Effect of updated best practices on ultrasound-guided peripheral IV dwell time in children

IMPORTANCE: Placement of intravenous access is challenging in pediatric patients. Complications and replacement of IV access is a common occurrence in pediatric patients. OBJECTIVE: This project evaluated a new training program for placement of pediatric USGIV lines. DESIGN: Quality improvement: pre-post cohort. SETTING: A tertiary pediatric hospital in the southwest United States. PARTICIPANTS: The pre-intervention cohort included 400 IV lines identified through retrospective chart review. A subset of 68 lines placed in the three months prior to the intervention were specific to the nurses undergoing training. The post-intervention cohort consisted of 359 lines obtained via convenience sampling. Lines were excluded if documentation lacked insertion/removal dates or reasons for removal. METHODS: The educational intervention was based on best practices, including appropriate catheter-to-vessel diameter ratios and optimal catheter length within the vessel. Training was delivered through asynchronous PowerPoint presentations, one-on-one clinical rounding, and badge card distribution. Mean dwell time and complication rates were assessed through chart review. A sample size of 353 lines was calculated to detect a 25% increase in dwell time; 359 lines were reviewed post-intervention. RESULTS: The average patient age was similar between groups (pre: 11.22 years; post: 11.28 years). A statistically significant increase in dwell time was observed post-intervention (mean 2.17 vs. 1.72 days, p = 0.0015). While overall complication rates remained stable, a significant reduction in early complications (within 0-1 day) was noted (p = 0.01778). CONCLUSIONS: These findings support integration of measurement-based decision-making in pediatric vascular access. Further multi-site studies are needed to confirm generalizability.