Arterial Catheterization with Ultrasound: Identifying Barriers for Compliance with a Local Arterial Line Policy

Abstract

Studies demonstrate that with the innovation of ultrasonography, the visualization via two-dimensional imaging increases first-attempt success rates with arterial catheterization. In contrast, multiple attempts from the traditional landmark method result with an increased risk of hematoma and arterial spasms (Anantasit, Cheeptinnakorntaworn, Khositseth, Lertbunrian, & Chantra, 2017). A local facility in Tucson, Arizona has a current policy in affect that requires the use of ultrasound with radial/brachial arterial catheterization. Observation conducted by the principal investigator revealed several arterial catheterizations attempts without the use of ultrasonography. This project identified barriers as to why certified registered nurse anesthetists (CRNAs) are noncompliant with the policy, which requires the use of ultrasonography (US) during arterial catheterization. A survey was created using the online tool, Survey Monkey, which posed 10 questions to CRNAs pertaining to years of experience, current policy requirements, utilization of US, and why or why not the use of US with arterial catheterization. Correspondence approved by the institutional review board (IRB), was sent to a convenient sample of 25 CRNAs who work within the operating room at the local facility and explained the aim of the project and the importance of participant anonymity. The correspondence was added to the Survey Monkey tool and distributed. A goal of 30% participation was set for meaningful analysis; 52% of which was achieved. The responses to each of the 10 questions were analyzed via the “analyze results” function tab within the Survey Monkey tool. Non-open-ended responses were aggregated and placed into data trend graph for interpretation. The survey demonstrated that 54% of CRNAs are unaware that a policy exists for use of US with arterial catheterization. Additionally, 46% of CRNAs are aware of an existing policy that requires the use of US, however they are reluctant to follow it. A third barrier was identified that 31% of respondents suggested that US was unavailable for use. Keywords: Ultrasonography, ultrasound guidance, Seldinger technique, arterial cannulation, catheterization, vasospasm, certified registered nurse anesthetist, Allen’s test, Survey Monkey, and Word Cloud.