# Teaching Ultrasound-Guided Peripheral Cannulation to Doctors in the UK: A Quality Improvement, Feasibility, and Impact Evaluation

## TL;DR

A one-hour training session improved doctors' confidence in using ultrasound for IV cannulation, potentially reducing delays in patient care.

## Contribution

Demonstrates that a brief, mixed-modality training session can significantly boost clinicians' confidence in ultrasound-guided cannulation.

## Key findings

- Self-reported confidence in ultrasound-guided cannulation increased from 1.35 to 9.23 after training.
- 74.3% of participants reported successful clinical use of the technique three months later.
- Only 5.7% of participants required escalation for difficult cannulations post-training.

## Abstract

Introduction

Timely peripheral IV access is essential for delivering lifesaving treatments such as IV antibiotics in septic patients. However, many doctors lack confidence and technical proficiency in ultrasound (US)-guided cannulation, which may contribute to treatment delays and unnecessary escalation to senior or anesthetic colleagues.

Methods

As part of a quality improvement initiative, a single-center pre-post educational evaluation without a control group was conducted to assess the impact of a brief US-guided peripheral IV cannulation (US-PIVC) teaching intervention on clinicians’ self-reported confidence and subsequent translation into clinical practice. A reproducible one-hour mixed-modality session combining concise didactic instruction with supervised hands-on practice using Blue Phantom 2-Vessel Vascular Block phantoms was delivered. US machines equipped with high-frequency linear probes were used. The primary outcome was change in self-reported confidence, measured using a 10-point Likert scale across six domains. Secondary outcomes included self-reported clinical application, escalation to senior or anesthetic colleagues, and perceived need for further phantom practice at three months. Baseline surveys gathered information regarding escalation for difficult cannulations and perceived treatment delays. Confidence was measured immediately before and after training, and a three-month follow-up survey assessed subsequent clinical use.

Results

Twelve sessions trained 84 doctors. Baseline responses (n = 67) indicated that 83.6% had escalated difficult cannulations to senior or anesthetic colleagues in the preceding six months, and 91.0% perceived delays in patient care due to IV access difficulties. Pre-session confidence across all domains was low (mean scores, 1.21/10-4.61/10). Post-session confidence increased markedly to mean scores of 8.96/10-10.00/10. Overall confidence in using the US to aid cannulation increased from 1.35 ± 0.89 to 9.23 ± 1.22. At the three-month follow-up (n = 35; 41.7% response rate), 74.3% reported successful clinical use of US-PIVC, 88.6% felt no additional phantom practice was needed, and 5.7% had required escalation; however, baseline and follow-up escalation data were derived from different respondent groups and therefore do not represent a matched comparison.

Conclusions

A single one-hour mixed-modality US-PIVC teaching session, delivered using existing hospital resources, was associated with substantial improvements in self-reported confidence and self-reported clinical application among respondents. As the primary outcome was subjective confidence and no objective performance or patient-level outcomes were collected, the clinical impact should be interpreted cautiously. Brief, structured US-PIVC teaching sessions may enhance perceived procedural independence if embedded early in training, although further evaluation incorporating objective metrics is required to confirm clinical benefit.