Bridging the Gap in Traditional PIVC Placement: An Evaluation of Operation STICK Vascular Access Outcomes

Abstract

Objective

Education and training is core to improving peripheral intravenous access outcomes. This study aimed to show that a vascular access training program (Operation STICK) in the emergency department (ED) improves the outcomes of traditionally placed peripheral intravenous catheters (PIVC).

Methods

This was a pre-post quasi-experimental study of traditionally placed PIVCs at a large ED in southeastern Michigan, United States. A control group (non-OSTICK) was compared to an experimental group (OSTICK) using a 3:1 propensity score matched analysis. Groups were comprised of ED patients with traditional PIVC placements in two separate six-month periods: non-OSTICK PIVCs from April to September 2021 and OSTICK PIVCs (placed by an OSTICK graduate) from October 2022 to March 2023. The primary outcome was PIVC functionality. The secondary outcome was adherence to best practices.

Results

A total of 6512 PIVCs were included in the study; 4884 (75.0%) were in the non-OSTICK group, while 1628 (25.0%) were in the OSTICK group. 68.1% of OSTICK PIVCs and 59.7% of non-OSTICK PIVCs were placed by ED technicians (p < 0.001). 91.3% of OSTICK PIVCs were placed on the first attempt, and 98.5% were placed within two attempts. A subgroup analysis of admitted patients (2540 PIVCs; 553 (21.8%) OSTICK-trained and 1987 (78.2%) non-OSTICK-trained) revealed 87.6% of OSTICK PIVCs and 80.3% of non-OSTICK PIVCs were 20 gauge (p < 0.001). The median proportion of dwell time to hospital length of stay was 94% for OSTICK PIVCs, compared to 88% for non-OSTICK PIVCs (p < 0.001).

Conclusion

This study underscores the value of education and training in enhancing vascular access outcomes. Implementing Operation STICK, a comprehensive vascular access training program, at a large ED has led to high first-stick success, adherence to best practice recommendations for site and device selection, and improved PIVC functionality for traditionally placed catheters.

Keywords:

• peripheral intravenous catheter
• venous access
• vascular access score
• traditional insertion
• operation stick
• palpation method

Data Sharing Statement

The data that support the findings of this study are available via a data access agreement. Please contact the corresponding author (AB) for this request.

Ethics Committee Approval

This study was approved by the Corewell Health Institutional Review Board. A waiver of informed consent was granted by the IRB as the study meets exemption based on design and objectives.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

AB, NM, ED, and SMG are founders of the Operation STICK vascular access program and are voting members of Operation STICK, LLC. Additionally, AB has research grant support from B. Braun Medical, Becton-Dickinson, Teleflex, Adhezion, Medline Industries, Moderna, and Access Vascular. AB is a paid consultant for B. Braun Medical, Teleflex, Lineus Medical and Interrad Medical. SMG is a paid consultant for Lineus Medical, Nexus Medical, PICC Excellence, and Fujifilm Sonosite. The authors report no other conflicts of interest in this work.