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Ultrasound-guided peripheral intravenous access reduces misses

At the recent American Institute of Ultrasound in Medicine (AIUM) 2012 Annual Convention, a study was presented that evaluated the monthly rate of central venous catheter (CVC) placement in high- and low-acuity patients from 2006 to 2010. The research team, from The George Washington University (GWU) Medical Center, found that inappropriately placed CVCs substantially decreased in hospitals that trained residents and ED staff to perform ultrasound-guided peripheral intravenous access (UGPIV).

In 2008, GWU Medical Center administrators decided to implement a UGPIV training program; by 2010, the numbers of CVCs placed was reduced by nearly 65%. In addition, the number of patients who received CVCs, but subsequently had them removed, reduced from 13% in 2006 to 1% in 2010. Dr. Hamid Shokoohi, MD, who led the research team, states that, “this is very important because we assume the people who go to the ICU are the most severe patients who need the CVC for reasons other than simply poor peripheral IV access. In 2006, only about a third (33.2%) of patients who got CVCs were admitted to the ICU; by 2010, this number went up to 82%.”

In addition to the reduction in numbers of inappropriately placed CVCs, according to an Advanced Emergency Nursing Journal article, the benefits of using ultrasonography for peripheral IV access include decreasing patient throughput, cost reduction, decreasing complications, increased patient and emergency medicine physician satisfaction, and emergency nurse autonomy.

Dr. Michael Blavais, MD, FACEP, professor of emergency medicine in the Department of Emergency Medicine, Northside Hospital, Forsyth, in Cumming, GA, chair of the AIUM Emergency and Critical Care Ultrasound Section, and who moderated the session at the AIUM, notes that UGPIV is “simple and extremely effective because it can help you avoid the central line completely. Obviously, many central lines do need to be placed, but as the study indicated, you can avoid it in as many as a third of cases.”

Although training is needed, Dr. Blavais says it’s not too difficult. “In general, we've found that training can be accomplished with a two-hour course, lectures, some demonstrations, practice on a phantom, and then trying it out on about five patients in a proper setting with the oversight of an expert.”

The need for UGPIV in other medical settings is increasing, and was recently included in the Emergency Nurses Association (ENA) three-year strategic plan, as well as a focus at the recent 2012 ENA Conference in New Orleans, LA. “The community health care providers tend to pick this up less, so they are the next big battleground,” Dr. Blaivas said. “The Emergency Nurses Association has put out a statement endorsing this, and I think you will start seeing more and more implementation.”