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Ultrasound guidance had the strongest overall evidence for difficult IV access across 24 randomized trials

International Emergency Nursing (PubMed)Jun 29, 2026

AI-summarized from the linked source. Educational brief, not medical advice.

Brief summary

A network meta-analysis of 24 randomized trials involving 8,014 adults with difficult IV access found that ultrasound guidance improved first-attempt and overall cannulation success versus standard practice, while local warming showed narrower benefits supported by less evidence.

What NurseJet pulled from the source

Difficult intravenous access can lead to repeated attempts, treatment delays, pain, and added cost. This systematic review searched four databases through February 1, 2026 and used a network meta-analysis to compare 11 active interventions across 24 randomized trials with 8,014 adults. Compared with standard practice, ultrasound guidance improved first-attempt success (OR 5.58, 95% CI 2.74 to 11.36) and was the only intervention with a significant overall-success benefit (OR 4.12, 95% CI 2.07 to 8.19). Local warming also improved first-attempt success and reduced procedure time and pain, but rested on more limited evidence. Near-infrared devices reduced attempts and improved satisfaction, while long catheters were associated with more pain and longer procedures. The authors judged ultrasound the most consistently supported option but cautioned that a sparse evidence network and assumptions behind indirect comparisons temper certainty.

Why this matters for nurses

Obtaining vascular access is a frequent nursing task, and repeated failed attempts can delay treatment while increasing pain. This review matters for emergency and med-surg nurses because it compares common escalation options in one analysis and separates the most consistently supported approach from promising but less certain alternatives.

Bedside takeaway

Worth knowing that across 24 randomized trials, ultrasound guidance had the most consistent evidence for first-attempt and overall success in adults with difficult IV access, while local warming showed narrower benefits with less evidence.

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Key takeaways

The network meta-analysis included 24 randomized controlled trials, 8,014 adults, and 11 difficult-access interventions.
Ultrasound guidance improved both first-attempt and overall cannulation success compared with standard practice.
Local warming improved first-attempt success and reduced procedure time and pain, but its evidence base was more limited.
The sparse comparison network and its transitivity assumption limit certainty about intervention rankings.

Practice implications

For nurses following an approved difficult-access pathway, the findings support timely escalation to an ultrasound-trained clinician when standard attempts are unlikely to succeed and consideration of local warming where protocol permits. The rankings should not replace patient assessment, local competency requirements, or the unit's vascular-access policy.

Limitations & cautions

The analysis combined trials of 11 interventions through direct and indirect comparisons, so rankings depend on the assumption that studies were sufficiently comparable. The network was sparse, evidence for some options was limited, and the abstract does not provide certainty ratings or enough setting detail to establish one universal pathway.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations

Exact source links

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International Emergency Nursing (PubMed)

International Emergency Nursing (PubMed). Comparative effectiveness of interventions for difficult intravenous access in adults: A systematic review and network meta-analysis of randomized controlled trials.

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https://pubmed.ncbi.nlm.nih.gov/42372652/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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Journal of the American Geriatrics Society (PubMed)Jul 11, 2026Research Article

In Medicare data for 79,417 older surgical patients discharged through skilled nursing before going home, 4% received a new gabapentinoid prescription and 38% of those new users had prolonged use.

Med-Surg GeriatricsAI summaryReview source

Research ArticleResearchMedication SafetyAI summary · original source linked below

Researchers linked Medicare hospital, outpatient, clinician, and Part D data from 2013 through 2020 to examine gabapentinoid use after 14 common operations in adults aged 66 or older who moved from the hospital to a skilled nursing facility and then home. Among 79,417 patients, the median skilled-nursing stay was 15 days. A total of 3,182 patients (4%) received a new gabapentinoid prescription, and 1,219 of those new users (38%) met the study definition of prolonged use. Female sex, gabapentinoid days' supply, emergency surgery, nonorthopedic and nonvascular surgery, and greater area deprivation were associated with prolonged use in adjusted analysis. The authors found that prolonged use was more common than previously reported among patients discharged directly home and called for more work on medication continuation after skilled-nursing discharge. The claims-based design did not determine whether an individual patient's prolonged use was clinically appropriate.

