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Introduction: Peripheral intravenous catheters (PIVs) are routinely utilized for infusions of medications and/or fluids in the healthcare setting. PIVs vary in length, gauge (catheter diameter), and other properties such as radiopaque guidewires, flexible guidewires, etc. The placement site, catheter length, and diameter is selected by the healthcare personnel inserting the PIV. The healthcare personnel inserting PIVs varies across institutions, but registered nurses insert most PIVs in the hospital setting. Ultrasound machines and vein illuminators are devices that can assist with PIV placement in patients that are identified as having difficult vascular access. The use of the ultrasound machine requires special training and competence for successful PIV placement. In the Cardiovascular Intensive Care Unit (CVICU) at Henry Ford Hospital (HFH) in Detroit, many nurses utilized an ultrasound machine to insert PIVs for patients with difficult vascular access. The nurses inserted 1-inch and 1.88-inch standard PIV catheters. All, but one of the nurses, had no previous ultrasound training. Since there is currently no Henry Ford policy requiring a nurse to have ultrasound training to insert PIVs, this had been the standard practice. This practice placed patients at risk for complications, decreased PIV dwell time, increased PIV cannulation attempts, and increased number of PIVs. Complications include PIV infiltrations, extravasation, and infection. In addition to lack of training, lack of appropriate supplies was identified. The PIVs available for insertion were 1-inch and 1.88-inch catheters. These PIVs were utilized to access deep brachial veins, however in most patients, a longer catheter is required to access deep brachial veins to achieve appropriate vessel purchase. To achieve appropriate vessel purchase and reduce risk of dislodgement, at least half of the catheter must be situated within the actual vessel. Methods: Nine nurses were selected to participate in the ultrasound-training program in the CVICU. Training included an online module and hands-on training with a BD clinical specialist. The nurses were trained to place the BD Accucath, a 2.25 inch, 20-gauge PIV, with a coiled tip guidewire. Training was completed within two weeks. In addition to training a group of nurses, education was provided to the unit staff and medical teams. Education included rationale for training, new type of PIV, and appropriate patient selection for ultrasound PIV placement. Approximately one month after program initiation, a difficult access algorithm was introduced to assist in decisions for vascular access in patients identified as difficult peripheral access. Results: Implementing the ultrasound training program increased the ultrasound-guided PIV dwell time from 3.47 days to 7.19 days, representing a 107.2% increase in dwell time. Additionally, there were no documented extravasations from ultrasound-guided PIVs in the 3 months following initiation of the training program. Conclusions: Appropriate catheter selection and ultrasound training to ensure competence, increases patient safety and dwell time of PIV catheters. Additional data is needed to determine secondary outcomes, such as decreased PIV cannulation attempts, decreased number of PIVs per patient, decreased costs, and decreased midline, PICC, and central line utilization rate. A decreased central line utilization rate will potentially decrease central-line associated bloodstream infections (CLABSIs).

Publication Date



Henry Ford Health


Detroit, Michigan


Quality Expo, posters, poster competition

Project #45: Unit-based Training Program for Ultrasound-Guided Peripheral Intravenous Catheter Insertion



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