Part 1 of a 2-part series: Implementation of Guidewire Peripheral IV Technology to Improve Care for DVA Patients in an Acute Care Hospital

Abstract:

Without established criteria for nurses to identify patients with difficult venous access (DVA) nor guidelines on when to seek assistance from those with advanced-skills in vascular access device (VAD) placement, patients are often subjected to multiple IV attempts. Furthermore, the lack of 24/7 availability of nurses with advanced placement skills can result in patients being subjected to an increased number of IV attempts and a differing level of care after hours.

Specialized vascular access teams have demonstrated improved patient outcomes, fewer complications, and reduced costs associated with vascular access (INS, 2016; Whalen et al., 2018). In an effort to improve patient outcomes related to vascular access device placement, specifically on DVA patients, a cohort of nurses were trained at a 275-bed public district hospital to insert guidewire assisted peripheral IV catheters using ultrasound. Despite numerous hurdles, a total of 34 nurses in various departments and working on all shifts were successfully trained and are now called upon to assist with IV placement for DVA patients.


Objectives:

• Discuss challenges faced when caring for difficult venous access patients.
• Review options to successfully place peripheral vascular access in difficult venous access patients.
• Describe steps to implement an ultrasound guided guidewire assisted peripheral IV program in an acute care hospital.
  

Part 2 of a 2-part series: Implementing Guidewire Peripheral IV Technology Hospital Wide to Improve Patient Outcomes

Abstract: 

A lack of standardized practice in IV placement and inconsistent availability of advanced-skilled vascular access nurses was identified at a 275-bed public district hospital. The gap included a lack of set standards to identify patients with poor peripheral vascular access and absence of clear expectations in the hospital policy to guide nurses when to seek the assistance of those with advanced vascular access placement skills. To address the gap in practice, a performance improvement project was piloted on four medical/surgical units to evaluate the effect of implementing a nurse-driven protocol for placement of vascular access on DVA patients. The protocol guided the nurse to consider calling for an advanced-skilled nurse to assist with IV placement once a DVA patient was identified. Otherwise, if attempts were made to place an IV, the nurse was to limit the number to no more than two per nurse and four attempts total before calling for assistance. This was intended to prevent deplete on of viable peripheral veins and avoid unnecessary escalation to the need for a PICC or other CVAD. A retrospective in-depth analysis was completed following the protocol implementation. Clinically significant findings included decreased time from the call for assistance to successful placement of difficult IVs, as well as higher first-time attempt success rates and longer catheter dwell times when guide-wire assisted peripheral IV catheters were inserted by specialty vascular access nurses. Opportunities for cost savings were identified by decreasing the number of attempts required to place an IV, fewer IV restarts, and prevention of advancement to more invasive lines. The results demonstrate the value of translating evidence in VAD placement into practice and leveraging technology to improve patient care.


Objectives:

• Examine the process for implementing a nursing protocol for peripheral IV placement on difficult venous access patients.
• Discuss best practices for improving patient outcomes related to peripheral IV placement in an acute care hospital.
• Explore potential cost savings by utilizing a guidewire assisted peripheral IV catheter and ultrasound for patients with difficult venous access.