Using ultrasound to improve peripheral intravenous access rates at an outpatient infusion center: a quality improvement project

Successful intravenous (IV) access on the first attempt is crucial for effective medication delivery, enhanced patient comfort, and prevention of complications and delays. This project aimed to improve the first-attempt IV cannulation success rate by implementing the ADIVA tool and ultrasound-guided technology in an outpatient infusion center.Methodology: This quality improvement project spanned twelve weeks and was conducted at an outpatient infusion center in Essex County, New Jersey. Patients were screened using the ADIVA tool, and those with a score >4 were eligible for ultrasound-guided IV placement. Staff became certified in ultrasound use and were encouraged to use ultrasound in these cases. Staff feedback was gathered through pre- and post-implementation surveys administered via Qualtrics, and retrospective chart reviews were conducted five weeks before and after the intervention.Results: The study included five clinical staff members and 198 pre-implementation and 169 post-implementation patients. The first-attempt IV cannulation success rate decreased from 94.44% pre-implementation to 89.35% post-implementation. Staff only utilized ultrasound after two or more failed attempts. Although no statistically significant change in first-attempt success was observed, staff surveys indicated an increased likelihood of utilizing ultrasound for future patients with difficult IV access (DIVA).Implications for Practice: Integrating the ADIVA tool with ultrasound-guided IV cannulation can improve first-attempt success rates in DIVA patients by facilitating early identification and intervention, but staff training and comfort are key to its successful use. Keywords: Adult difficult intravenous access (ADIVA) tool, difficult cannulation, ultrasound-guided intravenous (IV) therapy, ultrasound for difficult intravenous access