News from the Annual Scientific Meeting of the Association for Vascular Access
Nancy Moureau, RN, BSN, RN, CRNI®, CPUI, VA-BC™, this year’s recipient of the
Suzanne LaVere Herbst Award, presented her findings from an extensive literature review on the success rates of ultrasound-guided peripheral catheter/midline (USGPIV) insertion. Drawing on her decades of experience as an infusion nurse, Ms. Moureau began her talk by stating that USGPIV and midline catheter use has been continuing to increase as a response to address central line-associated blood stream infections (CLABSIs) and decrease the use of central venous catheters (CVCs). She continued that although the current data suggests USGPIV is a successful procedure, what she found in her research is that failed USGPIV attempts are a common occurrence and that these failures are also under-reported. Additionally, the number of attempts with USGPIV is actually high due to skewed data analysis in some widely accepted literature.
This current literature states that overall USGPIV success is between 47% and 100%. However, when the literature is examined more thoroughly, the first time insertion success is actually between 46% and 56%. The reason for the discrepancy lies in the definition of success. In many cases, success is defined as placing a catheter and confirming patency no matter how many sticks are required. Ms. Moureau’s literature search determined that USGPIV attempts ranged from between 1 to 10 attempts per patient.
Additionally, the literature also showed that first-hour failure rates were between 8% and 13%. This increased to over 45% within the first 24 hours and, finally, only 19% of catheters placed actually survived more than 72 hours.
To improve success, the speaker recommended scanning the vein to understand which access point on the peripheral anatomy is the best choice. Also, a recommendation of extensive training on USGPIV placement method was made which should include between 45 minutes and 4 hours of didactic sessions with additional insertions happening under supervision by an experienced user. However, when the speaker queried the audience to determine an approximation of how many attendees were using USGPIV placement, but were never formally trained, the percentage was high.
AVA 2014 attendees are able to access Ms. Moureau’s presentation at the AVA website. Click
here and browse speakers by name.
Procure the full article here.