Improving the Process of Arterial Blood Collection With Point of Care Ultrasound

Abstract

Background:

In 2017, I attended a seminar educating respiratory therapists on how to implement a vascular access program. The workshop introduced me to the benefits of using Point of Care Ultrasound (POCUS) for needle puncture procedures. I returned to my home hospital with aspirations of diving into developing a vascular access team of Respiratory Therapists. Unfortunately, when I brought the idea to my leadership team I was stopped in my tracks with a hard, No." My inherent persistence would not allow me to let go of the concept altogether. Respecting the boundaries set forth by my profession’s scope of practice and my hospital’s policies I conducted a pilot study comparing POCUS-guided arterial punctures with the traditional blind-stick palpation method.

Methods:

Data was collected from 100 adult patients to include 50 POCUS-guided and 50 blind-stick arterial punctures. The POCUS-guided team performed 35 successful POCUS-guided punctures before data collection to gain competency for the procedure. The study group included data from both radial and brachial puncture sites, using both transverse and longitudinal ultrasound views.

Results:

Average time for the blind-stick method in 50 patients was 31.68 minutes versus 12.14 minutes for the POCUS-guided method. For the blind-stick method, 18 of the 50 ABG’s (36%) were resulted in <20 minutes versus 43 of the 50 (88%) for the POCUS-guided method. Average puncture attempts required to successfully obtain a sample using the blind-stick method was 1.36 (35 successful on first attempt, 12 successful on second attempt and 3 successful on third attempt.) With 35 of 50 procedures being successful on first attempt, that gives a 70% first attempt success rate for the blind-stick method. Average puncture attempts required for the POCUS-guided method was 1.01, a first attempt success rate of 96% (48 successful on first attempt, 2 successful on second attempt.) Conclusions: POCUS was recognized as a best practice for deep needle puncture procedures in 2001. The technology is constantly evolving in terms of affordability, portability, miniaturization and ease of use. Drawing blood is the single most frequently performed medical procedure, with roughly 760 inpatient blood draws performed in the United States every minute. POCUS is a billable procedure that improves success rate, decreases complications and enhances the patient experience. POCUS should be considered the standard of practice for all needle puncture procedures including venous and arterial punctures. "