A Retrospective Look at Ultrasound Guided Peripheral IV Insertion in Pediatric … ·...
Transcript of A Retrospective Look at Ultrasound Guided Peripheral IV Insertion in Pediatric … ·...
Kacey Wiseman BSN, RN, CPN, VA-BC
John Pilcher BSN, RN, VA-BC, CRNI
A Retrospective Look at
Ultrasound Guided Peripheral IV Insertion in
the Pediatric
Population
Learning Objectives
Identify potential benefits and drawbacks of
Ultrasound Guided PIV’s.
Evaluate the potential for Ultrasound Guided PIV’s
in your institution.
Summarize current literature on Ultrasound Guided
PIV’s
Financial DisclosuresDisclosure of Relevant Financial Relationships
We have the following financial relationships to disclose:
John Pilcher• No Disclosures
• Employee of: Boston Children’s Hospital, Brigham and Women’s Hospital
Kacey Wiseman• No Disclosures
• Employee of: Boston Children’s Hospital
Disclosure of Off Label and/or Investigative UsesWe will not discuss off label use and/or investigate uses in this presentation.
John• Case Manager in many aspects of
social services
• Attended nursing school at John’s
Hopkins University
• 11 years of nursing experience
• Specialized in Vascular Access in
Adults and Children for past 6 years
Kacey• RN on a Surgical/Trauma/Burn Unit
for 6 years
• Began travel nursing
• Specialized in Vascular Access in
Pediatrics for past 3 years
A little bit about us…
Why Ultrasound (AGAIN…)?
Skill Level & Training
PICC Excellence
Computer based
modules
Computer Didactic
Blue Phantom
Hands on Practice
Successfully place 3
PIV’s in all age groups
with Preceptor
1:1 Instruction
Step 1 Step 2 Step 3
Boston Children’s HospitalLiterature
Blue Phantom
Short Didactic and
Practice
Step 1 and 2
Novice to Expert RN’sRN’s, Residents, Anesthesia
Mostly Novice
Definition of success – each article defines success in a different way
Mixed results, indications from literature.
Vessel preservation – planning for future PIV placement
Insert the title of your subtitle Here
36
232
442
ED ICU/ICP GENERAL INPATIENT
Total PIVs Placed
USG and Transillumination
0 10 20 30 40 50 60 70
USG
Transillumination
Average Length of Stay
SUCCESS RATES & INSERTION ATTEMPTS
Success Rate
80%
60 – 100%
Avg. Attempts
1st Attempt
68%
53 - 85%
1-4 Attempts
Success Rate
87%
2018
Avg. Attempts
1st Attempt
76%
21% 2 Attempts
1.28 Attempts
Literature Boston Children’s Hospital
Technique & Catheter Size
• Dynamic Needle Tip Positioning vs. Static
• One person self guided
• Two person self guided
• Two Person peer guided
• Short Axis vs. Long Axis
• Variety of catheter sizes and lengths
Literature
• One person self guided DNTP
• Short Axis
• Hold and Positioning
• Skin Marker
• 1.25” 24g and 1.75” 22g
Boston Children’s Hospital
Holding Techniques
Dwell TimesA Multi-Factoral Statistic…
2 Days
4 Days
LITERATURE
BCH
0 1 2 3 4 5
Literature Vs. Boston Children’s Hospital
Dwell Times Per Unit
0
1
2
3
4
5
6
7
ED ICU General Inpatient
4 Days1hr, 17min
6 Days8hrs, 36min
3 Days4hrs, 2min
1 Day
19hrs, 26min
3 Days
19hrs, 16min
2 Days
5hrs, 57min
A Closer Look….
