Winning Poster: Implementation of an ultrasound guided PIV training program for Nurses in a Pediatric Emergency Department

Abstract

Pediatric patients in the emergency department, especially those considered to have Difficult IV Access (DIVA), experience high levels of number of pokes, and IV-related complications (6, 7, 11, 20, 22, 25, 27). Audience: Nurses caring for DIVA patients. Synthesis: The evidence suggests that ultrasound is superior for venous access when compared to traditional methods in DIVA patients, and it can lead to a three-fold increase in the odds of first-attempt success, improved longevity of access, decreased IV-related complications, and a reduction in treatment delays (2, 3, 4, 6, 10, 12, 15, 17, 18, 21, 24, 26, 28). ED-specific USGIV training programs have been widely implemented and include didactic and precepted skills training (1, 2, 3, 9, 10, 15, 18). Evidence-based escalation algorithms are recommended to increase the effectiveness of USGIV interventions (3, 5, 13, 26). EBP Question: Does the implementation of a nurse-led USGIV training program improve first stick success, number of pokes, IV-related complications and treatment delays in a pediatric ED? Methods: The JHEBP model guided this EBP project. Implementation: A nurse-led USGIV training program was developed in collaboration with the Vascular Access Team. The training includes a didactic session, and a simulation session where learners demonstrate the ability to access a vessel on a training mold. Next, learners complete at least 20 precepted sticks in the patient care setting with an an 80 % success rate. Plan for Evaluation: Nurse adoption to practice and confidence will be assessed at program completion and after three months. Nurse competency will be monitored for first stick success rate (goal 80 %). IV related outcomes will be monitored monthly at the unit level via chart audit. Results: Two training sessions have been held and we have doubled the number of ultrasound nurses. The number of USGIV insertions has nearly quadrupled with a high first stick success rate (85 %–95 %). Conclusions: The program will continue to expand in 2025. The next steps are to collaborate with relevant stakeholders to develop and evaluate the use of an evidence-based algorithm to further guide USGIV use in the ED.