Piloting a structured nurse training program for ultrasound-guided peripheral IV catheter insertion in emergency care through service design

Background: Ultrasound-guided peripheral intravenous catheter (USG-PIVC) insertion improves success rates in patients with difficult intravenous access (DIVA) and reduces complications. However, widespread implementation remains limited by training demands and workflow integration challenges. This quality improvement initiative aimed to assess the implementation of a nurse-led USG-PIVC pilot program in a tertiary emergency department using a service design approach. Methods: A three-cohort nurse training program was conducted between June 2023 and February 2025 at the McGill University Health Centre. Training included didactic instruction, simulation, and supervised insertions. We conducted descriptive quantitative analysis of insertion outcomes and qualitative analysis of nurse interviews. Program adaptations were made between cohorts in response to participant feedback. Results: A total of nine nurses participated across three cohorts and attempted 101 insertions. Independent insertion success rates were 67%, 63%, and 77% in Cohorts 1, 2, and 3 respectively. While no nurses achieved certification in the first cohort, 100% did so in subsequent cohorts. Common challenges included difficulty visualizing the needle tip and limited practice opportunities during routine shifts. Modifications using a service design approach, such as smaller training groups, protected practice time in a calmer setting, and individualized feedback with formal evaluations were associated with improved performance and skill retention. Conclusion: Using the Tool+Team+Routine lens, we found that effective implementation required not only technical training (tool), but also team structure and dedicated learning environments (team and routine). These insights may inform broader implementation of nurse-led procedural innovations in acute care.