226 - Poking with Precision: Developing an Inpatient Nursing Program for Ultrasound-Guided Vascular Access

Publication Number: 226.6103

Robert Parker, Connecticut Children's Medical Center, Granby, CT, United States; Brenden Orsi, Connecticut Children's Medical Center, North Haven, CT, United States; Ashley Polson, Connecticut Children's Medical Center, Hartford, CT, United States

Background: Peripheral intravenous (PIV) cannulation often has high failure rates when traditional techniques are used, leading to patient discomfort and an increased reliance on central venous catheters (CVLs). Ultrasound guidance improves success rates, especially in patients with difficult intravenous access (DIVA), but adoption remains limited due to training gaps. This project aimed to develop a comprehensive ultrasound-guided PIV (USGPIV) training program for pediatric nurses to enhance competency, reduce complications, and improve patient care.

Objective: To develop, implement, and evaluate a structured USGPIV training program to improve insertion success rates, increase nurse confidence, and reduce reliance on central lines. Secondary aims compared the ease of use, comfort, and success rates of three devices (Sonosite, Butterfly iQ, GE VScan).

Design/Methods: Twenty pediatric nurses were enrolled. Participants completed an asynchronous pre-course module, a 2-hour didactic session, and 6-8 hours of hands-on simulation training. Three ultrasound devices were compared. Each nurse then performed a minimum of 10 supervised USGPIV placements on pediatric patients. Comfort and confidence levels were assessed pre- and post-training, with data analyzed via paired t-tests and descriptive statistics. Insertion success rates and number of attempts were tracked. Feedback on each device’s ease of use, image quality, and comfort was also collected.

Results: Prior to the course, none of the nurses had ultrasound experience. 13 nurses completed training. Nurses achieved a 75% first-attempt cannulation rate and an overall success rate of 86% on actual patients. Mean insertion attempts averaged 1.2. Average DIVA score was 4.23 ± 1.61, indicating predicted difficult access. A paired t-test demonstrated a significant increase in comfort levels, with scores rising from a pre-training mean of 1.55 to 3.55 post-training (t = -4.94, p < 0.001). The Sonosite was consistently rated as the most user-friendly device, offering superior image quality and facilitating efficient cannulations.

Conclusion(s): Our USGPIV training program effectively enhanced nurse competency and confidence, improving patient care. Significant improvements in success rates and fewer insertion attempts underscore its benefits. The Sonosite's superior performance suggests it as the preferred device for training and clinical use. Future plans include program expansion, curriculum refinement, and a train-the-trainer model to sustain USGPIV competency across settings.

Comfort With Ultrasound
Distribution of self-reported comfort levels with ultrasound use among pediatric nurses prior to and after training. Scored using a 1-5 scale (1 = very uncomfortable, 5 = very comfortable).

Descriptive Summary of USGPIV Attempts and Outcomes
Detailed analysis of ultrasound-guided peripheral IV (USGPIV) attempts, comparing success rates, insertion attempts, and patient DIVA scores, providing insights into overall and first-attempt success metrics.

Comparison of Ultrasound Device Preferences Among Pediatric Nurses
Survey results showing pediatric nurses' preferences for three ultrasound devices (Sonosite, Butterfly iQ, GE VScan Air) based on ease of use, image capture quality, comfort, and cannulation efficiency.

Comfort With Ultrasound
Distribution of self-reported comfort levels with ultrasound use among pediatric nurses prior to and after training. Scored using a 1-5 scale (1 = very uncomfortable, 5 = very comfortable).

Descriptive Summary of USGPIV Attempts and Outcomes
Detailed analysis of ultrasound-guided peripheral IV (USGPIV) attempts, comparing success rates, insertion attempts, and patient DIVA scores, providing insights into overall and first-attempt success metrics.

Comparison of Ultrasound Device Preferences Among Pediatric Nurses
Survey results showing pediatric nurses' preferences for three ultrasound devices (Sonosite, Butterfly iQ, GE VScan Air) based on ease of use, image capture quality, comfort, and cannulation efficiency.