1
|
Morioka D, Sagisaka R, Nakagawa K, Takahashi H, Tanaka H. Effect of timing of advanced life support on out-of-hospital cardiac arrests at home in Japan. Am J Emerg Med 2024; 82:94-100. [PMID: 38848664 DOI: 10.1016/j.ajem.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/14/2024] [Accepted: 05/24/2024] [Indexed: 06/09/2024] Open
Abstract
AIM In cases of out-of-hospital cardiac arrests (OHCA) occurring at home, Japanese emergency medical services personnel decide whether to provide treatment on the scene or during transport based on their judgment. This study aimed to evaluate the association between the timing of advanced life support (ALS) (i.e., endotracheal intubation [ETI] or adrenaline administration) for OHCA at home and prognosis. METHOD This retrospective cohort study used data from the Japan Utstein Registry and emergency transport data collected from patients who underwent pre-hospital ETI (n = 6806) and received adrenaline (n = 22,636) between 2016 and 2019. The timing of ETI or adrenaline administration was determined as "on the scene" or "in the ambulance." Multiple logistic regression analysis was used to estimate the association among the timing of ALS implementation, pre-hospital return of spontaneous circulation (ROSC), and survival at 1 month. RESULT ETI on the scene was significantly positively associated with pre-hospital ROSC (adjusted odds ratio [AOR], 1.81; 95% confidence interval [CI], 1.57-2.09) and survival at 1 month (AOR, 1.81; 95% CI, 1.47-2.23). Adrenaline administration on the scene was significantly positively associated with pre-hospital ROSC (AOR, 2.51; 95% CI, 2.33-2.70) and survival at 1 month (AOR, 2.13; 95% CI, 1.89-2.40). CONCLUSION Our analysis suggests performing ALS on the scene was associated with pre-hospital ROSC and survival at 1 month. Further efforts are needed to increase the rate of ALS implementation on the scene by emergency life-saving technicians.
Collapse
Affiliation(s)
- Daigo Morioka
- Faculty of Emergency Medical Science, School of Health Science and Medical Care, Meiji University of Integrative Medicine, Kyoto, Japan; Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan.
| | - Ryo Sagisaka
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan; Research Institute of Disaster Management and Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Koshi Nakagawa
- Department of Integrated Science and Engineering for Sustainable Societies, Faculty of Science and Engineering, Chuo University, Tokyo, Japan
| | - Hiroyuki Takahashi
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| | - Hideharu Tanaka
- Graduate School of Emergency Medical System, Kokushikan University, Tokyo, Japan
| |
Collapse
|
2
|
Wilson M, Stuart S, Lassiter B, Parker T, Martin C, Healy R, Treager C, Sulava E, Gower L, Fernandez P, Friedrich E. Pharmacokinetics of Tranexamic Acid (TXA) Delivered by Expeditious Routes in a Swine Model of Polytrauma and Hemorrhagic Shock. PREHOSP EMERG CARE 2024; 28:680-688. [PMID: 38634701 DOI: 10.1080/10903127.2024.2342025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/21/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVE Hemorrhage is the leading cause of preventable death in civilian trauma centers and on the battlefield. One of the emerging treatment options for hemorrhage in austere environments is tranexamic acid (TXA). However, the landscape is not amenable to the current delivery standard. This study compared the pharmacokinetics of TXA via a standard 10-minute intravenous infusion (IV infusion), intravenous rapid push over 10 s (IV push), and intramuscular injection (IM) in a swine polytrauma and hemorrhagic shock model (trauma group) compared to uninjured controls (control group). METHODS Thirty swine were randomized to the trauma or control group. Following anesthesia, the trauma group experienced a simulated blast injury and 40% controlled hemorrhage. Subjects in both groups were then randomized to receive 1 g/10 mL TXA via IV infusion, IV push, or IM. Animals were monitored for four hours with serial blood sampling. Serum TXA concentrations were measured by liquid chromatography with tandem mass spectrometry (LC-MS/MS) and analyzed. RESULTS The time to maximum TXA concentration (Tmax) was not affected by trauma in IV infusion or IV push, but was affected in the IM administration with Tmax significantly slower than the control group (p = 0.016). The minimum effective serum concentration of TXA (Ceff, 10 µg/mL) was reached in less than one minute with IV infusion and instantaneously with IV push. Despite lower bioavailability, the time to reach Ceff (Teff) was achieved via IM administration in less than 10 min for both groups (6.4 min trauma vs. 2.1 min control). CONCLUSIONS In austere prehospital environments, an alternative to intravenous infusion of a life-saving medication is desired. Administration of TXA via all three methods reached the level needed to cause substantial inhibition of fibrinolysis within 10 min. The IV push method showed similar pharmacokinetics to IV infusion of TXA but can be delivered quickly without sacrificing an access site for 10 min.
