According to ECRI , a healthcare quality and safety organization , the rapid rise in the use of point-ofcare ultrasound has outpaced the ability of many healthcare facilities to ensure that all users have the necessary training , experience , and skill to use the technology effectively and appropriately .
Mitigating cross-contamination is essential for protecting patient safety . Unfortunately , patient safety efforts are hampered by another concern surrounding the use of point-of-care ultrasound across all areas of medicine : lack of oversight and inadequate training .
According to ECRI , a healthcare quality and safety organization , the rapid rise in the use of point-of-care ultrasound has outpaced the ability of many healthcare facilities to ensure that all users have the necessary training , experience , and skill to use the technology effectively and appropriately . This observation led the nonprofit technology assessment group to add the modality to its list of “ 2020 Top 10 Health Technology Hazards ,” where the authors noted that the rapidly increasing use of point-of-care ultrasound devices has left many organizations struggling to keep up with appropriate safety measures . 11
“ Ultrasound is a powerful tool for guiding interventional procedures and its growth has expanded in many point-ofcare settings , including vascular access ,” says Daniel A . Merton , BS , RDMS , FAIUM , FSDMS , a principal project officer and diagnostic ultrasound specialist in ECRI ’ s health devices group . “ But training is inconsistent , with some users having greater exposure to the technology than others , and the lack of sufficient oversight increases the potential that patients will be adversely affected .”
Other than contamination concerns , says Merton , the biggest patient safety issue for vascular access procedures is not using ultrasound when it is clearly indicated . Even when ultrasound is available , a clinician without appropriate training may choose to use the standard blind technique , which can lead to multiple needlesticks and more discomfort for the patient . Such concerns are amplified by the sheer number of vascular access procedures , particularly PIV insertions , that are performed on any given day within a healthcare facility .
“ The potential for harm obviously increases with the number of procedures that are performed by users of varying skill levels with very little oversight or guidance ,” Merton notes .
According to Merton , the rise of such safety issues can be attributed in part to the perceived simplicity of the ultrasound technology . Point-of-care ultrasound scanners are highly portable , relatively inexpensive , and seemingly easy to use . But these characteristics have led to such a rapid adoption of the modality that safety policies and practices have yet to catch up .
“ These are serious safety concerns that are widely shared by many people in the industry , some of whom even refer to it as ‘ the Wild West of ultrasound ,’” says Merton . “ When there is a lack of guidance , it leads to a great deal of variability in terms of how and when the technology is used , which can directly impact patient safety .”
Indeed , a growing body of research shows that a lack of standardization in healthcare can compromise clinical outcomes and threaten patient safety . 12 ECRI included fragmentation across care settings in its list of Top Patient Safety Concerns for 2020 , noting that “ policies and education must align across care settings to ensure patient safety .” 13
The Association for Vascular Access ( AVA ) has echoed the call for a more systematic approach . In a 2019 position paper , the association wrote that a standardized approach to the use of ultrasound guidance for vascular access procedures “ minimizes variability in clinical practice , provides a framework for education and training , facilitates implementation , and enables quality analysis .” 14
Clinician Survey Confirms Significant Variation in UGPIV Practices
There is consensus that mitigating the risks of cross-contamination during UGPIV procedures is essential for protecting patient safety . However , there is still some variation among specific recommendations regarding infection control methods , probe disinfection , and proper aseptic technique .
Moureau has long been concerned about the lack of standardized UGPIV recommendations and the impact that practice variations could have on patient safety . Following this line of concern , in 2019 she conducted a survey to gain a better understanding of clinicians ’ beliefs and current practices regarding UGPIV insertion , while also identifying possible variability in supply usage across departments .
Responses from nearly 1,500 clinicians , primarily vascular access ( VA ) and emergency department ( ED ) clinicians , confirmed her hypothesis by revealing significant levels of variation across hospitals and other care settings . 5 The study marks one of the first attempts to quantify such variability and highlight important safety implications .
The survey results confirmed that UGPIV procedures are performed frequently : respondents indicated that they insert anywhere from five to 20 ultrasound-guided PIV catheters per day . But more than that , says Moureau , the results paint a clear picture of the fragmented landscape of UGPIV procedures , including widely varied use of transducer protection and gel .
While most organizations recommend sterile probe covers to minimize contamination during UGPIV procedures , only 59 percent of VA clinicians — and just 11 percent of ED clinicians — reported using a sterile probe cover . Gel use followed a similarly variable pattern , with 64 percent of VA personnel and just 13 percent of ED personnel reporting the use of sterile gel . In addition , more than 22 percent of all respondents indicated that they vary usage between multi-use gel bottles and single-use gel packets ( both sterile and non-sterile ).
The survey also highlighted safety concerns resulting from the presence of gel in the sterile insertion site area . Among the respondents , 41 percent of VA clinicians and 51 percent of ED clinicians reported instances of inadequate gel removal , which often results in securement and dressing adherence issues . Poor adherence of dressings can lead to catheter failure and accidental dislodgement . 15 More than half of all VA personnel ( 52 percent ) said they felt that aseptic technique is often compromised by post-procedure gel clean-up .
“ UGPIV has become increasingly common in the past 10 years ,