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Dissertation
Establishing Intravenous Access in an Ambulatory Surgery Center
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2024
Abstract
Background An opportunity existed at this ambulatory surgery center to optimize peripheral intravenous catheter (PIV) insertion processes and empower nursing staff to practice at their full scope. Difficult intravenous access (DIVA) can lead to higher healthcare costs, delays in care, and patient discomfort (Sou et al., 2017). Ultrasound guidance (USG) should be considered for early use in patients at high risk for DIVA (Sweeny et al., 2022). Purpose The purpose of this Doctor of Nursing Practice project was to implement evidence-based recommendations for the use of USG to place PIVs. At the project site, a combination of difficult vascular access patients, lack of experience, and high turnover among nursing staff resulted in suboptimal PIV placement rates. Methods The Iowa Model & Implementation Framework guided project implementation to bridge the gap between current practices and optimal PIV insertion. A mastery learning model was developed involving asynchronous education, live demonstration, deliberate simulation practice, and formative and summative assessment of USG PIV placement. Every simulated procedure was evaluated with a 12-point technique checklist created using the Modified Delphi method. Trainee competence was based on successful completion of all checklist points. Frequency of surgical case delays, cancellations, anesthesia consults for PIV placement assistance, and patient comments related to PIV issues were collected. Findings Five nurses were educated and demonstrated competency in USG PIV insertion. These individuals collectively placed 124 USG PIVs for patients during the first three months post-training. Outcomes included an 88.2% success rate. Preoperative anesthesia placed PIVs decreased from 6.38% to 0.88% (p = 0.02), and patient satisfaction regarding “skill of nurse inserting PIV” increased. Discussion A “train-the-trainer” approach was employed to foster sustainability. Interrater reliability between the project director and upcoming USG PIV skill evaluators was achieved to support continued staff training initiatives.
Details
- Title: Subtitle
- Establishing Intravenous Access in an Ambulatory Surgery Center
- Creators
- Kelsey Wood - University of Iowa
- Contributors
- Cormac O'Sullivan (Chair) - University of Iowa
- Resource Type
- Dissertation
- Project Type
- Poster
- Degree Awarded
- Doctor of Nursing Practice (DNP), University of Iowa
- Degree in
- Nurse Anesthesia
- Date degree season
- Spring 2024
- Publisher
- University of Iowa
- Number of pages
- 1 page
- Copyright
- Copyright © 2024 Kelsey Wood
- Language
- English
- Academic Unit
- Doctor of Nursing Practice Projects; College of Nursing
- Record Identifier
- 9984627256502771
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