Title: Implementation of ultrasound guided peripheral intravenous cannulation in patients with difficult venous access
Abstract:
Peripheral intravenous catheterization is a common nursing procedure. However, in patients with difficult venous access (DVA), conventional techniques are often time-consuming and associated with high failure rates. Ultrasound-guided (US-guided) peripheral intravenous catheterization has become a key strategy to improve injection success rates. Nevertheless, establishing standardized clinical protocols remains challenging. This review aimed to evaluate the feasibility and clinical value of implementing US-guided cannulation in patients with DVA. Guided by the five steps of evidence-based practice (Ask, Acquire, Appraise, Apply, and Assess), we synthesized evidence from seven relevant studies and implemented USguided intravenous catheterization in clinical settings. The injection success rates before and after implementation were compared. Literature findings supported the effectiveness of US-guided cannulation in improving outcomes in DVA patients. After implementation, the US-guided group achieved a firstattempt success rate of 58.4%, significantly higher than the 29.4% observed in the conventional group from the prior year (p< 0.05). The overall success rate was 72.6% versus 51.4% (p= 0.005), with fewer average cannulation attempts (p< 0.01), and no significant difference in complication rates (p= 0.24). Systematic staff training and clinical workflow optimization facilitated the successful integration of USguided techniques into routine practice. These findings suggest that expanding training to nurses with more than two years of clinical experience and promoting broader application across various patient
populations may further enhance care quality and reduce healthcare costs.
Keyword: Difficult peripheral vein injection, ultrasound guidance, injection success rate, evidence-based
