Graduation Date

Summer 2026

Submission Type

Dissertation/Thesis

Degree Name

Doctor of Nurse Anesthesia Practice

Department

Doctor of Nurse Anesthesia Practice (DNAP) Program

School

School of Nursing

Faculty Mentor

Catherine Johnson

Keywords

obstetric patients, difficult intravenous access, ultrasound-guided peripheral intravenous access, needs assessment, quality improvement, survey research, vascular access

Abstract

Obstetric (OB) patients frequently present physiological changes, including edema, obesity, and peripheral vasoconstriction, that increase the risk of difficult intravenous access (DIVA). Multiple IV attempts can delay time-sensitive therapies in obstetric emergencies and increase patient discomfort and provider workload. Research studies have supported the use of the Modified Adult Difficult Intravenous Access (A-DIVA) scale to assess patients for DIVA, and the use of point-of-care ultrasound (POCUS) guided peripheral intravenous access (PIVA). In 2025, a preceding Doctor of Nurse Anesthesia Practice (DNAP) project implemented A-DIVA in the Labor & Delivery (L&D) unit of an OB department and found that 35% of assessed patients were identified as DIVA. They also found variability in nursing IV practice and limited use of point-of-care ultrasound by CRNAs (O'Sullivan & Weaver, 2025). The purpose of this DNAP quality improvement (QI) project was to build upon the recommendations from a 2025 DNAP project, assess current practices, identify barriers, and expand POCUS use among CRNAs. Obstetric nurses and CRNAs were surveyed to assess familiarity with the A-DIVA scale and POCUS in DIVA patients. Findings showed practice variability, limited use of ultrasound, and a need for POCUS training and workflow support. About 10-15 CRNAs received POCUS training, and pre- and post-surveys indicated increased confidence in ultrasound use. Recommendations for further development include implementing standardized A-DIVA screening, integrating A-DIVA scoring into the electronic medical record, delivering spaced, simulation-based POCUS training, and continuing the project with the next DNAP cohort to build on these results.

Language

English

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