mean score of 9.6 vs. posttest mean score 16.2 (p = 0.0004) were found. Significant reduction in the number of IV attempts and time to successful cannulation were also observed for USGIV access compared to traditional blind sticks. Average number of IV attempts using USGIV access was 1.11 compared to 4.75 for blind sticks (p = 0.0001). Average time to successful cannulation for USGIV access was 9.53 min. compared to 46.8 min. for blind sticks (p = 0.0001). ED nurse feedback was positive, average of 3.4 out of 5 on the level of cannulation difficulty.

Conclusion and Implications: Implementation of an evidence-based policy and procedure for DIVA involving USGIV access techniques can facilitate successful cannulation and impact quality of care by decreasing number of attempts and time required. This can lead to greater patient and nurse satisfaction, reduced length of stay, and lower hospital costs.

Keywords:
Difficult IV Access
Repository Posting Date:
9-Dec-2013
Date of Publication:
9-Dec-2013
Conference Date:
2013
Conference Name:
2013 ENA Annual Conference
Conference Host:
Emergency Nurses Association
Conference Location:
Nashville, Tennessee, USA
Description:
2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Center
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.

Full metadata record

DC FieldValue Language
dc.language.isoen_USen_GB
dc.type.categoryAbstracten_GB
dc.typePosteren_GB
dc.titleUltrasound-Guided Peripheral Intravenous Insertion in the Emergency Departmenten_GB
dc.contributor.authorIgnacio, Alfieen_GB
dc.contributor.authorSantiago, Theresaen_GB
dc.contributor.departmentNon-memberen_GB
dc.author.detailsAlfie Ignacio, DNP, MSN, RN, ACNS-BC, FNP-BC, CEN, CCRN, CFRN, PHN, Zulu22373@aol.com; Theresa Santiago, BSN, RN, PHNen_GB
dc.identifier.urihttp://hdl.handle.net/10755/306598-
dc.description.abstract<p>Evidence-based Practice Abstract</p><p>Purpose: Patients presenting to the Emergency Department (ED) often require peripheral intravenous (IV) access to collect blood samples and administer IV medications and fluids. Although ED nurses are excellent in obtaining peripheral IV access, there are a number of patients who are difficult to cannulate. Inadequate IV access can lead to delays in treatment, possible increased length of stay, and patient dissatisfaction. The purpose of this project was to implement an evidence-based practice (EBP) guideline for difficult IV access (DIVA) based on the literature and the Emergency Nurses Association recommendations (2011) incorporating use of ultrasound guided IV (USGIV) access techniques.</p><p>Design: This was an EBP project guided by the steps of the Iowa EBP Model including baseline practice assessment, staff education and hands-on training, pretest-posttest, coaching/mentoring, and outcomes evaluation.</p><p>Setting: The practice change project was conducted in a 34-bed ED of a non-profit community hospital with over 60,000 visits per year.</p><p>Participants: The participants for this project included 17 DIVA patients to assess baseline practice using traditional blind sticks, 6 ED nurses who completed USGIV access education and training, and an additional 45 DIVA patients who underwent USGIV access to evaluate the impact of the practice change.</p><p>Methodology: An evidence-based USGIV access policy/procedure was developed and approved by the Nursing Practice Council. With the guidance of the clinical nurse specialist, two unit champions and 6 ED staff nurses completed training that involved a didactic educational session, pretest/posttests evaluation, and return demonstration of insertion. The practice change was implemented and monitored over a 6-month period. USGIV access procedures were documented on data collection forms identifying reason for the difficult stick, number of attempts, time to successful cannulation, site of insertion, and complications. Adherence to the practice change was monitored by unit champions and recorded on a coaching/mentoring form. ED nurse feedback/suggestions regarding the new policy/procedure were requested. Evaluation of the practice change was conducted during a 3-week period to assess impact on DIVA patient outcomes (number of IV attempts and time to successful cannulation).</p><p>Results: Significant differences in nurses’ knowledge regarding DIVA and USGIV access techniques - pretest mean score of 9.6 vs. posttest mean score 16.2 (p = 0.0004) were found. Significant reduction in the number of IV attempts and time to successful cannulation were also observed for USGIV access compared to traditional blind sticks. Average number of IV attempts using USGIV access was 1.11 compared to 4.75 for blind sticks (p = 0.0001). Average time to successful cannulation for USGIV access was 9.53 min. compared to 46.8 min. for blind sticks (p = 0.0001). ED nurse feedback was positive, average of 3.4 out of 5 on the level of cannulation difficulty.</p><p>Conclusion and Implications: Implementation of an evidence-based policy and procedure for DIVA involving USGIV access techniques can facilitate successful cannulation and impact quality of care by decreasing number of attempts and time required. This can lead to greater patient and nurse satisfaction, reduced length of stay, and lower hospital costs.</p>en_GB
dc.subjectDifficult IV Accessen_GB
dc.date.available2013-12-09T17:00:31Z-
dc.date.issued2013-12-09-
dc.date.accessioned2013-12-09T17:00:31Z-
dc.conference.date2013en_GB
dc.conference.name2013 ENA Annual Conferenceen_GB
dc.conference.hostEmergency Nurses Associationen_GB
dc.conference.locationNashville, Tennessee, USAen_GB
dc.description2013 ENA Annual Conference Theme: Safe Practice, Safe Care. Held at Gaylord Resort and Convention Centeren_GB
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission.en_GB
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