Without established criteria for nurses to identify patients with difficult venous access (DVA) nor guidelines on when to seek assistance from those with advanced-skills in vascular access device (VAD) placement, patients are often subjected to multiple IV attempts. Furthermore, the lack of 24/7 availability of nurses with advanced placement skills can result in patients being subjected to an increased number of IV attempts and a differing level of care after hours. Increased attempts can potentially increase complications related to VAD access and result in the need to place central lines (PICCs or CVADs) that would otherwise not be medically indicated, further increasing costs and risks to patients.
Specialized vascular access teams have demonstrated improved patient outcomes, fewer complications, and reduced costs associated with vascular access (INS, 2016; Whalen et al., 2018). In an effort to improve patient outcomes related to vascular access device placement, specifically on DVA patients, a cohort of nurses were trained at a 275-bed public district hospital to insert guidewire assisted peripheral IV catheters using ultrasound. Despite numerous hurdles, a total of 34 nurses in various departments and working on all shifts were successfully trained and are now called upon to assist with IV placement for DVA patients.
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