vascular access infection prevention
By Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC
Survey Reflects Clinicians ’ Struggles with UGPIV Practices and COVID-19
In an effort to gain a greater understanding of the education , policies and impact of the COVID-19 pandemic issues associated with ultrasound guided peripheral catheter ( UGPIV ) insertions and safety practices , a follow-up survey was conducted by this author and distributed as an adjunct to a previously published survey ( Moureau 2020 ). More than 1,400 voluntary responses were received including a remarkable 1,171 text ( SMS ) comments from clinicians describing their clinical experiences . This overwhelming and unexpected response suggested the need to share feelings and frustrations that ran high , during this past , unprecedented year .
While there was no expectation that UGPIV education practices for clinicians would continue during the crisis of COVID-19 , there was interest in understanding the preparation that occurred prior to the outbreak . The question to clinicians was : prior to performing UGPIV insertions did you receive education / training ? And , as a follow-up , what type of training was received ( selection of all that applied )? Included choices were : No training , on the job , online , lecture , hands-on , supervised insertions , and / or competency measurement of success . The vast majority ( 85.8 percent yes , 14 percent no ) stated yes , they had received training , however 90 percent selected “ on the job training ,” or “ no training / learned it myself .”
With the ability to select multiple types of training , most indicated supervised insertions and hands-on simulation as part of their education . Almost half responded that they had received online education ( 43.4 percent ), with less than one-third ( 27 percent ) mentioning a lecture format . It was encouraging to see that almost half ( 44.4 percent ) of respondents commented that their training included a measurement of competency associated with successful insertions . As the number of UGPIV insertions increase , and more and more clinicians take on this skill , there will be a need for consistent education and measurement of competency with the hope that this will become the norm and be standardized in terms of educational requirements .
As with education , this researcher was interested in whether or not facilities had policies for UGPIV practices . In this survey 61 percent stated yes ( there were policies in place ), and 38 percent no to policies on this practice . A quarter of the group ( 23 %) felt that UGPIV policies were not needed , and 47 percent said UGPIV were included within the peripheral intravenous catheter policies . Another 51 percent stated their policy had an educational
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As the number of UGPIV insertions increase , and more and more clinicians take on this skill , there will be a need for consistent education and measurement of competency with the hope that this will become the norm and be standardized in terms of educational requirements .
requirement , while 44 percent also said success and competencies were included . Notably , 25 percent of respondents skipped this question , leaving us to wonder if they didn ’ t know , or would have responded there were not any policies for UGPIVs . While policies may not be a requirement for all procedures , it seems reasonable to assume a relatively new skill and invasive procedure would have specified guidance and policies for who is qualified , how they become qualified , and safety practices that guide each UGPIV insertion . Among these safety practices are the standard aseptic technique measures , disinfection of equipment , and use of protective supplies used during the procedure .
The survey further explored the impact of COVID-19 on the availability and use of safety and protective measures for UGPIV insertions . In this section the responses included not only answers to the questions but a high number of text responses . Answers to the question on increases in number of UGPIV insertions during COVID-19 were somewhat split , no ( 57 percent ) and yes ( 43 percent ). While 88 percent said aseptic supplies were available , half of the respondents stated there were greater challenges with aseptic technique during the pandemic . A large number ( 65 percent to 73 percent ) said the level of transducer / probe protection and disinfection did not change .
But 535 participants responded by explaining their experiences and what did change . Comments included : “ Due to short supplies of cleaners we changed brands and / or methods of cleaning and also had to choose very carefully who needed UGPIV insertions ,” and “ We were unable to get sterile probe cover sleeves so we ordered sterile gel packets and used large [ dressings ] to cover probe ” or “ for UGPIV we could use either [ a dressing ] in our start kit or a sterile probe cover . The factors and changes cited were “ lack of supply , staff , and management support ; working under pressure ; quantity vs quality .” It appears , based on the comments , that many adjustments were required , not all positive such as “ we are not provided probe covers due to cost ; using some makeshift or leftover probe covers from PICC insertions on known COVID patients ” and “ probe covers not always kept in stock ; team members not disinfecting ultrasound as required .”
Many responses reflected good or improved practices “ enough PPS and supplies ; always thorough cleaning ” and we were always using aseptic non touch technique ANTT and had dedicated equipment for COVID unit ; difficulty getting sterile gel but borrowed from other units ; having everyone masked helped
www . healthcarehygienemagazine . com • march 2021
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