The ultrasound-guided peripheral intravenous catheters are used at the emergency department as alternative to traditional intravenous access due to optimal outcomes (Stone et al., 2013). This new type of technique of vascular access has been chosen for an emergency department patient due to its benefits it has come with especially to patient-centered characteristics that include obesity and past history of intravenous drug abuse. The rates of obesity are currently on the rise in the U.S. and therefore, the subset of emergency department patients are in need for alternative methods of intravenous access are increasing (Stone et al., 2013). Additionally, on characterizing the patients it will provide important information in consideration for their management. As such, without access to the new technology and if the peripheral intravenous cannot be placed, a patient will receive external jugular catheter or central venous catheters. This two traditional access have been established to have significant complication rates and it call only to be placed when there is the medical necessity, rather than for simply routine access(Stone et al., 2013). As a result, if it is placed in clients without a sign of central-line placement will expose the patient to complications such as pneumothorax, arterial puncture, and bacteremia. On the other hand, using ultrasound-guided peripheral intravenous access provide a less-invasive vascular-access alternative for those patients.
Benefits
The ultrasound guidance for the insertion of the peripheral intravenous (PIV) catheters is a new development that should be embraced by the healthcare industry. This technique comes with lots of benefits compared with the traditional method of gaining PIV access (Meer, 2015). This new technique will allow cannulation of the veins that are not palpable and visible. Secondly, it reduces the need for the central line and its probable complications. This is because the traditional method of PIV catheter insertion demands for expertise in vascular anatomy to estimate accurately the targeted vessel. Tradition approach (a central venous catheter) comes together with various problems which it will be overcome by the new technique (Meer, 2015). First, the traditional approach is having the problem of locating vessels which vary considerably due to anatomic variability. Secondly, veins through traditional approach can be distorted due to scarring from the last cannulation sclerosis. Third, through traditional approach veins are cumbersome to palpate to obese patients. Fourthly, patients who are difficult to access are continuously subjected to various insertion attempts by different operators thus making them have high risk of complications.
Fifthly, when traditional approach fails, the only means to gain intravenous access is the blind positioning of the PIV catheter at deep brachial vein or place an external jugular which comes along with high health risk. More so, most of the healthcare providers are not skilled in accessing blind brachial vein catheterization. This technique comes with high percentages of failure and complication. Furthermore, the external jugular vein is usually not visible in all patients and in most cases patients cannot tolerate Trendelenburg spotting applied to external jugular catheters (Meer, 2015). The possible solution to the above problems is the introduction of ultrasound equipment which is very useful for visualizing vessels.
Ultrasound PIV catheter placement has been tested to result in first-pass and higher overall success rates with very low complication rates (Meer, 2015). This alternative method and basilica vein cannulation safe and are associated with high success rate. Additionally, ultrasound-guided PIV placement is more successful, reduced the number of needle punctures, improved patient satisfaction and required less time. Ultrasound-guided placement can also be used by other trained emergency nurses and technicians apart from emergency physicians and residents who can effectively and safely perform ultrasound-guided PIV catheters thus, it will decrease the occurrence of procedural tasks needed by emergency physicians and ultimately decreased the cost of running the organization (Meer, 2015).
Cost or Budget Justification
If ultrasound-guided peripheral placement is used in emergency department, it will drastically diminish the rate of unsuccessful attempts (Schoenfeld et al., 201). It will eliminate frustration and delay which subsequently reduces the use of staff time and supplies. Hence, the use of ultrasound-guided peripheral intravenous will be beneficial to the organization. It will cost a vascular access nurse $25,000 to place a peripherally inserted central catheter (PICC) (Schoenfeld et al., 2011). Additionally, it will cost $6000 to place ultrasound peripheral intravenous (USPIV) in line. This will give a total of $31,000 which is sustainable. Nurses and other clinicians are also required to undergo USGPI which requires an additional cost. Nurses and clinicians will have to be taught on the core content such as infection prevention, insertion technique, patient education, family education, anatomy and physiology (Schoenfeld et al., 201). This will require an additional cost of $500 per each practitioner to enroll in class.
Evaluation
It is important that the outcomes are measured and analyzed. Before implementing the ultrasound-guided peripheral intravenous technique, it is crucial that all healthcare providers are properly trained (Schoenfeld et al., 2011). The potential complications of peripheral line maintenance and insertion, as well as inflammation, infection, infiltration, extravasation and phlebitis, will be track and evaluated after every three months (Schoenfeld et al., 201). Evaluation of the effectiveness of the ultrasound equipment will be done by giving out questionnaires to the various patients. The details of the severe insertion-related complications will be documented after assessment and the report to be filed after five months. It will be then given to the program leadership and the provider. The level of the patient satisfaction and comfort will serve as good indicators of the success of the program.
References
Meer, J. M. (2015). Ultrasonography Assisted Peripheral Line Placement: Overview, Indications, Contraindications. Retrieved from http://emedicine.medscape.com/article/1433943-overview
Schoenfeld, E. M., Shokoohi, H., & Boniface, K. (2011). Ultrasound-guided peripheral intravenous access in the emergency department: patient-centered survey. Western Journal of Emergency Medicine, 12(4).
Stone, P., Meyer, B., Aucoin, J., Raynor, R., Smith, N., Nelles, S., & Grissom, J. (2013). Ultrasound-guided peripheral IV access: Guidelines for practice. American Nurse Today, 8(8).