Dwell Times for USG PIVs
0
10
20
30
40
50
60
70
> 24Hrs
1 Day 2Days
3Days
4Days
5Days
6Days
7Days
8Days
9Days
10Days
11Days
12Days
13Days
14Days
15Days
16Days
18Days
19Days
22Days
43Days
57
69
47
40
29 31
20
9 9 9 8 6 4 4 3 1 2 2 3 1 1
Clinical Indication to D/C PIV
36%
42%
22%
Insufficient Documentation
OtherComplications
FunctioningPIV D/C
Technological
“Wow Factor”
Satisfaction and Perception
Studies and anecdotal experience at Boston
Children’ s hospital show overall increased
satisfaction when using Ultrasound Guidance
to place PIV’s from patients, families and
multidisciplinary team.
Complications and Drawbacks
• Arterial Puncture
• Failure rate 25% 1st
48 hours
• Infiltration, Leaking,
Phlebitis
Literature• Artery/Nerve puncture
potential complication
• Infiltration, Phlebitis,
Leaking, Unable to flush
• Non-Compressible Vessels
• Decrease central line
placement - Service or
Disservice?
Boston
Children’s Hospital
Here’s why ultrasound…
• Decrease Central Lines
• Line holidays
• Lab Drawing PIVs
• Emergent Access
• Otherwise unobtainable
patients
Continued Data Collection
Will concurrent central access with a
PIV alter the total time a PIV functions
without complication?
Thank you
BibliographyAvelar, A. F., Peterlini, M. A., & Pedreira, M. D. (2015). Ultrasonography-Guided Peripheral Intravenous Access in Children. Journal of Infusion Nursing, 38(5), 320-327. doi:10.1097/na
n.0000000000000126
Bair, A. E., Rose, J. S., Vance, C. W., Andrada-Brown, E., & Kuppermann, N. (2008). Ultrasound-Assisted Peripheral Venous Access in Young Children: A Randomized Controlled
Trial and pilot Feasibility Study. Western Journal of Emergency Medicine, IX(4), 219-224.
Benkhadra, M., Collignon, M., Fournel, I., Oeuvrard, C., Rollin, P., Perrin, M., . . . Girard, C. (2012). Ultrasound guidance allows faster peripheral IV cannulation in children under 3
years of age with difficult venous access: A prospective randomized study. Pediatric Anesthesia, 22(5), 449-454. doi:10.1111/j.1460-9592.2012.03830.x
Curtis, S. J., Craig, W. R., Logue, E., Vandermeer, B., Hanson, A., & Klassen, T. (2015). Ultrasound or near-infrared vascular imaging to guide peripheral intravenous catheterization in
children: A pragmatic randomized controlled trial. Canadian Medical Association Journal, 187(8), 563-570. doi:10.1503/cmaj.141012
Elia, F., Ferrari, G., Molino, P., Converso, M., Filippi, G. D., Milan, A., & Aprà, F. (2012). Standard-length catheters vs long catheters in ultrasound-guided peripheral vein
cannulation. The American Journal of Emergency Medicine, 30(5), 712-716. doi:10.1016/j.ajem.2011.04.019
Elkhunovich, M., Barreras, J., Pinero, V. B., Ziv, N., Vaiyani, A., & Mailhot, T. (2017). The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary
childrens hospital. The Journal of Vascular Access, 18(1), 57-63. doi:10.5301/jva.5000615
Fields, J. M., Dean, A. J., Todman, R. W., Au, A. K., Anderson, K. L., Ku, B. S., . . . Panebianco, N. L. (2012). The effect of vessel depth, diameter, and location on ultrasound-guided
peripheral intravenous catheter longevity. The American Journal of Emergency Medicine, 30(7), 1134-1140. doi:10.1016/j.ajem.2011.07.027
Gopalasingam, N., Obad, D. S., Kristensen, B. S., Lundgaard, P., Veien, M., Gjedsted, J., . . . Juhl-Olsen, P. (2017). Ultrasound-guidance outperforms the palpation technique for
