Poster - #2022UCDH-46 - Keywords: US-guided PIV Adult Infusion Oncology Outpatient

Not a Stab in the Dark- Ultrasound Guided Peripheral IV Placement in an Outpatient Adult Infusion Unit

Daphne Hampton, BSN, RN; Deborah Small, BSN, RN, OCN, CRNI, VA-BC; Denah Ballia, BSN, RN; Debra Burgess, MHA, BSN, RN, CSSGB
University of California Davis Health - Comprehensive Cancer Center Adult Infusion Unit

ABSTRACT:
Title: Not a Stab in the Dark- Ultrasound Guided Peripheral IV Placement in an Outpatient Adult Infusion Unit Primary Author: Daphne Hampton, BSN, RN Co-authors: Deborah Small, BSN, RN, OCN, CRNI, VA-BC; Denah Ballia, BSN, RN, OCN; Debra Burgess, MHA, BSN, RN, CSSGB Background: Appropriate and reliable intravenous access is a critical step in providing safe care when administering chemotherapy and other outpatient infusions. However, frequently traditional central venous catheters or peripherally inserted central catheters are not placed prior to patients receiving outpatient therapy and there is a heavy reliance on peripherally placed intravenous(PIV) catheters, which can sometimes be difficult to place in an outpatient oncology setting. Ultrasound guided(US-guided) PIV insertion allows patients to continue treatment and decreases the number of PIV attempts when central line placement is not an option. Patients currently needing US-guided PIV placement must wait for one of 2 trained nurses to become available(the nurse has their own patient load). Occasionally, there are no nurses trained in USG PIV placement scheduled to work in the Adult Infusion Unit and when this happens patients receive multiple sticks and sometimes their treatments are delayed if access can not be obtained. Purpose: The purpose of this EBP initiative is to develop a process to educate and train nurses in the placement of USG PIVs. The nurse trained in USG PIV placement will not have a patient load. They will function as a resource to their co-workers. The goal is for Adult Infusion patients with poor venous access receiving outpatient therapy to have a decrease in the wait time for PIV placements and in the number of attempts at PIV placement by June 2022. Methods: Initially the outpatient Adult Infusion department had one dedicated preceptor trained to provide ultrasound assistance. US-guided IV placement education was needed to expand staff resources. Interested nurses were identified and invited to take an online training class. Quality metrics selected to assess the benefit to patient outcomes included time of arrival in Adult Infusion to initiation of therapy, and the number of PIV sticks needed to obtain venous access. Results: Since implementing the quality initiative in March 2021, 10 nurses took the online training class and 5 have successfully cross trained and can serve in the resource nurse role. Coverage using USG technology for PIV starts was expanded to 6 days a week with a dedicated nurse scheduled each day. Wait time for availability of USG PIV placement was reduced by 17% and the number of US-guided lines placed increased 102%. The average number of attempts to place a PIV using US-guided technique vs. anatomical landmarks was somewhat higher. However, this is expected to change following a learning curve to master US-guided insertion skills. Conclusion: This EBP initiative implemented solutions aimed at improving access to US-guided PIV placement. Once nurses are trained, the availability of US-guidance can improve PIV start time, decrease PIV attempts, decrease the time to therapy initiation, and increase patient satisfaction. Next steps will be reviewing clinical practice for appropriate line use, based on the MAGIC algorithm for patients receiving irritants and vesicants. The long-term goal is for patients receiving irritants and vesicants to have a CVC or PICC.