022 How to Start a Nurse Ultrasound IV Access Training Program w/Bret Nelson, MD

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Bret P. Nelson, MD, RDMS, FACEP

Bret Nelson SAEM Headshot 20172
Courtesy of Bret Nelson
Twitter: @bretpnelson
Website: SinaiEM.us

Bret Nelson is a Professor of Emergency Medicine, Chief of the Emergency Medicine Ultrasound Division at the Icahn School of Medicine at Mount Sinai, Chief Editor of the ultrasound education website, www.SinaiEM.us. He is on the board of directors of the Society for Clinical Ultrasound Fellowships and active in the American College of Emergency Physicians (ACEP)’s Ultrasound Section and is among the authors of ACEP’s Emergency Ultrasound Guidelines. Served on the Board of Directors of the World Interactive Network Focused on Critical Ultrasound (WINFOCUS) and was Chair of the American Institute of Ultrasound in Medicine’s Point of Care Community of Practice

Authored several books, Manual of Emergency and Critical Care Ultrasound, Emergency Medicine Oral Board Review Illustrated, Atlas of Handheld Ultrasound, and Acute Care Casebook.

Dr. Nelson has lectured throughout the world on the use of point-of-care ultrasound to aid medical decision-making and improve patient safety. His research interests include ultrasound and medical education.

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“This isn’t some brand new skill. This is a technique through which you can optimize your existing skills in venous access.” ~Bret Nelson

How to Start a Nurse Ultrasound IV Training Program?!

Nurse Driven Program

  • Nurses interested in ultrasound should be the course director(s).
    • Doesn’t necessarily have to be the unit Nurse Educator.
    • If working with MD, have multiple Course Directors or MD can be there to help out initially.
    • Nurses can and should drive this program.
    • Nurses teaching nurses a new skill offers insight that providers aren’t able to provide.
  • Only takes 1-2 Nurses to drive practice change within a unit!

Multidisciplinary Course Directors and/or Instructors (RN and MD)

  • Both nurses and physicians bring a lot of their own skills to the table.
  • Combining skills, we learn from each other and ultimately become better at obtaining IV access with ultrasound use.

ED Initiative for ED Nurses and ED Culture Utilizing Multidisciplinary Support

  • A positive initiative that improves patient care.
  • We created a culture where once a nurse finishes competency, they are able to place ultrasound-guided IV access on their own. Sometimes, you run into trouble and usually it’s because the patient has limited veins, so they are still able to ask for help. Have another person look with the ultrasound. It’s okay to ask for help!
  • This has also increased more collegial respect between disciplines and increased teamwork.
  • Nurse buy-in and Physician buy-in
  • We decided to make this program optional for nurses.
  • Currently we only have this program for our adult population in the ED.
  • Nurses love the program and so do our patients!

Support from Nursing and Physician Leadership

  • Talk to your Nursing and Physician Directors of your department.
  • Keep them in the loop.
  • I have found Leadership to be extremely supportive and helpful.

Nursing Policy and Nursing Education

  • Written policy for nurses is important to have in writing within your department/institution.
    • Work with your Nursing Director and/or Nursing Education in order to develop policy if it’s not already written or change/expand existing policy.
    • Know your policy. Some may restrict this skill to nurses working in specific departments.
    • Took us awhile to get the green light and policy.
  • Nursing Education requires nurses to have a training program and competency before performing skill on their own.
    • Lots of admin stuff but worth it.
    • *Docs reading this – There’s no workaround, you must do this.
    • Our training program requires the following:
      • Didactic portion
      • Hands-on training portion with using gel models and ultrasound machines
      • Competency
        • *Our competency requires nurses to have 10 supervised insertions and an OSCE checklist for the first one.
        • You may find you will need less or more supervised insertions.

Desire for Program/Currently No Program

  • Send nurses from your shop to an established course to obtain skill
    • Beneficial to brush up on existing skills
    • Beneficial to experience a different course and apply teaching methods in own shop
  • Take the initiative and work with a provider who has ultrasound training

Program Improvement

  • See what works for your shop and modify the training program to suit your needs
  • Get feedback from nurses who have taken the training program.
  • Get feedback from physicians who are helping with supervision.

Our Tip Sheet! (in the spirit of #FOANed and #FOAMed)

RN_USTip Sheet 

Bret and I would love your feedback on this!

Write your comments below!

