A Novel Streamlined Triphasic Approach to Training Pediatric Emergency Staff for Ultrasound-Guided Peripheral Intravenous Access.

Abstract

Introduction: Ultrasound-guided peripheral intravenous access enhances the clinical management of pediatric patients with difficult intravenous access. However, the quality and depth of the training required to master this skill can vary significantly. We instituted a novel curriculum to streamline the training process using a simplified 3-phase approach.

Methods: This prospective observational study included emergency nurses and paramedics trained in ultrasound-guided peripheral intravenous placement from October 2020 to November 2021. Pediatric emergency nurses and paramedics with experience and proficiency in standard peripheral intravenous placement were included. The training curriculum included 3 phases: (1) 3 hours of didactics, machine, and phantom training; (2) at least 10 supervised cannulations; and (3) 10 unsupervised cannulations in patients with difficult intravenous access. Participants were assessed at each phase and 6 months after the initial training.

Results: Thirty participants completed the training. The average years of experience was 6.37 years (standard error of mean 1.17). Likert rating of comfort level with ultrasound machine competency, vascular anatomy, image acquisition, interpretation, and clinical integration respectively increased significantly between the pretraining survey and post-training survey [2.83 (0.29) vs 4.07 (0.12); 2.83 (0.29) vs 4.30 (0.12); 2.33 (0.23) vs 4.22 (0.13); and 3.00 (0.34) vs 4.22 (0.18); P < .05]. This was sustained for more than 6 months after training. We observed a concomitant decrease in peripheral intravenous attempts (standard 2.86 ± 0.22 vs ultrasound-guided peripheral intravenous 1.2 ± 0.08). The training was valuable (4.9 ± 0.05) and changed clinical management (4.5 ± 0.20) of patients with difficult intravenous access.

Discussion: These findings support the integration of ultrasound-guided peripheral intravenous access as part of staff training to enhance pediatric emergency nurses' paramedic cannulation skills and improve patient management.