Table 2.

Study Characteristics and Educational Approach

Study	Participants	Study Design	Aim	Setting	Protocol Details	Education
Acuña, et al 202019	Nurses Paramedics	Prospective Observational Study	Evaluate performance of a handheld US device for difficult PIVA as performed by nurses/paramedics in the ED	ED – United States	Discretionary assessment of difficulty by operator based on failed attempts or perceived difficulty. Patients deemed difficult were enrolled and assigned either USGPIVA or SOC. Success defined as catheter visualized within the vessel and able to be flushed easily.	Device – Philips Lumify. 8-hour educational session (lecture and didactic education). Familiarization with POCUS device and how to optimize image quality.
Ault, et al 201523	Nurses	Prospective Observational Study	To determine the number of US-guided IV placements required for a nurse to develop proficiency and consistency	Medical Procedure Center – United States	Difficulty assessed by operators if there was a lack of a palpable or visible vessel or if the patient had a history of requiring US-guided IV access or central venous access. Proficiency determined by 10 successful supervised attempts and proficiency score of 4 or 5 for 3 consecutive attempts.	Device – Sonosite M-Turbo. 3-phase educational program including 1:1 didactic session, demonstration of proficiency on phantom model, and supervised attempts on live patients.
Bahl, et al 201620	Nurses	Prospective, Non-Blinded, Randomized Control Trial	Investigated the outcomes associated with nurse performed US- guided IV access when compared to landmark approach on difficult vascular access patients	ED – United States	Patients presenting to ED were randomized to 1 of 2 cannulation techniques. Either USGPIVA or SOC (landmark method). Success was determined by the extraction of 5ml of non-pulsatile blood or flush of 5ml normal saline. Developed robust inclusion criteria to select DIVA patients.	Device – Sonosite M-Turbo. Participants attended a 1.5-hour didactic educational session, followed by hands on familiarization. Certification was provided upon 10 successful IV placements.
Duran-Gehring, et al 201624	ED Technicians	Retrospective Review of Prospectively Collected Data	To determine the success and complication rates of ED technicians performing US-guided peripheral IV placement	ED – United States	None of the participants had prior US experience. An algorithm was developed to predict difficult IV with physician input. Patients were then potentially enrolled to receive up to 3 US-guided IV attempts by the participants with success, failure, and complication rates recorded.	Device – Sonosite M-Turbo. 18 emergency technicians (paramedics) enlisted to participate. 3-phase educational program beginning with training, demonstration of competence, and then clinical application.
McCarthy, et al 201625	ED Technicians	Randomized Control Trial with a 2-Group Parallel Design	To determine the superior method of IV placement in patients with varying levels of difficulty	ED – United States	Patients enrolled were sorted into easy access, moderately difficult, and difficult access groups. Enrolled patients were then randomized and assigned to either USGPIVA or SOC. If first attempt failed, the patient was then randomized a second time to a procedure.	Device – Sonosite M-Turbo or Zonare Ultra. All of the participants were familiar and proficient with the procedure as part of their existing practice.
Oliveira, et al 201626	Nurses Military Corpsmen	Prospective Observational Study	To develop a program to train nurses, corpsmen, and physicians in US-guided IV placement and assess the degree of success in outcomes	Military Hospital – United States	Two of the nurse participants had prior US experience. The program developed was not defined in this study.	Device – Sonosite M-Turbo. 8 nurses and 8 corpsmen participated in the study. Nurses and corpsmen were required to attend one training session, comprised of a 30-minute didactic session, and complete 3 supervised US-guided IV placements.
Price, et al 201922	Nurses ED Technicians	Prospective, Randomized, Comparative Evaluation Study	To determine if US-guided IV placement first attempt success is improved with double tourniquet technique	Tertiary Care Hospital ED – United States	Patients had to have had one failed blind attempt at IV placement, >18 years old, and predicted to be difficult to be enrolled in the study. Patients enrolled were then randomized to either single or double tourniquet technique followed by USGPIVA.	Device – Sonosite X-Porte. All participants had minimum 1 year experience with the procedure and no education was offered prior to commencement of the study.
Resnick, et al 200827	Nurses	Prospective, Randomized, Comparison Study	To compare the practice of no skin marking versus no skin marking when performing US-guided PIVA	ED – United States	Participants were categorized by the number of USGPIVA attempts and experience they previously had. Patients were enrolled and randomized to either no skin marking or skin marking approach. UGPIVA was then attempted either with or without skin marking.	Device – Sonosite Titan L38. Nurses were given a 2-hour educational session including simulated practice on phantom models.
