Magnet Coordinator McLeod Regional Medical Center Florence, South Carolina
Purpose - What was the goal of the study?: To evaluate the impact of a quality improvement initiative that implemented near-infrared (NIR) technology to improve peripheral intravenous catheter (PIVC) placement in oncology and nephrology patients likely to have difficult intravenous access (DIVA). Staff were educated on NIR-guided PIV assessment and equipped with NIR devices.
Background - What was the problem? Why was it important?: Over 300 million PIVCs are placed annually in the United States, making it the most frequently performed medical procedure.[1-2] An average of 2.18-2.35 attempts are required to place a single PIV. Patient characteristics, along with provider confidence and experience, influence the likelihood of success. Repeated attempts lead to an increased use of resources and increased risk of venous depletion, nerve damage, paresthesia, hematomas and arterial puncture. New technologies that enhance PIV access, such as NIR vein visualization, have become available over the last decade. NIR can improve PIV access, by decreasing the time to successful placement and the number of attempts, especially in patients with potentially difficult PIV access.[6-12] Yet, adoption of this beneficial technology is limited. This poster will present findings of a survey administered to nurses using NIR (n=55) compared with those not using NIR (n=41) in an oncology and nephrology unit. Outcome measures included first attempt success and usability of the NIR device (AV500, AccuVein Inc., Newton, MA). The A-DIVA scale was used to identify patients with potentially difficult PIV access.
Results - What were the findings?: A 20% increase in first attempt success rate was found in the NIR group (n=40, 72.7%) vs the No NIR group (n=21, 51.2%), and this was statistically significant (P = .035). For patients categorized as moderate risk on the A-DIVA scale (n = 36) a 65% increase in first attempt success rate was found in the NIR group (n = 19, 82.6%) vs the No NIR group (n = 2, 15.4%), and this was also statistically significant (P < .05). Most participants (n=24, 92.3%) reported that the NIR device was effective and had good usability in terms of improving PIVC placement skills.
Conclusions - What do the final outcomes mean?: This quality improvement initiative highlighted the impact of NIR vein visualization technology on first attempt success in an oncology and a nephrology unit. First attempt success was significantly higher using NIR vein visualization technology and in patients with a moderate A-DIVA score. Further data collection is needed to validate the findings of this initiative. Nonetheless, NIR vein visualization technology is a valuable clinical tool that can improve PIVC access and care. A key component of successful adoption of NIR vein visualization technology is ensuring that devices are routinely used as an assessment tool rather than an escalation tool.