Delphi method validation of a procedural performance checklist for insertion of an ultrasound-guided peripheral intravenous catheter

• Published in: The American journal of emergency medicine Vol. 34; no. 11; pp. 2227 - 2230
• Main Authors: Jung, Christine F., MD, Breaud, Alan H., MPH, Sheng, Alexander Y., MD, Byrne, Mark W., MD, Muruganandan, Krithika M., MD, Dhanani, Muhammad, MD, Leo, Megan M., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016; Elsevier Limited
• Subjects: Anesthesia; Blood; Catheterization, Peripheral - methods; Catheters; Checklist; Colleges & universities; Critical care; Delphi method; Delphi Technique; Emergency; Emergency medical care; Experts; Hospitals; Humans; Medical instruments; Medicine; Patients; Phlebotomy; Physicians; Safety devices; Ultrasonic imaging; Ultrasonography, Interventional; Womens health
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2016.08.006

[...]a keep/discard round resulted in a final 16-item checklist (Table 3). Institution Specialty Boston Medical Center Emergency medicine/emergency ultrasound faculty Boston Medical Center Anesthesia critical care Boston Medical Center Pulmonary critical care Brigham and Women's Hospital Emergency medicine Brigham and Women's Hospital Emergency medicine/internal medicine critical care fellow Brigham and Women's Hospital Emergency medicine/emergency ultrasound fellow Beth Israel Deaconess Medical Center Emergency medicine/emergency ultrasound fellow Brown Alpert Medical School Emergency medicine/emergency ultrasound faculty Maine Medical Center Emergency medicine/emergency ultrasound faculty Massachusetts General Hospital Emergency medicine/emergency ultrasound faculty Mayo Clinic Emergency medicine/emergency ultrasound faculty New York University Medical Center Emergency medicine/emergency ultrasound faculty University of Arizona College of Medicine Emergency medicine/emergency ultrasound faculty University of Colorado School of Medicine Emergency medicine/emergency ultrasound faculty Yale University School of Medicine Emergency medicine/emergency ultrasound fellow Table 1 Expert demographics for the development of USG PIV checklist Item no.\n03) Wording change 8 8.07; 8 (1.10) Wording change 6 Keep 11 8.07; 9 (1.28) Wording change 9 8.27; 8 (0.80) No change 7 Keep    10 7.67; 8 (1.05) Wording, order change (moved to 3)         8 Keep 12 8.13; 9 (1.25) Wording change 11 7.20; 7 (1.21) Wording change 9 Keep 13 8.13; 9 (1.92) Wording change 12 7.80; 8 (1.15) Wording change 10 Keep 14 7.73; 8 (1.39) Wording change 13 7.40; 8 (1.40) No change 11 Keep 15 7.07; 7 (1.79) Wording change 14 6.93; 7 (1.49) Wording change 12 Keep 16 5.47; 5 (1.50) Wording change 15 6.67; 7 (1.68) Wording change 13 Keep 17 7.80; 8 (1.47) Combined with 16      18 7.33; 7 (1.29) Combine with 15      19 5.93; 6 (1.87) Wording change 16 6.53; 6 (1.77) Wording change 14 Keep 20 7.87; 8 (1.46) Wording change 17 7.73; 8 (1.28) No change 15 Keep 21 5.87; 6 (2.17) Discarded      22 7.33; 8 (1.80) Wording change 18 7.80; 8 (1.15) No change 16 Keep 23  Added as #4      Table 2 US-guided PIV placement checklist item modified Delphi process Introduce yourself, verify correct patient, and explain the procedure (including risks and benefits) Gather supplies (angiocatheter, extension tubing, probe cover, sterile gel, cleaning agent, blood tubes, saline flush, etc) Position machine and patient Place machine within line of sight Position arm to optimize exposure for target vessel Set up machine Select linear high frequency probe Select vascular or other appropriate superficial setting Perform hand hygiene and put on gloves Prescan to locate venipuncture site Identify any contraindications (fistula, overlying infection, etc) Place tourniquet on proximal upper arm Scan for suitable venipuncture sites Select target vessel Distinguish vein from artery using compression and/or Doppler imaging Consider vein size, depth, and course Acquire image of target vessel Prepare probe and venipuncture site Clean and apply cover to probe Use sterile gel as coupling agent Prep site with approved antiseptic agent Optimize image Position and stabilize probe by resting hand on the patient Align vessel in middle of the screen by out-of-plane technique Optimize depth and gain Visualize needle tip Enter skin with needle, continually visualizing needle tip Confirm needle is within the vessel by blood flash and visualization of needle tip using out-of-plane and/or in-plane technique Advance catheter into the vessel and deploy needle safety device Secure catheter Attach extension tubing Remove ultrasound gel and clean site Secure catheter and apply clean dressing Collect blood samples, remove tourniquet, and flush with normal saline while observing for signs of infiltration Position patient's arm to prevent catheter dislodgement Complete postprocedure cleanup Dispose of sharps in appropriate container Discard waste and clean work area Clean ultrasound probe and return machine to storage area Document procedure in patient medical record Table 3 Final 16-item procedural checklist for USG PIV catheter insertion