During ultrasound project, missed cannulations decreased by 53%
The average number of missed cannulations per month decreased from 12 to 5.4 when staff were trained on ultrasound guided cannulation, according to research presented at the American Nephrology Nurses Association National Symposium.
“As the [end-stage renal disease] ESRD population ages it becomes more imperative to find cannulations methods that decrease the number of missed cannulations,” Alice Luehr, DNP, RN, CNN, director of dialysis at St. Peter’s Health, wrote.
The results come from a 5-year follow-up of a process improvement project that took place from 2013 to 2017. Luehr performed an electronic health record analysis of missed cannulations and use of a bedside ultrasound machine. The timeline for the project was split in three phases: phase 1 began before the ultrasound machine was purchased; in phase 2A and 2B, staff used the ultrasound; and when phase 3 began, an ultrasound guided cannulation policy, procedure, training program and competency evaluation program were established.
July 2019 through October 2019 had the highest rate of missed cannulations, which Luehr wrote was attributable to an ultrasound machine purchased in June 2019 with slightly different functionality. Investigators found 30.5% of the missed cannulations during these months were performed by a newly hired, recent graduate RN.
Luehr wrote that since guided cannulation has become the standard at St. Peter’s Health dialysis, “the number of large infiltrations seen from missed cannulations has become a thing of the past.
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Luehr, A. Use of ultrasound guidance during cannulation: Five years later. Presented at: American Nephrology Nurses Association National Symposium; Aug. 29-31, 2020 (virtual meeting).
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