Introducing an ultrasound-guided longer length peripheral IV catheter for patients with difficult venous access

Aim: Insertion of a peripheral intravenous catheter (PIVC) is one of the most common procedures carried out in hospitals worldwide, but failure rates are unacceptably high. This local quality improvement project aimed to assess improvements in first-stick success rate, dwell time and overall catheter success rate when implementing a longer-length peripheral intravenous catheter (LPIVC) under ultrasound guidance for patients with difficult venous access (DVA). Methods: Data were collected from 386 DVA patients requiring a PIVC at one hospital. Number of catheter insertion attempts, catheter dwell time and reason for catheter removal were recorded for each patient. To implement the new DVA catheterisation pathway, registered nurses undertook a training programme comprising workshops and ultrasound-guided cannulation technique practice on phantoms. Costs and waste weights associated with LPIVC insertion, compared with midline insertion, were calculated. Results: First-stick success rate was 95.0% using the LPIVC under ultrasound guidance. Dwell time ranged from 1 to 80 days, with a large proportion of those dwelling <1 day being placed in day-case patients. Treatment success rate with the LPIVCs was 83.6%. Equipment costs for an LPIVC insertion were £89.22 lower than for a midline insertion, and the weight of waste generated per procedure was 1 kg lower for LPIVCs. Conclusions: First-stick success rate of LPIVCs, aided by improved purchase in the vein and visualisation with ultrasound guidance, was very high, superior to rates reported in other studies. The procedure provides a better patient experience as successful first attempts avoid unnecessary further insertion attempts. Other benefits are increased nursing time efficiency, a reduction in clinical waste and the lower cost of the equipment required.