Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Central venous catheters are placed in the emergency department (ED) when difficult peripheral access limits care or when critical medications require central access because of their sclerotic nature or incompatibility with other drugs. Ultrasound-guided peripheral intravenous (IV) access offers a less invasive alternative. We evaluated whether implementation of a structured ultrasound-guided peripheral intravenous training program for ED nurses and technicians was associated with changes in ED central venous catheter use.

Methods: We performed a retrospective chart review at our 50-bed academic community ED, which holds a Level II trauma designation. This center has an ED census of 80,000 patients per year, a 4:1 nursing to patient ratio with an admission rate of 20-25% with expected monthly variation. A structured ultrasound-guided peripheral IV curriculum for nurses and technicians launched in November 2023. The primary endpoint was annual ED central venous catheter placement count, identified through procedure documentation in the electronic health record. Training that was conducted for nurses and clinical technicians consisted of three hours of didactic and hands-on training, followed by a period of procedural supervision. We compared the baseline year 2022 with the first two full post-implementation years, 2024 and 2025. The analysis was descriptive.

Results: Central venous catheter placements in the ED decreased from 387 in 2022 to 275 in 2024 and 218 in 2025, corresponding to absolute reductions of 112 placements (28.9%) and 169 placements (43.7%), respectively. By the end of 2025, 33 nurses and ED technicians had completed training and competency sign-off.

Conclusion: Implementation of a structured ultrasound-guided peripheral IV training program for nurses and technicians was associated with fewer ED central venous catheter placements at our institution. These findings support further multicenter evaluation using patient-level outcomes and visit-adjusted rates.