Salleras-Duran, et al 20164	Nurses	Descriptive, Observational Study	To examine the success of US-guided IV placement in patients predicted to be difficult	ED – Spain	All patients requiring peripheral IV, >18 years old, and met requirements for US-guided IV placement were included. Patients indicated for US-guided IV placement were those determined difficult by the nurse operator using a 10-point Likert scale. Nurses recorded variables after each procedure for evaluation.	Device – N/A. Participants completed a 20-huor training course covering US basic concepts and simulated practice.
Schoenfeld, et al 201128	ED Technicians	Prospective Observational Study	To assess the success of ED technicians when placing US-guided peripheral IV catheters	ED – United States	At least two attempts at traditional IV placement had to have occurred, and/or patients with established history of difficult access requiring alternative intervention to be included in the study. Technicians completed a survey at the completion of each survey, documenting a range of variables.	Device – Sonosite M-Turbo. 19 ED technicians participated in the study. Participants completed a 2-hour training session that was didactic and hands-on.
Shokohi, et al 20139	ED Technicians	Retrospective Cohort Study	To assess whether the introduction of US-guided IV access program in the ED resulted in less CVC use	ED – United States	Study period was 6 years. Investigators observed the rate of CVC placement after the implementation of an US-guided IV placement program.	Device – N/A. Technicians were provided with 2-hour educational session comprised of both didactic and hands-on learning.
Skulec, et al 20205	Paramedics	Controlled, Prospective, Randomized, Non-Blinded Clinical Study	To compare two different approaches of US-guided IV placement and the landmark method of IV placement by paramedics	Out-of-Hospital – Czech Republic	5 paramedics participated in the study. Patients were included if they were conscious and indicated for prehospital IV placement. Enrolled patients were then randomized in a predefined 1:1:1 ratio to IV insertion fully controlled by US guidance, IV insertion partially controlled by US guidance (target vein identification only), or landmark method.	Device – GE Vscan Dual Probe. Paramedics were naïve to US prior to commencement of the study. Paramedics attended a 1-day emergency POCUS course for beginners that comprised of both hands-on and didactic education sessions.
Stolz, et al 201618	Nurses Paramedics	Prospective Observational Study	To determine how many attempts were required to achieve proficiency with US-guided IV placement in nurses and paramedics	ED – United States	All participants were previously naïve to the USGPIVA placement procedure but proficient in traditional PIVA. Interested nurses or paramedic could electively enroll in the training to participate in the program. Participants were required to complete a survey after each procedure, documenting variables for collection.	Device – Mindray M7 and Ultrasonix SonixTouch. 33 participants were included in the study. Each were provided with 2-hours of training including didactic and hands components.
Vinograd, et al 201829	Nurses	Prospective Observational Study	To examine the success, complications, and longevity of US-guided IVs placed in a pediatric ED	ED – United States	Patients were included after multiple failed blind attempts, a history of difficulty, educational purposes, and patient or family request. Participants completed a survey after each procedure and documented key information.	Device – N/A. 24 nurses participated in this study. Nurse participants were provided with 4-hour training session including didactic and hands-on components.
Weiner, et al 201310	Nurses	Two-Site, Prospective, Non-Blinded, Pilot Study	To determine if trained emergency nurses can place US-guided IVs and subsequently require less physician intervention	ED – United States	Patients were enrolled in a convenience sample and assigned to either SOC or US-guided IV arm. Patients were included if they were adults, indicated for IV access, and were predicted to be difficult.	Device – Sonosite M-Turbo and Zonarae z.one Ultra Convertible Ultrasound System. Each participant was provided with 2-hour training session including didactic and hands-on components.
Miles, et al 201221	Nurses	Prospective, Multicenter, Pilot Study	To evaluate the success of program implemented to facilitate nurse led US-guided PIVA in the ED	ED – United States	Patients were eligible for inclusion if they either had two failed blind attempts or reported a history of DIVA. Consenting patients were assigned to have either US-guided IV access or SOC.	Device – Sonosite MicroMaxx Portable. Participants received 8-hour tutorial from experienced emergency physician including didactic and hands-on elements.

Abbreviations: ED, emergency department; US, ultrasound; PIVA, peripheral intravenous access; IV, intravenous; CVC, central venous catheter; USGPIVA, ultrasound-guided PIVA; SOC, standard of care; DIVA, difficult intravenous access; POCUS, point-of-care ultrasound.