6435 Introducing paediatric ultrasound guided cannulation in a district general hospital

Objectives The aim of this project was to introduce ultrasound guided venous access to the paediatric department in a busy DGH to reduce the number of cannulation attempts in children. Peripheral venous access in children is a frequently performed, sometimes challenging, procedure with an estimated first attempt success rate of 53–75%.¹ Up to 30% of children have difficult intravenous access for a multitude of reasons such as frequent cannula requirements or large body habitus. In these children first attempt success rates are much lower, at 40–50%.² Our objectives were to purchase an ultrasound machine for the general paediatric wards and train paediatric clinicians to use it for peripheral venous access. Methods Questionnaires given to paediatric clinicians to assess whether this was an skill they were competent in, and/or if they were keen to learn. Business plan submitted to the hospital charity fund to purchase a dedicated ultrasound machine for paediatric use. Created a group of 'champions' within the department who were trained to become competent to train others in the procedure. Ran drop-in training sessions for clinicians to attend using mannikins and live models. Sought feedback from clinicians regarding the training sessions, and from patients and parents for their views on this new technique. Results 100% of clinicians thought that US guided cannulation was a useful skill to learn, yet only 16.7% had had training. The business plan was well received and we were able to purchase the ultrasound machine. Feedback from the drop in training sessions showed that 100% of attendees found the sessions 'extremely useful'. Additionally, we received positive feedback from patients and parents, one quoting: 'The machine made the world of difference and I am hoping has saved my daughter from a lifelong phobia of needles.' Conclusion There was a clear desire for, and lack of expertise in, ultrasound guided cannulation amongst the paediatric clinicians. There were several barriers to introducing this training program including the lack of ultrasound machine and paucity of clinicians competent to teach. We are very grateful to the Kingston Hospital Charity for their financial support in purchasing the ultrasound. We are also grateful to St George's Hospital PICU for allowing a number of us to attend their ultrasound course helping us to train up our own team of local 'champions'. Going forward the major challenge will be sustaining this project which we hope will be achieved through having numerous champions who are long-term staff. References Girotto C, Arpone M, Chiara Frigo A, Micheletto M, Mazza A, da Dalt L, et al. Emergency Medicine Journal (External validation of the DIVA and DIVA3 clinical predictive rules to identify difficult intravenous access in paediatric patients.). 2020;37:762–7. Rizvi MB, Silver EJ, Khine H, Sellinger C. Paediatric Emergency Care (Modified DIVA Score). 2022 Oct;38(10):e1646–9.