and within this length of time we would expect better policy development and standardization of practices ,” says Moureau . “ But these results clearly demonstrate numerous gaps that need to be addressed , opening the door for performance improvements that will lead to safer ultrasound-guided PIV procedures .”
Addressing Gaps in UGPIV Procedures
Effective policies must address the key areas that impact patient safety during ultrasound-guided PIV insertions , says Moureau . As we have seen , among the most important areas to be considered are establishing methods to perform proper aseptic technique , providing probe protection , using single packet gel , and maintaining appropriate levels of probe disinfection . Aseptic Technique According to the Association for Vascular Access ( AVA ), effective aseptic technique is critical for minimizing infection risk and protecting patient safety , particularly during the insertion and maintenance of such vascular access devices as PIV catheters . The importance of using aseptic technique arises from both the invasive nature of the procedure and the increasing frequency with which such procedures are being performed . 17
AVA recommends the use of aseptic non-touch technique ( ANTT ), a protocol designed specifically to be used across care settings for all clinically invasive procedures . The ANTT protocol is based on the premise that reducing the variables in aseptic practice and standardizing aseptic technique reduces infection rates and improves patient safety . 17
For any PIV insertion , ANTT includes attention to such details as using clean gloves , preventing the sterile needle from coming into contact with various connection points or contaminated gloves , properly disinfecting the skin , and not touching the skin after performing aseptic preparation .
“ While we can never achieve full sterility with PIV catheter insertions due to the necessary contact between the needle and the skin , aseptic non-touch technique is a powerful tool to help prevent the spread of pathogens that cause infection ,” says Moureau . “ However , the effectiveness of this technique is diminished if it ’ s not done in a consistent manner , and my research indicates that many clinicians are not following the basic principles of ANTT .”
In March 2019 , Moureau conducted a poll of several hundred clinicians , which revealed a wide gap between clinicians ’ understanding of contamination risks and actual UGPIV practices . 4 While 86 percent of poll respondents said they recognized the risks of contamination associated with the ultrasound probe and gel , less than 33 percent said their facilities followed proper aseptic technique ( including sterile probe covers and sterile gel ) with every procedure . In Moureau ’ s more recent survey , more than half of vascular access clinicians indicated that they felt aseptic technique is frequently compromised by post-procedure gel clean-up . 18 Probe Protection In addition to aseptic technique , barrier methods such as probe covers can provide an added level of protection and have been shown to be effective in preventing bacterial transmission from inadequately disinfected probes . Transparent dressings are no longer recommended by ultrasound manufacturers or organizations like AVA , as they may leave a film residue on the probe that can result in deterioration of the vital transmission surface .
There is a disconnect between these recommendations and what is happening during UGPIV procedures . According to
Moureau ’ s most recent survey , only 59 percent of vascular access ( VA ) clinicians and 11 percent of emergency department ( ED ) clinicians always use a sterile probe cover . Meanwhile , 31 percent of respondents said they use transparent dressings for probe protection , with more than half of vascular access clinicians and nearly 20 percent of ED clinicians reporting that they always use transparent dressings . 18 Gel Use Ultrasound-guided PIV insertion procedures require the use of gel to transmit sound waves through the skin . Gel applied at the insertion site can pose a significant contamination risk if not used properly . Gel applied near sterile needle insertion imposes a significant risk of contamination , as the gel can contact microorganisms from the skin , and sometimes even the clinician ’ s gloves . Without proper precautions , the spreading of gel across the skin and various points of contact increases the risk of bacterial transmission into the bloodstream during the procedure .
In response to such concerns , many organizations recommend the use of sterile gel to add a higher level of patient safety . In addition , there is a trend toward single-use gel packets to further minimize
As we have seen , among the most important areas to be considered are establishing methods to perform proper aseptic technique , providing probe protection , using single packet gel , and maintaining appropriate levels of probe disinfection .
contamination risks associated with multi-use gel bottles . However , Moureau notes that even with sterile gel , application at the insertion site may result in contamination as it spreads across the skin .
Moureau ’ s recent survey revealed that there is great variation in gel use , sometimes even within an individual facility . More than 22 percent of all respondents indicated that they vary between multi-use gel bottles and single-use gel packets ( both sterile and non-sterile ). This suggests that clinicians are utilizing whatever supplies happen to be available rather than following a consistent protocol designed to maximize patient safety . 18
The survey also identified issues with gel removal , with 41 percent of VA personnel and 51 percent of ED personnel reporting that inadequate gel removal led to securement and dressing adherence issues . Poor dressing adherence can result in catheter failure and accidental dislodgement , not to mention increased contamination rates . 19-20 Transducer Disinfection Ultrasound transducer disinfection is where many practice recommendations diverge , as evidenced by conflicting published guidelines regarding the appropriate level of disinfection a transducer must undergo between UGPIV procedures .
The differences among practice recommendations stem from differing interpretations of the Spaulding classification system , a widely accepted standard designed to determine the level of disinfection required for reusable medical devices based on the potential risk of infection posed to patients . The Spaulding system classifies device usage into three categories : critical , semi-critical , and non-critical . Devices that may contact sterile tissue or the bloodstream are classified as critical usage . Devices that contact