peripheral venous catheterisation in anaesthetised toddlers: A randomised study. Acta Anaesthesiologica Scandinavica, 61(6), 601-608. doi:10.1111/aas.12901
BibliographyGottlieb, M., Holladay, D., & Peksa, G. D. (2018). Comparison of Short- vs Long-axis Technique for Ultrasound-guided Peripheral Line Placement: A Systematic Review and
Meta-analysis. Cureus. doi:10.7759/cureus.2718
Heinrichs, J., Fritze, Z., Vandermeer, B., Klassen, T., & Curtis, S. (2013). Ultrasonographically Guided Peripheral Intravenous Cannulation of Children and Adults: A Systematic
Review and meta-Analysis. Annals of Emergency Medicine, 61(4), 444-453. doi:10.1016/j.annemergmed.2012.11.014
Jeon, L. W. (2012, July 20). BD Task – 9-block design [Video File]. Retrieved from https://www.youtube.com/watch?v=VYObq3X-4Oc
Kanipe, W., Shobe, K., Li, Y., Kime, M., & Smith-Miller, C. A. (2018). Evaluating the Efficacy and Use of Vein Visualization Equipment Among Clinical Nurses in an Intermediate
Care Environment. Journal of Infusion Nursing, 41(4), 253-258. doi:10.1097/nan.0000000000000286
Larsen, P., Eldridge, D., Brinkley, J., Newton, D., Goff, D., Hartzog, T., . . . Perkin, R. (2010). Pediatric Peripheral Intravenous Access. Journal of Infusion Nursing, 33(4), 226-235.
doi:10.1097/nan.0b013e3181e3a0a8
Ng, C., Ng, L., & Kessler, D. O. (2017). Attitudes towards three ultrasound-guided vascular access techniques in a paediatric emergency department. British Journal of Nursing, 26(19).
doi:10.12968/bjon.2017.26.19.s26
Oakley, E., & Wong, A. (2010). Ultrasound-assisted peripheral vascular access in a paediatric ED. Emergency Medicine Australasia, 22(2), 166-170. doi:10.1111/j.1742-6723.2010.01281.x
Otani, T., Morikawa, Y., Hayakawa, I., Atsumi, Y., Tomari, K., Tomobe, Y., … Hataya, H. (2018). Ultrasound-guided peripheral intravenous access placement for children in the
emerrgency department. European Journal of Pediatrics. https://doi.org/10.1007/s00431-018-3201-3
Paladini, A., Chiaretti, A., Sellasie, K. W., Pittiruti, M., & Vento, G. (2018). Ultrasound-guided placement of long peripheral cannulas in children over the age of 10 years admitted to
the emergency department: A pilot study. BMJ Paediatrics Open, 2(1). doi:10.1136/bmjpo-2017-000244
BibliographySchnadower, D., Lin, S., Perera, P., Smerling, A., & Dayan, P. (2007). A Pilot Study of Ultrasound Analysis before Pediatric Peripheral Vein Cannulation Attempt. Academic Emergency
Medicine,14(5), 483-485. doi:10.1197/j.aem.2006.12.016
Smith, H. M., Kopp, S. L., Johnson, R. L., Long, T. R., Cerhan, J. H., & Hebl, J. R. (2012). Looking into Learning: Visuospatial and Psychomotor Predictors of Ultrasound-Guided
Procedural Performance. Regional Anesthesia and Pain Medicine, 37(4), 441-447. doi:10.1097/aap.0b013e318257a551
Triffterer, L., Marhofer, P., Willschke, H., Machata, A., Reichel, G., Benkoe, T., & Kettner, S. (2012). Ultrasound-guided cannulation of the great saphenous vein at the ankle in
infants. British Journal of Anaesthesia, 108(2), 290-294. doi:10.1093/bja/aer334
Vinograd, A. M., Zorc, J. J., Dean, A. J., Abbadessa, M. K., & Chen, A. E. (2017). First-Attempt Success, Longevity, and Complication Rates of Ultrasound-Guided Peripheral
Intravenous Catheters in Children. Pediatric Emergency Care, 1. doi:10.1097/pec.0000000000001063