The effect of ultrasound guidance on the perceived difficulty of emergency nurse-obtained peripheral IV access

Emergency nurses (ENs) typically place peripheral intravenous (IV) lines, but if repeated attempts fail, patients usually receive central line access. To measure the effect of ultrasound (US) guidance on the perceived difficulty of EN peripheral IV access in Emergency Department patients, a prospective observational study was conducted of ENs in a level I trauma center with a census of 75,000, performing US-guided IV line placement in difficult stick patients (difficult or hard stick patients defined as repeated blind IV placement failure or established history of blind IV placement failure). ENs trained on an inanimate model after a 45-min lecture. Surveys were filled out after each US-guided IV attempt on a patient. ENs could decline to fill out surveys, which recorded reason for US use, type of patient, success, technique used, and difficulty. Successful cannulation was confirmed by drawing blood and infusion of 100 mL of IV fluids. Student's t-test was used to compare data. A total of 321 surveys were collected in a 5-month period; no ENs declined to participate. There were 258 (80%) of the patients rated as very hard sticks before US, 59 as hard, 3 as easy, and none as very easy. Of the 258 very hard sticks without US, 29 were still rated as very hard even with US use; 43 changed to hard, 112 changed to easy and 137 to very easy. After a brief tutorial, ultrasound guidance for IV access in emergency patients significantly decreased the perceived difficulty in difficult access patients.