Improving First Time IV Success Rates in the Emergency Department Through the Implementation of an Ultrasound-Guided IV Training Program

Authors

• Tram Dinh, University of Texas Health at HoustonFollow

Date of Doctor of Nursing Practice Project Completion

Spring 2026

Faculty Advisor

Daisy Mullassery

Abstract

Purpose

This quality improvement (QI) project was conducted at a Level III trauma emergency department (ED) in Fort Worth, TX. The aim was to improve first-attempt intravenous (IV) success rates for patients with difficult IV access (DIVA) to at least 50% and reduce average disposition times.

Background

Patients with DIVA frequently experience delays in care, including prolonged time to establish IV access, obtain laboratory studies, perform contrast-enhanced imaging, and administer IV medications. Ultrasound-guided IV (USGIV) access is an evidence-based technique shown to reduce these delays and improve timely care for patients with DIVA.

Methodology

The Plan-Do-Study-Act (PDSA) model guided development and implementation of a USGIV training program for ED nurses. First-attempt IV success rates and patient disposition times were compared between pre- and post-intervention periods, with iterative program adjustments informed by weekly data extraction. The sample included 66 patients with DIVA. A key limitation was delays in obtaining USGIV access for patients in the waiting room.

Results

First-attempt IV success rates improved from 20% pre-implementation to 67% post-implementation. Average disposition times decreased from 279 minutes to 268 minutes. Four nurses successfully completed the training program.

Implications

Implementing a USGIV training program for ED nurses improved key ED metrics for patients with DIVA, including first-attempt IV success rates and disposition times.

Strategies to facilitate USGIV placement for patients in the waiting room warrant further evaluation.

Sustaining the training program and promoting routine USGIV use for patients with DIVA may help reduce delays in care and improve ED performance metrics.

Keywords

Difficult IV access, Ultrasound guided IV, Intravenous access

Recommended Citation

Tram Dinh, "Improving First Time IV Success Rates in the Emergency Department Through the Implementation of an Ultrasound-Guided IV Training Program" (2026). Doctor of Nursing Practice Final Project Abstract. 177.
https://digitalcommons.library.tmc.edu/dnp_abstract/177