The use of paramedics to establish an in-hospital ultrasound-guided peripheral intravenous access program

Abstract

Introduction:

The objective of this study is to evaluate the feasibility and effectiveness of an ultrasound-guided peripheral intravenous access program performed by paramedics in the emergency department.

Methods:

This was a retrospective, multicenter study. The medical director for each site was required to provide proof of completion of didactic training on the use of ultrasound to facilitate peripheral intravenous catheter placement; paramedic completion of hands-on training; and direct observation of successful cannulation. Training and requirements for credentialing were standardized among all institutions. Each institution utilized a secure data collection tool to collect data. Paramedics were required to complete a brief survey to collect quality improvement data each time an ultrasound-guided peripheral intravenous access attempt was made.

Results:

A total of 1368 survey responses were collected over 19 different sites. The overall success rate for ultrasound-guided PIV catheter placement was 95.72% (1297). Of those successful cannulations, 96.38% (1250) were completed on the first attempt of insertion, 3.32% (43) required two attempts, and 0.31% (4) reported requiring three attempts. Twenty-four complications following cannulation attempts were reported, with the most common being infiltration. The out-of-plane approach was most often used (83.77%, 1146), versus in-plane approach (16.23%, 222). The most frequent site of peripheral intravenous catheter placement was the forearm. (57.7%, 749), followed by the antecubital fossa, brachial and basilic vein respectively. The highest complication rate occurred at the basilic vein.

Conclusion:

In the face of expanding staffing shortages and a continued need for timely peripheral intravenous catheter placement, it is imperative to explore its application among paramedics. By incorporating ultrasound-guided peripheral intravenous catheter placement into their practice, paramedics may have the potential to improve the efficiency and success of catheter placements, thereby enhancing patient outcomes and streamlining workflow in the emergency department.