Key takeaways

The cohort included 79,417 Medicare patients aged 66 or older who underwent one of 14 operations and transitioned through skilled nursing before returning home.
New gabapentinoid use occurred in 3,182 patients, or 4% of the full cohort.
Among those newly prescribed a gabapentinoid, 1,219 patients, or 38%, had prolonged use.
The study describes prescribing persistence and associated factors but does not establish that prolonged use was inappropriate.

Why this matters on shift

A medication started around surgery can follow a patient across hospital, skilled-nursing, and home settings, making its original purpose and intended duration easy to lose. This study matters for nurses because medication reconciliation and clear handoff documentation can make a new gabapentinoid visible for review at each transition.

Bedside takeaway

Be aware that 38% of the older surgical patients newly prescribed a gabapentinoid during a hospital-to-skilled-nursing-to-home transition had prolonged use, a persistence signal that warrants reconciliation without assuming inappropriateness.

Nursing implications

During medication reconciliation, nurses can clarify and document when a gabapentinoid was started, its current indication, and whether continued use remains intended, then route uncertainty through the prescriber or pharmacist. The study does not support labeling every prolonged prescription inappropriate or independently stopping a patient's medication.

Limitations & cautions

This retrospective claims analysis used 2013 to 2020 Medicare data and cannot establish why a prescription continued or whether continued use was appropriate. It may not generalize to younger patients or newer prescribing patterns, and associations with prolonged use do not establish that the identified factors caused it.
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Citations · exact source links

Journal of the American Geriatrics Society (PubMed). Prolonged Use of Postoperative Gabapentin After Discharge From a Skilled Nursing Facility.

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Annals of Work Exposures and Health (PubMed)Jun 3, 2026Research Article

In a randomized study of 42 medical and nursing students, N95 instruction improved knowledge and quantitative fit, video and guided training retained better fit than text at 3 months, and standardized exertion reduced fit.

Leadership Med-SurgAI summaryReview source

Research ArticleResearchInfection ControlNew Grad FriendlyAI summary · original source linked below

This prospective study randomized 42 medical and nursing students with little prior N95 experience to text-based, video-based, or person-guided training. Knowledge-question accuracy rose from 46.0% at baseline to 65.9% immediately after training, then declined to 59.2% at 2 weeks and 54.9% at 3 months; knowledge results did not differ significantly among training groups. Median quantitative fit factor increased from 28 before training to 143.5 immediately afterward and remained above baseline at 130 after 2 weeks and 126 after 3 months. At 3 months, fit remained significantly better with video or guided instruction than with text alone (P=0.029). During treadmill walking at 1.5 and 3 miles per hour, fit factor declined as respiratory and heart rates increased. The authors concluded that training effects fade, video or guided formats better preserve fit performance, and exertion may compromise fit. The trial did not measure workplace exposure or infection.

Key takeaways

The randomized study included 42 medical and nursing students assigned to text, video, or person-guided N95 training.
Median fit factor rose from 28 before training to 143.5 immediately after training, then measured 126 at 3 months.
Video and guided instruction retained better quantitative fit than text instruction at 3 months, while knowledge did not differ by group.
Quantitative fit declined during standardized walking as respiratory and heart rates increased.

Why this matters on shift

Passing instruction once does not guarantee that N95 knowledge or fit performance will remain stable during later clinical work. This study matters for infection-prevention nurses and educators because it measures both retention over three months and the effect of movement, not only immediate post-training knowledge.

Bedside takeaway

Be aware that video and guided N95 instruction preserved quantitative fit better than text alone at 3 months in 42 students, while fit declined during exertion; this supports reinforcement but does not define a refresher schedule.

Nursing implications

For respiratory-protection programs, the findings support hands-on or video-supported instruction, objective fit testing, and reinforcement rather than relying on text alone. The study does not define an ideal refresher interval or replace institutional fit-testing requirements, manufacturer instructions, or reassessment when respirator fit may have changed.

