TOP 77 - Speeding Up Access: A Quality Initiative For Ultrasound Guided IV Placement

Publication Number: 1835.TOP 77

Will T. Lester, University of Texas Southwestern Medical School, Dallas, TX, United States; Anna Silberman, University of Texas Southwestern Medical School, Dallas, TX, United States; Olivia L. Hoffman, University of Texas Southwestern Medical School, Dallas, TX, United States

Background: Ultrasound guided peripheral IV (USGIV) placement is safe and effective in critically ill children. The standard practice for obtaining peripheral venous access in our pediatric intensive care unit (PICU) is a nurse-driven consult to the vascular access team (VAT) for USGIV placement. However, the VAT has limited staffing and serves all children admitted to our 490-bed hospital. Patients admitted to the PICU have unpredictable clinical courses that may require emergent venous access. Our clinical providers (attending physicians, fellow physicians, and advanced practice providers) are immediately available to care for these patients, and placing peripheral venous access is within their scope of practice.

Objective: We globally aimed to decrease the median time to successful venous access in critically ill patients by training clinical providers to place USGIV lines to supplement our VAT. Specifically, we aimed to decrease the median time to successful venous access by 25% within 6 months of project implementation.

Design/Methods: We collected data from patients admitted to the PICU in a large, quaternary, academic, pediatric medical center from November 1, 2024 to June 30, 2025 to establish baseline data. We defined the outcome of time to successful venous access as the time from VAT consult to the time of line documentation in the electronic medical record. PDSA cycles began in July 2025 and focused on training clinical providers to perform USGIV placement, primarily through didactic sessions and simulation with task trainers. Pre- and post-participation surveys were collected to track project participation and enhance the didactics for future participants. Additional interventions included individualized education to allow for peer-to-peer supervision as participants gained USGIV proficiency. The second phase of PDSA cycles began in October 2025 and focused on enhancing the notification system for the PICU's vascular access needs. Interventions to achieve this included education at PICU nursing staff meetings, advising nurses how to include the clinical providers in addition to the VAT of vascular access needs real time. We anticipate having six months of data from PDSA cycles analyzed via standard QI methodology by end of January 2026.

Speeding Up Access Key Driver Diagram
This is the key driver diagram for our quality improvement initiative.