Date of Award

2018

Document Type

Open Access Dissertation

Department

College of Nursing

Sub-Department

Nursing Practice

First Advisor

Stephanie Burgess

Abstract

The purpose of this quality improvement project is to compare the use of ultrasound to guide placement of peripheral intravenous (USGPIV) catheters versus standard techniques in difficult access patients, as measured by the number of attempts required to obtain venous access and total cost related to means of obtaining peripheral venous access between a nurse driven USGPIV and VAT team consults or physician assistance. The appraised evidence indicates USGPIV increases the number of successful PIV placements, prevents non-essential central lines and excessive needle sticks, and reduces patients and healthcare professionals frustrations (An et al., 2016, Au et al., 2012, Dargin, Rebholz, Lowenstein, Mitchell, Feldman, 2010, Gregg et al., 2010 & Shokoohi et al., 2013, Walsh, 2008). In January 2018, the author implemented a non-blinded, randomized control pilot program comparing USGPIV’s to traditional insertion techniques. The quality improvement pilot program took place in a Medical Intensive Care and Medical Step-down Unit. A total of five nurses completed USGPIV training through online instruction modules, followed by didactic and hands-on training. Over a 40-day trial, seventy patients with difficult venous access requiring a peripheral intravenous catheter where randomized using traditional coin flip-selection to receive either an USGPIV or traditional PIV. Nurses collected randomized data via completing questionnaires designed to capture USGPIV and traditional PIV success rates, number of attempts required for successful peripheral access and time used to place venous access. Through SAS, a power tool to assist clinician’s analyze data, frequency distributions and mean tables were calculated to describe the quality improvement projects data. Chi-square test indicated a statistically significant difference in success rates and number of attempts between the placement of USGPIVs and traditional PIVs (P value <0.0001). T-test and Wilcoxon test presented a significant difference between mean minutes to obtain peripheral access and cost of equipment used between USGPIVs and traditional PIVs (P value <0.0001). Training bedside nurses how to place an USGPIV has shown to increase peripheral access success rates and decrease the overall cost associated with establishing venous access among difficult access patients. The quality improvement projects data is consistent with the evidence-based literature. The evidence further supports the programs expansion on a larger scale

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