Graduate Publications and Other Selected Works - Doctor of Nursing Practice (DNP)

Document Type

Poster

Publication Date

Fall 2025

Abstract

BACKGROUND: Difficult intravenous access (DIVA) is a frequent challenge in coronary care units (CCUs). Multiple failed attempts delay treatment, increase discomfort, and escalate reliance on specialized IV teams. Evidence supports ultrasound-guided techniques to improve insertion success; however, training and protocols are often lacking.

LOCAL PROBLEM: This project occurred in the CCU of a Level I Trauma Center in the Southeastern U.S., where critically ill patients frequently presented with DIVA. Nurses regularly relied on the IV team, creating delays, greater resource use, and reduced patient satisfaction and outcomes. The project aimed to address these issues by training CCU nurses in ultrasound-guided IV insertion to improve efficiency and care delivery.

METHODS: A quality improvement framework guided by the Model for Improvement and Plan-Do-Study-Act (PDSA) cycles was used. Participants included CCU nurses and DIVA patients. Baseline data were collected on IV team utilization. Training incorporated ultrasound simulation, competency assessment, and protocol implementation. Data sources included nurse documentation, electronic health records, and staff questionnaires.

INTERVENTIONS: Interventions involved nurse training in ultrasound-guided IV insertion and the rollout of a unit protocol to build skill, confidence, and consistency. Collaboration with clinical leaders, educators, and stakeholders supported adoption and sustainability.

RESULTS: In 2025, 28.87% of IV team calls were for IV access versus 23.52% in 2024 during the same period. June 2025 showed 17.65% of calls for IV access compared to 25.25% in June 2024, though other 2025 months had higher percentages than 2024.

CONCLUSIONS: The implementation of ultrasound-guided IV insertion in the CCU improved nurse confidence and patient satisfaction, despite challenges in training and equipment availability. Prioritizing this technique and IV access protocol enhanced patient care and will continue to improve workflow in the unit.

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