362 - Training Pediatric Emergency Staff On Ultrasound-Guided Peripheral Intravenous Access Placement

Poster Number: 362

Benjamin Nti, Riley Hospital for Children at Indiana University Health, Indianapolis, IN, United States; Pamela C. Soriano, Riley Hospital for Children at Indiana University Health, Zionsville, IN, United States; Sean C. Mulligan, Indiana University School of Medicine, Indianapolis, IN, United States; Emily Dever, Riley Hospital for Children at IU Health, Indianapolis, IN, United States; Tresanay Bentley, Indiana University School of Medicine , Riley Hospital For Children at Indiana University Health, Indianapolis, IN, United States; Elizabeth Weinstein, Indiana University School of Medicine, Indianapolis, IN, United States

Background: Difficult intravenous access (DIVA) in the pediatric patients adversely impacts patient experience and may delay important diagnostic testing and medication administration. Ultrasound guided peripheral intravenous (USG-PIV) access improves IV-related clinical management. Nurses can successfully perform USG-PIV cannulation, but a current training standard in the emergency department (ED) is lacking.

Objective: We instituted a novel curriculum to train nurses and paramedics in pediatric USG-PIV and assessed whether we can improve confidence, competency, and clinical utilization of this modality. Secondary outcomes included evaluation number of IV attempts before successful IV cannulation.

Design/Methods: This is a prospective observational study of ED nurses and paramedics trained in USG-PIV placement from October 2020-November 2021. Pediatric ED nurses and paramedics with experience and proficiency in placing standard PIV were included. The training curriculum included 3 phases: 1. An initial 3-hours of didactics, ultrasound, and phantom training; 2. At least 10 supervised cannulations, and 3. 10 unsupervised cannulations in DIVA patients. Participants were required to complete a presurvey, pass a skills and knowledge assessment with a post-survey following completion of initial training and a second assessment 6-months after the initial training.

Results: Thirty-one nurses and paramedics met the criteria for training. Twenty-eight (90.3%) were registered nurses and 3 (9.7%) were certified paramedics. Five ((16.1%) had prior history of ultrasound experience but no formal training or certification. The average years of experience was 6.4 years (Standard Error of Mean [SEM]+/-1.17). Likert rating of pre-training survey versus post-training survey comfort level showed a significant increase in ultrasound machine competency, vascular anatomy and image acquisition, interpretation, and clinical integration respectively (2.33+/-0.34 vs. 4.17+/-0.12; 2.83+/-0.29 vs. 4.17+/-0.12; 2.33+/-0.23 vs. 4.05+/-0.10; and 1.45+/-0.34 vs 4.05+/-0.18; p < 0.05). USG-PIV for patients with DIVA increased and comfort level was sustained greater than 6 months after training, which subsequently affected patient care and experience by decreased PIV attempts (Standard 2.86+/-0.22 vs. USG-PIV 1.2+/-0.08).Conclusion(s): These findings support the use of a standard USG-PIV educational curriculum as part of training to enhance pediatric ED nurse and paramedic cannulation skills and to reduce IV attempts in pediatric patients.