P3.S374: Integrating Point of Care Ultrasound (POCUS) for Peripheral Intravenous Catheter Placement within a Military Pediatric Residency Program

Purpose/Objectives: Peripheral intravenous catheter (PIVC) placement is the most common procedure performed in hospitals, but also one of the most traumatic for our pediatric patients. POCUS-guidance for the placement of PIVCs is associated with improved success rates and increased longevity over traditional methods. Integrating POCUS enhances care across many fields in medicine, including within operational environments, though is still rarely used in pediatrics. Thirty recent graduates from a single military pediatric residency were surveyed in 2023 regarding their proficiency in placing PIVCs. Of seventeen respondents, 94% felt it was somewhat important-to-essential to be able to place PIVCs while only 47% felt their training in residency was adequate to succeed some-to-most of the time. Our project aims to address this perceived training gap by integrating POCUS for PIVC placement into the curriculum. Of note, the skills needed to master PIVC placement with ultrasound translate to comfort with other modalities of POCUS. Therefore, this training will also provide residents an avenue for learning to use POCUS both procedurally and diagnostically.

Design/Methods: Our team created a standardized curriculum for teaching residents to place PIVCs with ultrasound guidance. Before obtaining ultrasound guided PIVC access on patients, residents are required to demonstrate that they understand how to evaluate vessels with ultrasound, and they must successfully cannulate a vessel on an ultrasound gel phantom. At least 10 subsequent live cannulations must be supervised by someone credentialed and proficient in placing PIVCs with ultrasound. After each attempt, residents are asked to complete a survey to assess their performance. This data, along with an annual review, is used to evaluate progress and adjust the curriculum to yield the best results.

Results: All 19 of our current pediatric residents have received standardized training on POCUS-guided PIVC placement, and each resident demonstrated success with the procedure at least once and within three attempts. The average annual number of PIVCs placed by our residents has more than doubled with 46 POCUS-guided attempts recorded thus far. The max number performed by a single resident is six. However, procedural confidence, even with low volume, correlates significantly with number of attempts (P=0.0017) (See Figure). Seven months following the curriculum implementation, 80% of residents report preference for ultrasound guided PIVC placement compared to traditional methods.

Conclusion/Discussion: Improved proficiency with PIVC placement is desired by graduates from our program. To date, few pediatric residencies have integrated POCUS training. Early trends suggest that PIVC placement with POCUS is preferred by trainees over traditional methods with minimal iterations. POCUS skills also enhance care in humanitarian and operational settings where military pediatricians are commonly utilized. Our project highlights a current deficiency and demonstrates a method to close it with low-barrier procedural training, while also laying a framework for integrating POCUS-training into larger curriculum.