QAPI 147 - Promoting Ultrasound-guided Peripheral Insertion (UGPIV) to Reduce Midline Utilization, Lower Costs, Safeguard Vasculature, and Enhance Patient Outcomes

Background: The Vascular Access Team (VAT) of a 288 hospital bed places Midlines for peripheral infusions and for poor venous access. Ultrasound-guided intravenous catheters (UGPIVs) were not in use as an alternative access. Patients were getting standard peripheral intravenous catheters (PIVCs) by unit nurses. This also puts patients at risk for potential infections and unnecessary additional sticks. Additionally, midline utilization is more costly than placement of a UGPIV. The cost of midline catheter is $190 and the 20g 1.88 inches peripheral intravenous catheter used costs $1.53. Infusion Therapy Standards of Practice states “Use ultrasound for PIVC and Midline insertion. Adult- studies report fewer venipuncture attempts and decreased escalation to central venous access.”

Methods: The VAT diligently assessed all midline placement orders, ensuring clinical justification based on factors like medication type, therapy duration, and potential future midline needs. This data-driven approach helped optimize catheter selection and minimize unnecessary Midline placements.

Results: The results of the initiative were impressive. Midline orders were cut by a staggering 51% from 2021 to 2023, with a corresponding decrease in actual placements. As Midline use declined, UGPIV placements steadily rose, indicating successful adoption. This shift in practice translated to estimated cost savings of $422,750 over a three-year period, demonstrating the significant financial benefits of avoiding unnecessary midlines. Beyond cost savings, promoting UGPIVs had a profound impact on patient care. Fewer sticks and faster placements led to improving the overall patient experience. UGPIVs also helped preserve valuable upper arm veins for future access, safeguarding patients from potential complications associated with repeated attempts and Midline use.

Conclusions: The success of this initiative underscores the power of UGPIVs to revolutionize intravenous access. By promoting UGPIVs through education, policy, and data-driven assessment, healthcare institutions can ensure better patient outcomes, optimize resource utilization, and ultimately, deliver a more cost-effective and compassionate standard of care.