Ultrasound-Guided Intravenous Access as a First-Line Approach by Nurses: A Quality Improvement Project

Background: Up to 9% of patients admitted to EDs (Emergency Departments) have difficult intravenous insertion access issues (DIVA). This creates delays in patient care that includes interruptions for physicians providing medical emergency care. Often the utilization of RNs to perform US (ultrasound) IV insertions is limited related to lack of training and supportive policies.

Local Problem: The site for this project was an ED Level 1 Trauma Center associated with a large teaching hospital located in the southeastern U.S. Prior to the implementation of the process improvement project, there was no formal education of RNs in the use of US for difficult insertion IVs, resulting in patient care delays and physician interruptions for IV starts. The purpose of this project was to reduce patient care delays related to patients with difficult IV insertions with the aim to train RNs to perform ultrasound-guided IV insertions.

Methods: The Model for Improvement was utilized as a guide for this project. Using the PDSA (plan, do, study, act), which included a review of the literature for best practice, the RN education and ultrasound protocol was developed. Pre- and post-implementation DIVA patients' baseline door-to-IV start and door-to-blood collection times were measured.

Interventions: US educational sessions were developed and taught to 15 RNs in the ED.

Results: ED increased the number of US proficient RNs to 24. Physician IV starts decreased by 12%. There were no significant differences between pre and post-intervention time to IV (p=0.552) or time to blood draw (p=0.081).

Conclusions: The project increased RN availability for US-guided access and reduced physician interruptions. Post-intervention door-to-IV and door-to-blood draw times were not significantly different, possibly relating to ED volume during the time of the project. The project site will continue the RN US education program.