title: The use of ultrasound for peripheral IV placement by vascular access team nurses at a tertiary children's hospital.
abstract: OBJECTIVE
  Children receiving treatment in the hospital frequently require intravenous (IV) access. Placement of short peripheral catheters can be painful and challenging especially in those children who have difficult access. Many children's hospitals have teams of specialized vascular access nurses experienced in peripheral catheter insertion, and at times use vein visualization devices, including ultrasound (US), to assist in peripheral IV placement. Our objectives were to describe the prevalence and success rate of US-guided peripheral IV placement by vascular access team nurses at a single tertiary children's hospital.
  
  
  METHODS
  We retrospectively reviewed quality assurance data kept by our institution's vascular access team between February, 2014 and March, 2014. Data extracted included: age, gender, number of attempts, if difficult, if ultimately successful and modality used to aid IV placement. Descriptive statistics and chi-square tests were used to analyze and report data.
  
  
  RESULTS
  There were 1111 patient-nurse encounters reported for peripheral IV placement over a six-week period, and a total of 1579 attempts. Ultimately 84% of the patients had successful IV placement. Overall, visualization and palpation was the most frequently used technique (50.1%), followed by near-infrared light (40.6%), US (8.0%), and transillumination (1.3%). The success rate of US (60% overall and 59.2% difficult) was not significantly different from other advanced visualization techniques.
  
  
  CONCLUSIONS
  Vascular access team nurses use US infrequently for peripheral IV placement, including in children with difficult access. Methods to increase its skillful use in difficult access patients and improve successful IV placements should be explored.
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California - USA.
authors.forename: Marsha
authors.initials: M
authors.lastname: Elkhunovich
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California - USA.
authors.forename: Joanna
authors.initials: J
authors.lastname: Barreras
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California - USA.
authors.forename: Valerie
authors.initials: V
authors.lastname: Bock Pinero
authors.affiliation: Children's Hospital Los Angeles, Los Angeles, California - USA.
authors.forename: Nurit
authors.initials: N
authors.lastname: Ziv
authors.affiliation: University of Southern California, Los Angeles, California - USA.
authors.forename: Aisha
authors.initials: A
authors.lastname: Vaiyani
authors.affiliation: LAC+USC Medical Center, Los Angeles, California - USA.
authors.forename: Thomas
authors.initials: T
authors.lastname: Mailhot
mesh_terms: D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation / Q000451:nursing*; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D006776:Hospitals, Pediatric; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007259:Infrared Rays; D009741:Nursing Staff, Hospital; D010173:Palpation / Q000451:nursing; D010348:Patient Care Team; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D014172:Transillumination / Q000451:nursing; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional / Q000451:nursing*; D062666:Vascular Access Devices