This issue of Military Medicine presents a much-needed article presenting the work of Samantha Filipovich et al. from Naval Hospital Jacksonville, entitled “Training Program for Ultrasound-Guided Intravenous Catheter Insertion” on peripheral intravenous catheter (PIV) placement—one of the most common procedures performed in the healthcare setting. Although most PIV insertions are relatively quick to perform by experienced staff, some patients are difficult, which can sometimes delay care for an hour or more. Novice physicians, nurses, and technicians can have a very tough time getting PIV placement, resulting in unnecessary pain, discomfort, and distress to the patient. In this article, the authors described their implementation of a training program for ultrasound-guided PIV (USGPIV) insertion to improve PIV access success and included an assessment of the change in knowledge and self-reported confidence that the training brought to the staff. This study based their training on an existing military program from the Minot Air Force Base (AFB) in North Dakota.¹ The Minot AFB study showed significant improvement in PIV placement and increased patient satisfaction. Although similar data were not collected, the Naval Hospital Jacksonville study found a significant increase in knowledge, confidence, and use of US. A meta-analysis of USGPIV found that the use of US reduced the number of attempts, reduced the time needed to access a vein, and increased patient satisfaction.² However, this meta-analysis points out that factors such as skill of the operator, technical assessment of suitable veins, and technique used are generally not reported and thus the efficacy of USGPIV as compared to success without the use of a device is still elusive. This lack of solid evidence could be one reason why US is not a regular tool for use in placing PIVs. Furthermore, both military-based studies found that having advocates or champions for use of USGPIV was essential to keeping long-term support and skill available in a unit. Since military facilities rotate personnel regularly, maintaining a successful USGPIV program within a specific military treatment facility (MTF) is challenging.

中文翻译：

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需要改善外周静脉通路

本期军事医学提供了一篇急需的文章，介绍了 Samantha Filipovich 等人的工作。来自杰克逊维尔海军医院，题为“超声引导静脉导管插入培训计划”关于外周静脉导管 (PIV) 放置 - 在医疗保健环境中执行的最常见程序之一。尽管大多数 PIV 插入由经验丰富的工作人员执行相对较快，但有些患者很难进行，有时会延迟护理一个小时或更长时间。新手医生、护士和技术人员在放置 PIV 时可能会遇到非常困难的时间，从而给患者带来不必要的疼痛、不适和痛苦。在本文中，作者描述了他们实施超声引导 PIV (USGPIV) 插入培训计划以提高 PIV 访问成功率，并包括对培训给员工带来的知识变化和自我报告信心的评估。这项研究基于他们在北达科他州迈诺特空军基地 (AFB) 的现有军事计划进行的培训。¹ Minot AFB 研究显示 PIV 放置有显着改善，并提高了患者满意度。虽然没有收集到类似的数据，但海军医院杰克逊维尔的研究发现美国的知识、信心和使用显着增加。USGPIV 的一项荟萃​​分析发现，使用 US 减少了尝试次数，减少了进入静脉所需的时间，并提高了患者满意度。²然而，该荟萃分析指出，操作者的技能、合适静脉的技术评估和使用的技术等因素通常没有报告，因此与不使用设备的成功相比，USGPIV 的功效仍然难以捉摸. 缺乏确凿证据可能是 US 不是用于放置 PIV 的常规工具的一个原因。此外，两项基于军事的研究都发现，拥有使用 USGPIV 的拥护者或拥护者对于保持部队的长期支持和技能至关重要。由于军事设施定期轮换人员，在特定的军事治疗设施 (MTF) 内维持成功的 USGPIV 计划具有挑战性。