Collapse
Affiliation(s)
- Mallori Wilson
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Sean Stuart
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
- Department of Military and Emergency Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | | | - Timothy Parker
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Clyde Martin
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Robert Healy
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Christopher Treager
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Eric Sulava
- Combat Trauma Research Group, Department of Emergency Medicine, Naval Medical Center Portsmouth, Portsmouth, Virginia
| | - Lorie Gower
- General Dynamics Information Technology, Fairfax, Virginia
| | | | | |
Collapse
|
3
|
de Grunt MN, de Jong B, Hollmann MW, Ridderikhof ML, Weenink RP. Parenteral, Non-Intravenous Analgesia in Acute Traumatic Pain-A Narrative Review Based on a Systematic Literature Search. J Clin Med 2024; 13:2560. [PMID: 38731088 PMCID: PMC11084350 DOI: 10.3390/jcm13092560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 04/19/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Traumatic pain is frequently encountered in emergency care and requires immediate analgesia. Unfortunately, most trauma patients report sustained pain upon arrival at and discharge from the Emergency Department. Obtaining intravenous access to administer analgesics can be time-consuming, leading to treatment delay. This review provides an overview of analgesics with both fast onset and parenteral, non-intravenous routes of administration, and also indicates areas where more research is required.
Collapse
Affiliation(s)
- Midas N. de Grunt
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Bianca de Jong
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Markus W. Hollmann
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| | - Milan L. Ridderikhof
- Department of Emergency Medicine, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands;
| | - Robert P. Weenink
- Department of Anaesthesiology, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands; (M.N.d.G.); (B.d.J.); (M.W.H.)
| |
Collapse
|
4
|
Mitra TP, Coulter-Nile S, Jegathees T, Luong J, Shetty A, Lai K. Spiced RCT: Success and Pain Associated with Intravenous Cannulation in the Emergency Department Randomized Controlled Trial. J Emerg Med 2024; 66:57-63. [PMID: 38278677 DOI: 10.1016/j.jemermed.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 09/03/2023] [Accepted: 10/01/2023] [Indexed: 01/28/2024]
Abstract
BACKGROUND Peripheral venous cannulation is one of the most common procedures in medicine. A larger cannula allows higher rates of fluid to be provided if needed in a deteriorating patient; however, it is also perceived that larger-gauge cannula placement is associated with increased pain and procedural difficulty. OBJECTIVE This study aimed to compare the pain and procedural difficulty experienced during insertion between 18-gauge (18G) and 20-gauge (20G) cannulas. METHODS We conducted a single-blinded, randomized controlled trial on adult patients who required peripheral IV cannulation within a tertiary hospital emergency department between April and October 2018. Patients were randomized to either the 18G or 20G cannula group. The primary outcomes of the study-pain experienced by patients and procedural difficulties experienced by clinical staff-were recorded on two separate 10-cm visual analog scales. Other outcomes include first-attempt success rate, operator designation, complications, and the intent and actual use of the IV cannula were documented on preformatted questionnaires. RESULTS Data from 178 patients were included in the analysis. Eighty-nine patients were allocated to each cannula group. There were no statistically or clinically significant differences between mean pain score (0.23; 95% CI 0.56-1.02; p = 0.5662) and mean procedural difficulty score (0.12; 95% CI 0.66-0.93; p = 0.7396). between the two groups. There was no difference in first-attempt success rate (73 of 89 vs. 75 of 89; p = 0.1288), complications (2 of 89 vs. 1 of 89) between the 20G group and 18G group, respectively. CONCLUSIONS There was no significant difference between the 18G or 20G cannula for either pain experienced by patients or procedural difficulty experienced by clinicians.
