Health System Impact of Emergency Department-Based Vascular Access Program in Patients with Difficult Intravenous Access

TL;DR

This paper describes how a specialized team in an emergency department improved vascular access for patients with difficult intravenous access using ultrasound-guided techniques.

Contribution

The paper introduces a tiered vascular access program led by trained paramedics and EMTs using ultrasound guidance in an academic medical center.

Findings

The vascular access team successfully implemented a program for difficult intravenous access patients.

The program reduced the need for more invasive access and improved vascular preservation.

The team's training and oversight by ultrasound-trained faculty enhanced patient care and hospital efficiency.

Abstract

Ultrasound guided (USG) peripheral intravenous (PIV) access is a vital use of point of care ultrasound (POCUS) that decreases time to access, reduces need for more invasive access, preserves vasculature, and improves patient experience.

We describe the impact of an Emergency Department (ED) based vascular access program with a specialized team of paramedics and emergency medical technicians (EMTs). This team is trained in USG PIV access to assist with patients that have difficult intravenous access (DIVA) both in the ED and throughout the academic medical center.

This descriptive report details the implementation, development, and evolution of a highly skilled vascular access team trained in USG PIV placement at a single academic center. Under the guidance of ultrasound fellowship trained, board-certified Emergency Medicine (EM) ultrasound faculty, ED paramedics and EMTs are provided comprehensive training and oversight of USG PIV placement. Program description, patient selection, and billing capture are described. This report met Institutional Review Board exemption criteria as a descriptive quality improvement project.

This report details the formation and maintenance of a highly skilled vascular access team. The team is comprised of paramedics and EMTs who have been trained in USG PIV placement allowing them to care for patients with DIVA. The evolution of this team has allowed the development of a tiered approach to vascular access and vascular preservation throughout the organization, benefitting both patients and hospital staff.

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