Limitations & cautions

The trial included only 42 medical and nursing students, most without prior formal respirator training, so results may not generalize to experienced clinicians. Follow-up lasted three months, exertion was standardized on a treadmill, and the study measured knowledge and fit factors rather than workplace exposure or infection outcomes.
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Citations · exact source links

Annals of Work Exposures and Health (PubMed). Temporal effects of educational interventions on fit and knowledge retention of N95 filtering facepiece respirator under rest and exertion.

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Infection Control and Hospital Epidemiology (PubMed)Jul 10, 2026Research Article

In a single-center quasi-experimental pre-post study, a nurse-led antimicrobial-stewardship workflow in a medical emergency unit was associated with higher antibiotic-guideline adherence (82.4% to 91.0%) and more cultures collected before antibiotics (23.0% to 40.3%).

Med-Surg EmergencyAI summaryReview source

Research ArticleResearchInfection ControlQuality ImprovementAI summary · original source linked below

Emergency units make high-volume, time-sensitive antibiotic decisions but are often underrepresented in antimicrobial-stewardship programs. In this quasi-experimental pre-post study at a tertiary hospital, trained stewardship nurses first audited antimicrobial-use patterns and identified intervention targets. During the intervention phase, they reviewed antibiotic prescriptions, reinforced adherence to institutional guidance, monitored device-related practices and diagnostic use, and joined audit-and-feedback discussions with clinical teams. Guideline adherence increased from 82.4% at baseline to 91.0% during the intervention. The proportion of cultures obtained before antibiotics rose from 23.0% to 40.3%, culture positivity increased from 8.0% to 22.0%, and antibiotic de-escalation also increased, although the abstract did not provide a numerical de-escalation estimate. The authors concluded that integrating trained nurses into emergency-unit stewardship was feasible and was associated with more rational antimicrobial and diagnostic practices, but the nonrandomized design does not prove that the intervention caused the changes.

Key takeaways

The intervention embedded trained stewardship nurses into prescription review, device-practice monitoring, diagnostic review, and audit-and-feedback with the emergency clinical team.
Adherence to the hospital's antibiotic guidelines increased from 82.4% before the intervention to 91.0% during it.
Cultures collected before antibiotic initiation increased from 23.0% to 40.3%, while culture positivity rose from 8.0% to 22.0%.
Antibiotic de-escalation increased, but the abstract did not report its size or patient-centered clinical outcomes.

Why this matters on shift

Nurses already see antibiotic timing, specimen collection, device care, and response to therapy unfold at the bedside, placing them in a strong position to spot stewardship gaps. This study matters because it tested a nursing role that connected those observations to real-time review and team feedback in a busy emergency setting.

Bedside takeaway

Worth knowing that a nurse-led emergency-unit stewardship audit was linked to higher guideline adherence and more cultures before antibiotics, but the single-center pre-post design cannot establish cause or patient benefit.

Nursing implications

For infection-prevention and emergency nurses, the findings support formal nurse participation in locally approved stewardship workflows, particularly checking whether ordered cultures are obtained before the first antibiotic when clinically feasible and escalating guideline mismatches through the designated team. The study does not justify independent antibiotic changes outside local scope, orders, or stewardship policy.

Limitations & cautions

This was a single-center, nonrandomized pre-post study, so secular changes, case mix, staffing, or clinician behavior may have contributed to the differences. The abstract does not report the number of patients or prescriptions, intervention and baseline durations, statistical uncertainty, antibiotic consumption, adverse events, resistance outcomes, or patient outcomes.
AI-summarized from the linked source. Review the original article before applying to practice.

Citations · exact source links

Infection Control and Hospital Epidemiology (PubMed). Evaluating a nurse-led, audit-based antimicrobial stewardship in the medical emergency unit of a tertiary level hospital.

Explain this for my unit

Open original sourceFull brief

AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Among older surgical patients with a new gabapentinoid prescription, 38% had prolonged use after skilled nursing

Video or guided N95 training preserved quantitative fit better than text alone at 3 months in a 42-student trial

A nurse-led stewardship audit raised antibiotic-guideline adherence and pre-treatment culture collection in an emergency unit