Kessler Ross, Hall Jane, Chipman Anne K, Hall Michael Kennedy, Amick Ashley
Department of Emergency Medicine, University of Washington, Seattle, WA, USA.
J Vasc Access. 2025 Mar;26(2):578-585. doi: 10.1177/11297298241230109. Epub 2024 Feb 19.
Ultrasound-guided peripheral IV catheter (USGIV) insertion is as an effective procedure to establish access in patients with difficult intravenous access (DIVA), a condition frequently encountered in the Emergency Department (ED). This study describes a DIVA quality improvement program focusing on rapid identification of DIVA patients and emergency nurse USGIV training and evaluates its impact on overall frequency of USGIV use and process measures related to quality of patient care.
This is a retrospective cohort study of patients over 18 years of age, presenting to a single, tertiary care hospital between September 1, 2018 and September 30, 2020. Difference-in-difference analysis was used to compare ED process measures pre- and post-implementation of the DIVA Program, and multivariate logistic regression was used to identify associations between patient characteristics and difficult IV access.
The frequency of ED encounters associated with USGIV placement more than doubled post-implementation of the DIVA Program, rising from 606 to 1323. There were improved covariate-adjusted time estimates of core ED process measures for encounters associated with USGIV placement post-implementation, including decreases in time to CT with contrast from 4.8 h (95% CI = 4.4-5.2) to 4.1 h (95% CI = 3.8-4.4), pain medications from 2.4 h (95% CI = 2.1-2.6) to 1.8 h (95% CI = 1.6-2.0), IV antibiotics from 3.0 h (95% CI = 2.4-3.7) to 2.1 h (95% CI = 1.5-2.6), and ED length of stay from 6.4 h (95% CI = 6.2-6.6) to 6.0 h (95% CI = 5.9-6.2).
A nurse-focused quality improvement program focused on teaching and promoting USGIV as a modality for managing difficult IV access was associated with increases in USGIV placement and improvements in core process measures related to quality of patient care.
超声引导下外周静脉导管（USGIV）置入是为静脉穿刺困难（DIVA）患者建立通路的有效方法，DIVA在急诊科（ED）是一种常见情况。本研究描述了一项针对DIVA的质量改进计划，重点是快速识别DIVA患者以及对急诊护士进行USGIV培训，并评估其对USGIV总体使用频率以及与患者护理质量相关的过程指标的影响。
这是一项对2018年9月1日至2020年9月30日期间到一家三级医疗中心就诊的18岁以上患者的回顾性队列研究。采用差分分析比较DIVA计划实施前后的急诊过程指标，采用多因素逻辑回归分析确定患者特征与静脉穿刺困难之间的关联。
DIVA计划实施后，与USGIV置入相关的急诊就诊频率增加了一倍多，从606次增至1323次。实施后，与USGIV置入相关的急诊核心过程指标的协变量调整时间估计有所改善，包括增强CT检查时间从4.8小时（95%CI=4.4-5.2）降至4.1小时（95%CI=3.8-4.4），使用止痛药物时间从2.4小时（95%CI=2.1-2.6）降至1.8小时（95%CI=1.6-2.0），静脉使用抗生素时间从3.0小时（95%CI=2.4-3.7）降至2.1小时（95%CI=1.5-2.6），急诊留观时间从6.4小时（95%CI=6.2-6.6）降至6.0小时（95%CI=5.9-6.2）。
一项以护士为重点的质量改进计划，专注于教授和推广将USGIV作为处理静脉穿刺困难的一种方式，与USGIV置入次数增加以及与患者护理质量相关的核心过程指标改善有关。
