Date of Award

Spring 5-23-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice



First Advisor

Dr. Kevin Maxwell PhD, DNP, FNP-BC, RN


Background: Single plane ultrasound (US) probes are currently standardized for initiating US guided peripheral intravenous (USGPIV) access for difficult intravenous access (DIVA) patients in the emergency department (ED). Emerging literature reveals the increased efficacy of biplane US probes for USGPIV access with an improved success rate of up to 36.6%.

Purpose of Project: Implement best practice recommendations by integrating one biplane US probe for USGPIV access at a Level 1 Trauma Center ED in Southern California after training ten registered nurses (RN) on its use. The project aimed to improve patient outcomes, department flow, RN education, and utilization of US devices for peripheral intravenous (PIV) insertion.

PICO(T): Does implementing biplane US probes for USGPIV access for adult patients in the ED affect RN utilization, patient outcomes, and department flow over a six month period compared to baseline US probes?

Methods: A brief educational module with online and in-person training components was integrated for ten previously US certified ED RNs. After developing and implementing a property function in the electronic medical record (EMR), RNs were able to chart their use of biplane probes for USGPIVs. Following education, RNs were provided access to a single biplane probe for live implementation with DIVA patients in the ED at their own discretion on thirteen randomized day shifts over a six month period. Data was then collected and analyzed retrospectively using EMR reports.

Results: Utilization of the biplane method improved outcomes compared to the single plane method resulting in a 23.8% reduction in the average number of attempts required to obtain access, 80% decrease in subsequent critical care vascular access placement, and 33.1% decrease in length of stay (LOS). Patients who received biplane USGPIVs required greater time until access was obtained. After in-person training, there was an increase in the rate of both single plane and biplane US probe use compared to baseline. A cost benefit analysis (CBA) and return on investment (ROI) were calculated, indicating a significant cost reduction with continued implementation of biplane US probes.

Conclusion: Biplane US probes for USGPIV access in the ED setting improved patient outcomes and may result in significant cost reduction compared to single plane US probes.


This manuscript is pending approval and publication by the Advanced Emergency Nursing Journal, and revisions will be made to this submission following publication. Per AENJ requirements, a one-year embargo has been requested.

Available for download on Wednesday, May 07, 2025

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Nursing Commons