Insertion of a peripheral intravenous catheter is the most commonly performed invasive medical procedure among hospitalized patients. When coupled with ultrasound technologies for vascular visualization, well trained clinicians achieve greater first-time procedural success for peripheral IV insertions.
According to vascular access expert Nancy Moureau, RN, PhD, CRNI, CPUI, VA-BC, inconsistent and fragmented training can make it difficult for clinicians to establish competency and master the skills needed to perform successful ultrasound-guided peripheral IV insertions.
To address the lack of standardized UGPIV training, Moureau and her team at PICC Excellence developed a comprehensive training program, which recently became the first educational program to be recognized with a Seal of Approval from the Infusion Nurses Society. The INS Seal of Approval is designed to reflect the credibility of education, competency-based training and content that adheres to INS standards for infusion-related practices (see sidebar below).
The Ultrasound Mastery Training Toolbox
The ultimate training package for procedures and best practices, the UGPIV Mastery Training Toolbox provides learners, trainers, and healthcare organizations with a comprehensive approach to mastering UGPIV insertions which ensures proficiency at every step.
The UGPIV Mastery Training program’s systematic process of learning follows established evidence from mastery learning processes which incorporate levels of achievement and accountability.
“Applied to ultrasound-guided peripheral catheter insertions, these instructional methods promote greater patient safety, preserve vessel health, reduce failed insertion attempts, and drive higher-level success with this increasingly common procedure,” says Moureau.
The first UGPIV Mastery Certificate was awarded in January to emergency vascular access expert Jon Bell, RN, MSN, VA-BC, CEN. Bell also completed the instructor mastery training workshop and is now one of PICC Excellence’s UGPIV Mastery instructors.
“One of the biggest challenges with UGPIV insertions is their significant learning curve. Placing IVs under ultrasound guidance isn’t a one-and-done skill; it’s something that takes practice,” says Bell. “Teaching the procedure in a structured, methodical way sets the expectation that mastering this skill requires time and effort and provides a clear pathway which people can commit to from the beginning.”
Program Content
The UGPIV Mastery Training program, as a blended educational approach, combines online courses, simulated practice, and supervised insertions, leading to a final examination to award the UGPIV Mastery Certificate. A resource manual includes detailed instructions for each step of the training and skills module. The tools for collecting insertion data demonstrate training completion and minimal competency.
Mastery Training. Online modules establish a strong foundation for understanding the 3 stations of the needle, and needle signs of ultrasound-guided PIV insertions. Topics include the basics of ultrasound, infection prevention, key concepts of aseptic non-touch technique (ANTT), basic anatomy, vein and catheter selection, probe protection and needling skills, and other necessary elements of ultrasound training.
Guided Practice. Modules for teaching hands-on skills guide clinicians toward achieving the minimum performance score, which must be satisfied before moving on to supervised patient insertions.
Supervised Insertions. Real-world patient insertions are supervised by a preceptor and scored according to the difficulty of the insertion and the level of success in achieving and maintaining PIV access.
Independent Insertions. Clinicians demonstrate competency by collecting data about their first 10 insertions, including dwell time, vein diameter, catheter size, and other factors.
Upon completion of the training elements, candidates receive access to the program’s final examination. Passing the exam entitles candidates to UGPIV Mastery Certification and inclusion in the PICC Excellence online mastery certificate registry.
“This course is a game changer because it standardizes the learning process,” says Bell. “It ensures people are receiving consistent messaging for the entire duration of their training—even if it’s with different instructors. They’re not dependent on learning my way, and then having to learn another way with a different instructor.”
The course can be purchased by individuals or via a multi-user licensing package for hospitals or other organizations.
Widespread Benefits
The use of UGPIV techniques has expanded to many healthcare specialties, helping clinicians achieve success even for patients who present with difficult vascular access conditions. The UGPIV Mastery program benefits clinicians in any specialty where venous access may be required, including emergency departments, intensive care units, surgery departments, outpatient infusion or oncology centers, and home-care settings.
The program is not limited to beginners, nor does it require a previous level of knowledge or expertise. Those who are new to UGPIV procedures benefit from the program’s standardized, step-by-step instruction process. For experienced inserters, the package includes train-the-trainer preceptor skills to help them learn how to train other clinicians. These more experienced clinicians benefit from the program’s streamlined and systematic instruction, which helps them implement UGPIV techniques successfully across their organization. Testimonials of advanced inserters state they have become even more proficient by using the needling signs and skills included in the UGPIV Mastery Package.
“Even someone who’s already good at UGPIV insertion can get better,” says Moureau. “Regardless of where a candidate is starting from, the course provides a standardized roadmap to give them the tools and skills needed to be successful every time.”
Mastering Ultrasound Practices
The PICC Excellence UGPIV Mastery program makes use of the concepts and requirements found in the latest edition of the INS Infusion Therapy Standards of Practice. The INS standards recommend that organizations:
- Establish comprehensive training programs for ultrasound-guided procedures, supporting clinicians throughout the novice-to-expert continuum.
- Assess and document clinician competency in the use of vascular visualization technologies for the insertion of vascular access devices. Competencies should include assessment of vessel size, depth, and location; potential complications; and adherence to aseptic non-touch technique (ANTT).
The UGPIV Mastery program emphasizes instruction in clinical capabilities that are essential for safely achieving venous access. Two examples:
Needling Skills. Both the online and simulated portions of the UGPIV Mastery program emphasize the need for clinicians to achieve needling skills prior to undertaking real-world patient insertions. Course instruction includes understanding the significance of the three stages of needle insertion and identifying key visual signs indicating needle position on the ultrasound screen.
Aseptic Procedure. As a necessary component of the safety process for ultrasound-guided PIV insertions, the program demonstrates how sterile probe covers or sterile barrier and securement dressings can protect patients from infection with pathogens transmitted via touch or contaminated gel. When combined with basic ANTT principles, probe covers or barrier dressings provide sufficient protection without the need for a fully sterile procedure, which is costly and not justified based on current literature.
“Receiving the INS Seal of Approval award acknowledges the PICC Excellence UGPIV Mastery Training program adheres to the INS Standards of Practice,” says Moureau. “This ultrasound Mastery Toolbox is the first systematic competency-based training program that takes a learner from zero to trainer. The levels of achievement provide measurement ratings and complete documentation which can be used by the institution demonstrating competent performance of the procedure.”
