Peter J Carr1,2,3, James C R Rippey1,3,4, Charley A Budgeon5,6, Marie L Cooke2,3, Niall Higgins3,7, Claire M Rickard2,3. 1. Emergency Medicine, The University of Western Australia, Perth, Western Australia - Australia. 2. National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland - Australia. 3. Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia. 4. Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia. 5. Centre for Applied Statistics, The University of Western Australia, Perth, Western Australia - Australia. 6. Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia. 7. Royal Brisbane & Women's Hospital, Brisbane, Queensland - Australia.
Abstract
BACKGROUND: We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon. METHODS: A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained. RESULTS: A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age <40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success. CONCLUSIONS: Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: 'normal' body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.
BACKGROUND: We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon. METHODS: A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained. RESULTS: A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age &lt;40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success. CONCLUSIONS: Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: 'normal' body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.
Authors: Josh M Leipheimer; Max L Balter; Alvin I Chen; Enrique J Pantin; Alexander E Davidovich; Kristen S Labazzo; Martin L Yarmush Journal: Technology (Singap World Sci) Date: 2020-01-22
Authors: Peter J Carr; James C R Rippey; Marie L Cooke; Chrianna Bharat; Kevin Murray; Niall S Higgins; Aileen Foale; Claire M Rickard Journal: BMJ Open Date: 2016-02-11 Impact factor: 2.692
Authors: Miguel Angel Rodriguez-Calero; Ismael Fernandez-Fernandez; Luis Javier Molero-Ballester; Catalina Matamalas-Massanet; Luis Moreno-Mejias; Joan Ernest de Pedro-Gomez; Ian Blanco-Mavillard; Jose Miguel Morales-Asencio Journal: BMJ Open Date: 2018-02-08 Impact factor: 2.692
Authors: Fredericus H J van Loon; Loes W E van Hooff; Hans D de Boer; Seppe S H A Koopman; Marc P Buise; Hendrikus H M Korsten; Angelique T M Dierick-van Daele; Arthur R A Bouwman Journal: J Clin Med Date: 2019-01-26 Impact factor: 4.241