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INSPIRED: Instruction of sonographic placement of IVs by registered nurses in the emergency department

Published:April 20, 2018DOI:https://doi.org/10.1016/j.ajem.2018.04.032
      Ultrasound (US)-guided peripheral IV (US-PIV) placement is a well-established procedure in patients with difficult IV access [
      • Maiocco G.
      • Coole C.
      Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence.
      ,
      • Shokoohi H.
      • Boniface K.
      • McCarthy M.
      • et al.
      Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients.
      ]. Ultrasound has proven to improve success rates and decrease complications in patients with difficult IV access due to obesity, IV drug abuse, and chronic illness or hospitalization; it also reduces the need for central venous catheters (CVC) in this population [
      • Maiocco G.
      • Coole C.
      Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence.
      ,
      • Shokoohi H.
      • Boniface K.
      • McCarthy M.
      • et al.
      Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients.
      ,
      • Bahl A.
      • Pandurangadu A.V.
      • Tucker J.
      • Bagan M.
      A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.
      ]. While the majority of research has focused on physician-performed US-PIVs, some studies have evaluated US-PIV insertion by emergency medical technicians and registered nurses (RNs), documenting successful US-PIV insertion rates of 87–97% [
      • Maiocco G.
      • Coole C.
      Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence.
      ,
      • Bahl A.
      • Pandurangadu A.V.
      • Tucker J.
      • Bagan M.
      A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.
      ,
      • Schoenfeld E.
      • Boniface K.
      • Shokoohi H.
      ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access.
      ]. The Emergency Nursing Association endorsed the use of US-PIVs in 2011 [
      • Crowley M.
      • Brim C.
      • Proehl J.
      • et al.
      ENA emergency nursing resources development committee. Emergency nursing resource: difficult intravenous access.
      ].
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      References

        • Maiocco G.
        • Coole C.
        Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence.
        J Nurs Care Qual Jan-Mar. 2012; 27: 51-55
        • Shokoohi H.
        • Boniface K.
        • McCarthy M.
        • et al.
        Ultrasound-guided peripheral intravenous access program is associated with a marked reduction in central venous catheter use in noncritically ill emergency department patients.
        Ann Emerg Med Feb. 2013; 61: 198-203
        • Bahl A.
        • Pandurangadu A.V.
        • Tucker J.
        • Bagan M.
        A randomized controlled trial assessing the use of ultrasound for nurse-performed IV placement in difficult access ED patients.
        Am J Emerg Med. 2016 Oct; 34: 1950-1954
        • Schoenfeld E.
        • Boniface K.
        • Shokoohi H.
        ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access.
        Am J Emerg Med. 2011 Jun; 29: 496-501
        • Crowley M.
        • Brim C.
        • Proehl J.
        • et al.
        ENA emergency nursing resources development committee. Emergency nursing resource: difficult intravenous access.
        J Emerg Nurs. 2011; 38 (Jul 2012): 335-343