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Improving Intravenous Access in Anesthesia Practice
Dissertation

Improving Intravenous Access in Anesthesia Practice

Megan Clements
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Difficult intravenous access (DIVA) is a common challenge in perioperative care, contributing to procedural delays and increased complications. Ultrasound-guided vascular access (USGVA) improves first-attempt success rates, reduces procedure time, and enhances patient safety; however, many experienced Certified Registered Nurse Anesthetists (CRNAs) were trained prior to incorporation of ultrasound education into anesthesia curricula. Purpose: The purpose of this Doctor of Nursing Practice project was to implement and evaluate a USGVA training program for experienced CRNAs to improve knowledge, confidence, and short-term skill retention in managing DIVA patients in the main operating room. Methods: A quality improvement design guided by the Iowa Model of Evidence-Based Practice was utilized. The intervention included an online didactic module followed by hands-on simulation training. Knowledge and confidence were measured at baseline, immediately post-intervention, and at 30-day follow-up. Repeated-measures analysis of variance and Friedman testing were used to evaluate changes over time. Direct observation assessed clinical translation of ultrasound-guided peripheral intravenous placement skills. Findings: Seven participants completed all study phases. Knowledge scores increased significantly from baseline to post-training (p < .001) and remained significantly higher at 30-day follow-up (p = .002). Confidence scores improved significantly from baseline to post-training (p = .002) and were sustained at follow-up (p = .004). Observational assessment confirmed appropriate application of ultrasound-guided technique in clinical practice. Discussion: A structured didactic and simulation-based USGVA training program significantly improved CRNA knowledge and confidence, with sustained short-term retention and successful translation to practice. Standardized ultrasound education for experienced anesthesia providers may support improved efficiency, provider competency, and perioperative safety.
 ultrasound-guided vascular access difficult intravenous access education training simulation

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