Background: Ultrasound guided peripheral IV (USGPIV) placement is a critical skill that currently requires placement by providers or critical care nurses at Yale-New Haven Hospital. In particular, our Liver and Kidney Transplant unit requires frequent support for IV access placement from our Hospitalist Procedure Team (HPT) and critical care nursing intervention (SWAT team). There are inherently many challenges regarding vascular access in this patient population – anasarca, limb restrictions, and multiple lifesaving (yet incompatible) infusions to name a few.
Purpose: To reduce delays in care while simultaneously off-loading some of the USGPIV procedure volume from the SWAT team and Hospitalist Procedure Team by training bedside RNs in USGPIV placement.
Description: An advanced practice provider (APP) member of the HPT created a pilot curriculum in USGPIV for bedside RNs. This included a formal hour-long presentation to the service line, and hands-on training during regular shifts. A crucial aspect of the project is that the nurses have access to a Sonosite ultrasound (which the unit owns for the liver service to perform paracentesis). The pilot group of charge RN trainees (three, at the time) were able to offer fast and effective IV placement for patients for whom access was a challenge. The training garnered interest amongst non-charge nurses who saw the skill as valuable and is now offered to any nurse who is already comfortable with traditional IV placement. There are currently 6 fully trained members of the team with more being on-boarded. Preliminary data suggest a 17% reduction in the unit’s utilization of the SWAT team and a 58% reduction in utilization of the HPT for IV access from 2023 to 2024.
Conclusions: APP-led education for USGPIV successfully trained bedside RNs in USGPIV placement, resulting in reduced utilization of SWAT and HPT IV services. There were also fewer delays in IV access establishment, as access could be immediately addressed by unit nurses rather than waiting for a centralized IV team to respond. Another benefit has been RN job satisfaction in expanding their skill set and scope of practice. Benefits that are anticipated (but difficult to track at this time) include: increasing first-attempt PIV placement rate, decreasing the total number of PIVs per patient per admission, and increasing patient satisfaction with care.