Addressing the need for catheter placement skill

Laura Hollis, DNP, RN, NE-BC

Any patient who’s had a central Venous access device or peripheral IV placed knows the feeling of closing their eyes, bracing themselves and hoping it just takes one needle stick to get it right. “It can be anxiety-provoking,” says Laura Hollis, DNP, RN, NE-BC, Vice President of Nursing Operations, HCA Healthcare, TriStar Division. “We want patients to have a pleasant vascular access experience. We want to get it right the first time.”

However, IV placement and catheterization skills are declining nationally, and, in addition to causing patient pain and anxiety, an error could result in suboptimal patient care (and ultimately, reflect poorly on the healthcare facility).

The reason for skill deficiency

Jordan Pujals, MSN, RN, VA-BC

“For the past 10 years, we’ve seen a steady decline in nurses’ comfort level placing peripheral IVs,” says Jordan Pujals, MSN, RN, VA-BC, East Region Director of HealthTrust Workforce Solutions Vascular Access Services. During the pandemic, nursing students missed out on a lot of inpatient educational experiences and had less time on the hospital floor.

“Across the nation, there were limitations to bedside clinical opportunities for nursing students in learning to place regular IVs, which had a downstream impact after completing their education,” shares Hollis. In addition, new nurses are typically precepted by established nurses using skill checklists. Given the national nursing shortage, nurses may come from various staffing sources and are not always familiar with a facility’s equipment, making training even more difficult.

Stacey Holt, MSN, CCNS-BC, CCRN-K

Because bedside staff does not always have the skillset or time to place peripheral IVs, facilities are increasingly using PICC teams, says Stacey Holt, MSN, CCNS-BC, CCRN-K, HCA Healthcare’s TriStar Division Director of Clinical Programs. Health systems are also trying to reduce lengths of stay, and IVs may not need replacing during a patient’s hospitalization. An IV inserted in the emergency department may stay in place until the patient is discharged. This also decreases the opportunities for nurses to practice the skill.

Providing education

Some facilities have purchased ultrasound machines or portable vein-finder devices to assist nurses in needle placement. The problem? “If you don’t know how to turn the vein finder on, it becomes just a pricey paperweight,” says Pujals. She asked for a training program and worked with Hollis and Holt to develop one. Now, 11 of the 17 TriStar Division hospitals have vein-finder devices, and nurses are receiving education on using them. Holt’s team provides various educational opportunities for staff to learn how to use ultrasound and vein-finder devices for venous access. Sometimes device representatives provide roving education in the units to show how they work, or new nurses follow a program pathway that introduces them to the device. Nurse residents following the training pathway receive dedicated classes on the skill, as do those in the critical care pathway. These sessions include a video about the product, didactic education on inserting the lines and hands-on experience using the devices.

Training is empowering

The TriStar Division works hand-in-hand with HealthTrust and supplier partners to ensure the proper supplies and resources are on the formulary. “We’re ensuring our facilities are stocked with compatible and standard resources for inserting peripheral IVs or midlines and other vascular resources. We’re ensuring we comply with our formulary requirements,” Hollis says.

That process included reevaluating the supplies to stock longer catheters that easily remain in the vessel once inserted. The ultrasound-guided IV helps nurses ensure proper placement.

While the program is too new to provide measurable results, Pujals shares that one hospital has seen a decrease in peripheral IV failures and requests for repeated IV sticks. “The nurses feel more confident and are doing a better job,” she adds.

Hollis says that TriStar plans to roll out the education across the division and to share it with the HCA Healthcare enterprise for other divisions to consider as a best practice.

For now, the educational efforts are having a positive impact. “Training empowers the nurses,” says Pujals. “It makes a difference in how nurses feel about their job, and they appreciate that facility leadership wants them to continue their education and growth.”

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