Pilot Study

Multi-center Qualitative Observational Evaluation of Ultrasound Probe Protection using a Sterile Transparent Barrier and Securement Dressing to Standardize UGPIV Catheter Insertions

Michael Drafz1, Kurt Goeller2, Benilda Dizon3, Aisha Cobbs4, Nancy Moureau5*

1Clinical Lead Vascular Access Service, Sharp Metropolitan Medical Campus, San Diego, CA, USA

2Advanced Clinician Vascular Access Service, Sharp Grossmont Hospital, San Diego, CA, USA

3Vascular Access Specialist, Sharp HealthCare Chula Vista, Chula Vista, CA, USA

4Medical Writer, Social Circle, GA, USA

5 Vascular Access Specialist and Chief Executive Officer, PICC Excellence, Inc., Hartwell, GA, Adjunct Associate Professor, Griffith University, Brisbane, Australia

*Corresponding author: Nancy Moureau, PICC Excellence, Inc Hartwell, GA 30643 USA

Received Date: 14 April, 2023

Accepted Date: 24 April, 2023

Published Date: 27 April, 2023

Citation: Drafz M, Goeller K, Dizon B, Cobbs A, Moureau N (2023) Multi-center Qualitative Observational Evaluation of Ultrasound Probe Protection using a Sterile Transparent Barrier and Securement Dressing to Standardize UGPIV Catheter Insertions. Int J Nurs Health Care Res 6: 1418. https://doi.org/10.29011/2688-9501.101418

Abstract

Ultrasound-guided peripheral intravenous (UGPIV) catheter insertions are commonly used to establish intravenous access in patients with difficult vascular access. Probe protection and supply usage with UGPIV insertions in acute care varies across clinicians and departments, with a lack of standardization. This multicenter qualitative evaluation compared probe protection using a sterile transparent barrier and securement dressing with a sterile sheath probe cover to standardize UGPIV catheter insertions. Investigators posited that by separating the gel and ultrasound probe from the skin, the barrier dressing would provide a standardized alternative to sheath probe covers. Results of 210 individual clinician responses following the use of the probe protective barrier dressing reported 97% to agree/strongly agree for the significant parameters of gel separation, adherence, size, imaging, ease of use, improved aseptic technique, and preference over sterile probe cover. Ninety-nine percent of respondents recommended adopting the new dressing and standardized procedure instead of the current probe sheath cover. Analysis of before and after supply costs for UGPIV probe protective supplies using the sheath probe cover was $10.54 and $4.47 using the barrier dressing. Incorporating the barrier dressing resulted in a 57% cost reduction in supplies. While more research is warranted on probe protection, the findings of this study suggest that standardization of the UGPIV protocol may be facilitated and improved using a transparent barrier dressing versus a probe sheath cover.

Keywords: Asepsis; Peripheral venous catheterization; Costeffectiveness; Occlusive dressings; Standardization; ultrasoundguided.

Introduction 

Nearly 60% of patients who require intravenous medication administration have difficult vascular access (DIVA), necessitating the use of visualization technologies such as ultrasound guidance to successfully achieve peripheral venous access [1]. It is estimated that 12 million ultrasound guided peripheral intravenous (UGPIV) catheter insertions are performed annually in North America [2]. Breaks in aseptic technique and failure to standardize the practice of ultrasound guided catheter insertion place patients at risk and increase the cost of acute care services. In the absence of standardized supplies and procedures for UGPIV insertions, supply usage, and best practices often vary between departments within the same facility. Results from a cross-sectional descriptive survey investigating supply usage practices among 26,649 clinicians involved in UGPIV insertions highlighted clinically meaningful inconsistencies in the use of supplies (i.e., gloves and gels) and concordance with aseptic techniques. Such variability has the potential to undermine patient safety. Thus, there is an ongoing need to evaluate the standardization of UGPIV insertion supply usage, probe protection, and safety. Given the steady rise in the number of DIVA patients and the demand for UGPIV catheter insertions, attention is being given to concerns over disinfection practices, ultrasound device protection, variability of supplies used, cost, and lack of standardization in the application of aseptic technique during the procedure [3-6].

Ultrasound transducers, commonly referred to as probes, are used as visualization technology to aid in locating the veins of DIVA patients. Typically, a cover or barrier is placed over the probe, which eliminates direct exposure of the surface of the ultrasound probe to the skin at the insertion site [7]. Application of unprotected probes to the skin during UGPIV insertions is a source of concern that compromise this aseptic procedure. Sterile and single-use probe covers afford considerable protection from equipment contamination at the insertion site [8]. In most cases, probe covers must be used in conjunction with ultrasound conductive gel applied to the probe face and skin to facilitate sound transmission. The use of conductive gel is problematic because it is often contaminated during ultrasound procedures and can introduce pathogens at the insertion site. Infection outbreaks have identified gel contamination as the mode of transmission in numerous reports [9]. Single-use, sterile gel packets are recommended for percutaneous procedures where the gel is applied to the skin, with probe covers requiring gel [7,8,10]. Single-use bacteriostatic or non-sterile packets of gel may be used with external ultrasound assessments performed on intact skin or when gel does not touch the catheter insertion area,8 as with transparent barrier and securement dressings [11,12]. Different probe covers and protection methods are available, some allowing gel elimination or separation from the insertion site. For example, the procedure first described by Thorn et al. [13] used a transparent dressing, folded, to perform an ultrasound guided venipuncture utilizing separation of the gel from the insertion site.

A comparison of different types of probe protection for UGPIV insertions is warranted to continue to improve all aspects of the procedure for safety, efficiency, and cost control. This report describes the qualitative clinician feedback of a multicenter evaluation that compared a sterile transparent securement and barrier dressing to conventional sterile probe covers used in UGPIV insertions and the associated supply costs. Therefore, the purpose of this qualitative probe protection and supply evaluation aimed to establish a standardized aseptic UGPIV insertion procedure using either the sterile probe sheath cover or the transparent barrier securement dressing for probe protection.

Materials and methods

This multi-center qualitative evaluation was initiated by a southwestern hospital group, and supported by the manufacturer for product and training, to compare UGPIV insertions using conventional sterile sheath probe covers versus the sterile transparent barrier and securement dressing (UltraDrape Barrier and Securement Dressing, Parker Laboratories, Fairfield, New Jersey, USA) [11]. Institutional hospital review, ethical review, and waiver of consent were received for this study under IRB# MCHS 190307-1. Inclusion criteria included patients admitted to the acute care facilities under standard hospital consent, 18 years of age or older, who required UGPIV insertion to establish vascular access. For the study, the procedure training included a three-step application with an adherent ultrasound view area, a gel and ultrasound probe separation flap, the gel removal layer, and a dressing pull-down section of the transparent barrier dressing [11].

Clinicians involved in the study were members of the vascular access team with prior experience in UGPIV insertions. The clinicians received initial training on the Aseptic Non Touch Technique (ANTT) guidelines and standardized UGPIV insertion procedures that integrated the sterile transparent barrier and securement dressing for probe protection. Each clinician participant was observed performing three insertions using the sterile transparent barrier and securement dressing, according to the manufacturer’s instructions (Figure 1). The participants entered responses immediately following each procedure into a Likert survey tool, accessed through the Survey Monkey online link (Appendix 1).