Reference: click here for dropbox link and easy download

  1. AIUM Practice Parameter for the Use of Ultrasound to Guide Vascular Access Procedures. (2012). American Institute of Ultrasound in Medicinehttps://www.aium.org/resources/guidelines/usGuidedProcedures.pdf
  2. Au, A. K., Rotte, M. J., Grzybowski, R. J., Ku, B. S., & Fields, J. M. (2012). Decrease in central venous catheter placement due to use of ultrasound guidance for peripheral intravenous catheters. The American Journal of Emergency Medicine,30(9), 1950-1954. http://dx.doi.org/10.1016/j.ajem.2012.04.016
  3. Brannam, L. (2004). Emergency Nurses Utilization of Ultrasound Guidance for Placement of Peripheral Intravenous Lines in Difficult-access Patients. Academic Emergency Medicine,11(12), 1361-1363. doi:https://doi.org/10.1197/j.aem.2004.08.027
  4. Costantino, T. G., Parikh, A. K., Satz, W. A., & Fojtik, J. P. (2005). Ultrasonography-Guided Peripheral Intravenous Access Versus Traditional Approaches in Patients With Difficult Intravenous Access. Annals of Emergency Medicine,46(5), 456-461. doi:https://doi.org/10.1016/j.annemergmed.2004.12.026
  5. Duran-Gehring, P., Bryant, L., Reynolds, J. A., Aldridge, P., Kalynych, C. J., & Guirgis, F. W. (2016). Ultrasound-Guided Peripheral Intravenous Catheter Training Results in Physician-Level Success for Emergency Department Technicians. Journal of Ultrasound in Medicine,35(11), 2343-2352. doi:https://doi.org/10.7863/ultra.15.11059
  6. Emergency Nurses Association. (2015). Clinical Practice Guideline: Difficult Intravenous Access. https://www.ena.org/docs/default-source/resource-library/practice-resources/cpg/difficultivaccesscpg.pdf?sfvrsn=9944da58_12
  7. Feinsmith, S., Huebinger, R., Pitts, M., Baran, E., & Haas, S. (2017). Outcomes of a Simplified Ultrasound-Guided Intravenous Training Course for Emergency Nurses. Journal of Emergency Nursing. doi:https://doi.org/10.1016/j.jen.2017.10.001
  8. Fields, J. M., Dean, A. J., Todman, R. W., Au, A. K., Anderson, K. L., Ku, B. S., . . . Panebianco, N. L. (2012). The effect of vessel depth, diameter, and location on ultrasound-guided peripheral intravenous catheter longevity. The American Journal of Emergency Medicine,30(7), 1134-1140. doi:https://doi.org/10.1016/j.ajem.2011.07.027
  9. Moore, C. (2013). An Emergency Department Nurse-Driven Ultrasound-Guided Peripheral Intravenous Line Program. Journal of the Association for Vascular Access,18(1), 45-51. http://dx.doi.org/10.1016/j.java.2012.12.001
  10. Oliveira, L., & Lawrence, M. (2016). Ultrasound-Guided Peripheral Intravenous Access Program for Emergency Physicians, Nurses, and Corpsmen (Technicians) at a Military Hospital. Military Medicine,181(3), 272-276. doi:https://doi.org/10.7205/MILMED-D-15-00056
  11. Schoenfeld, E., Boniface, K., & Shokoohi, H. (2011). ED technicians can successfully place ultrasound-guided intravenous catheters in patients with poor vascular access. The American Journal of Emergency Medicine,29(5), 496-501. doi:https://doi.org/10.1016/j.ajem.2009.11.021
  12. Shokoohi, H., Boniface, K., Mccarthy, M., Al-Tiae, T. K., Sattarian, M., Ding, R., . . . Yadav, K. (2013). Ultrasound-Guided Peripheral Intravenous Access Program Is Associated With a Marked Reduction in Central Venous Catheter Use in Noncritically Ill Emergency Department Patients. Annals of Emergency Medicine,61(2), 198-203. http://dx.doi.org/10.1016/j.annemergmed.2012.09.016

Cite this post as:

Yun Cee Dirsa. 022 How to Start a Nurse Ultrasound IV Access Training Program w/Bret Nelson, MD. Resus Nurse Podcast and Blog. Published on September 12, 2018. Date accessed December 19, 2018. Available at https://resusnurse.com/2018/09/12/022-how-to-start-a-nurse-ultrasound-iv-access-training-program-w-bret-nelson-md/.

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