• Am J Emerg Med · Aug 2021

    Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses.

    • Evan M Davis, Sarah Feinsmith, Ashley E Amick, Jordan Sell, Valerie McDonald, Paul Trinquero, Arthur Moore, Victor Gappmaier, Katharine Colton, Andrew Cunningham, William Ford, Joseph Feinglass, and Jeffrey H Barsuk.
    • Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, USA. Electronic address: edavis@epmg.com.
    • Am J Emerg Med. 2021 Aug 1; 46: 539-544.

    BackgroundDifficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA.ObjectivesWe aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA.MethodsWe retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV.ResultsA total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p < 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p < 0.001).ConclusionDIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.Copyright © 2020 Elsevier Inc. All rights reserved.

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