Brief Summary:
This study compares two different methods nurses use to place an intravenous (IV) drip, which is needed for many cancer treatments.
Traditional method: The nurse finds a vein by touch and sight.
Ultrasound-guided method: The nurse uses a small, handheld ultrasound scanner to see the vein under the skin to help guide the needle.
Sometimes it can take more than one attempt to get an IV drip in place, which can be uncomfortable. For cancer patients, whose veins can be more fragile, this is a common challenge. This research will help determine if using ultrasound helps achieve successful IV placement on the first try more often, which may improve the treatment experience.
Participation involves random assignment (like a coin toss) to have the IV placed with either the traditional method or the ultrasound method. The research team will then collect some information about the IV placement. Participation is entirely voluntary and will not affect standard medical care.
Detailed Description:
Peripheral intravenous catheter (PIVC) insertion is a fundamental procedure for administering systemic anti-cancer therapy (SACT). A significant clinical problem in oncology is the high prevalence of patients with difficult intravenous access (DIVA), leading to multiple insertion attempts, procedural pain, anxiety, and treatment delays. The traditional landmark technique, reliant on visual and palpatory cues, is often insufficient for this population.
Ultrasound guidance represents a potential technological advancement for PIVC insertion, allowing for visualization of deeper vasculature. While evidence supports its use in emergency and critical care settings, its efficacy and implementation within routine oncology nursing practice are not well-established. Existing studies in this specific population are limited and of low certainty.
This trial employs a pragmatic, mixed-methods design to evaluate the real-world effectiveness of ultrasound-guided PIVC insertion by trained oncology nurses compared to the standard technique. The embedded qualitative component is critical for understanding the contextual factors influencing implementation, including clinician acceptability and the patient experience, which are vital for guiding future scale-up if the intervention is proven effective.
The intervention involves a structured, competency-based training program for oncology nurses in ultrasound-guided vascular access, developed and delivered by clinical experts at the University of Galway. The program's curriculum is grounded in task analysis and includes supervised clinical practice to ensure procedural competency prior to participant enrollment.
The study is conducted across a spectrum of oncology care settings to enhance the generalizability of the findings. The design accounts for key clinical covariates known to influence insertion success, such as DIVA status, through stratified randomization and adjusted statistical models. Data collection integrates quantitative metrics with in-depth qualitative interviews to provide a comprehensive assessment of the intervention's impact on both clinical outcomes and human factors.