Collapse
Affiliation(s)
- Tatum Priyambada Mitra
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; Emergency Department, Westmead Children's Hospital, Sydney, New South Wales, Australia; Wollongong Hospital, Wollongong, New South Wales, Australia
| | - Sarah Coulter-Nile
- Westmead Hospital, Sydney, New South Wales, Australia; Royal Hospital for Women, Prince of Wales Hospital, Sydney, New South Wales, Australia
| | - Thuvarahan Jegathees
- Westmead Hospital, Sydney, New South Wales, Australia; Westmead Children's Hospital, Sydney, New South Wales, Australia
| | - Jason Luong
- Westmead Hospital, Sydney, New South Wales, Australia
| | - Amith Shetty
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; New South Wales Ministry of Health, New South Wales, Australia
| | - Kevin Lai
- Emergency Department, Westmead Hospital, Sydney, New South Wales, Australia; University of Sydney, Sydney, New South Wales, Australia
| |
Collapse
|
5
|
Alruwaili A, Khorram-Manesh A, Ratnayake A, Robinson Y, Goniewicz K. The Use of Prehospital Intensive Care Units in Emergencies-A Scoping Review. Healthcare (Basel) 2023; 11:2892. [PMID: 37958036 PMCID: PMC10647734 DOI: 10.3390/healthcare11212892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 10/20/2023] [Accepted: 10/30/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Amidst a rising tide of trauma-related emergencies, emergency departments worldwide grapple with the challenges of overcrowding and prolonged patient wait times. Addressing these challenges, the integration of prehospital intensive care units has appeared as a promising solution, streamlining trauma care and enhancing patient safety. Nevertheless, the feasibility of such an initiative becomes murky when considered globally. This review delves into the intricacies of prehospital intensive care units' deployment for trauma care, scrutinizing their configurations, operational practices, and the inherent challenges and research priorities. METHODS A scoping review was performed for eligible studies. The result was uploaded to the RAYYAN research platform, facilitating simultaneous evaluation of the studies by all researchers. RESULTS A total of 42 studies were initially selected. Four studies were duplicates, and 25 studies were unanimously removed as irrelevant. The remaining studies (n = 13) were included in the review, and the outcomes were categorized into diverse subgroups. CONCLUSIONS A country's emergency medical services must achieve specific milestones in education, competency, resource availability, and performance to effectively harness the potential of a prehospital intensive care unit. While certain nations are equipped, others lag, highlighting a global disparity in readiness for such advanced care modalities.
Collapse
Affiliation(s)
- Abdullah Alruwaili
- Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Al Ahsa 36428, Saudi Arabia
- King Abdullah International Medical Research Center, Al Ahsa 36428, Saudi Arabia
- Ministry of National Guard—Health Affairs, Al Ahsa 36428, Saudi Arabia
- School of Health, University of New England, Armidale, NSW 2350, Australia
| | - Amir Khorram-Manesh
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 41345 Goteborg, Sweden;
- Center for Disaster Medicine, University of Gothenburg, 40530 Gothenburg, Sweden;
- Gothenburg Emergency Medicine Research Group (GEMREG), Sahlgrenska University Hospital, 41305 Goteborg, Sweden
| | - Amila Ratnayake
- Army Hospital Colombo, Department of Surgery, Colombo 08, Sri Lanka;
| | - Yohan Robinson
- Center for Disaster Medicine, University of Gothenburg, 40530 Gothenburg, Sweden;
- Swedish Armed Forces Centre for Defence Medicine, 42605 Västra Frölunda, Sweden
| | | |
Collapse
|
6
|
Burton SO, Donovan JK, Jones SL, Phillips LM, Anderson DJ, Meadley BN. Use of point of care ultrasound (POCUS) by intensive care paramedics to achieve peripheral intravenous access in patients predicted to be difficult: An out-of-hospital pilot study. Australas Emerg Care 2023; 26:164-168. [PMID: 36307321 DOI: 10.1016/j.auec.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Intravenous cannulation is a common procedure for paramedics. Difficulty is often encountered and may result in escalation of care to an intensive care paramedic (ICP). Ultrasound-guided peripheral intravenous access (USGPIVA) is used in-hospital as an alternative approach. Historically limited to physicians, it is increasingly embraced by non-physicians, with point of care ultrasound (POCUS) devices more affordable, portable, and suited to the out of hospital environment. OBJECTIVE To explore the utility of ICP-performed USGPIVA for patients who are predicted to be difficult according to a difficult intravenous access scoring tool. METHODS This was a prospective observational pilot study of ICPs who used the adult difficult intravenous access (A-DIVA) scale to predict difficulty and perform USGPIVA using a contemporary POCUS device. RESULTS For the 32 patients enroled, the overall success rate was 50% of which 87% were successful on the first attempt. Mean A-DIVA score was 4.1/5, and paradoxically, success improved with A-DIVA-predicted difficulty. CONCLUSION ICPs can perform USGPIVA with moderate success. The A-DIVA score could be useful for paramedics to predict difficult cannulation. Future research should focus on increasing exposure, training time and enhancing feedback to paramedics performing USGPIVA.
Collapse
Affiliation(s)
- Samuel O Burton
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Jake K Donovan
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Samuel L Jones
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| | - Luke M Phillips
- Alfred Health, Victoria, Australia; Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, Victoria, Australia
| | - David J Anderson
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Alfred Health, Victoria, Australia
| | - Benjamin N Meadley
- Ambulance Victoria, Doncaster, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia
| |
Collapse
|
7
|
Barsky D, Radomislensky I, Talmy T, Gendler S, Almog O, Avital G. Association Between Profound Shock Signs and Peripheral Intravenous Access Success Rates in Trauma Patients in the Prehospital Scenario: A Retrospective Study. Anesth Analg 2023; 136:934-940. [PMID: 37058730 DOI: 10.1213/ane.0000000000006342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Abstract
BACKGROUND Hemorrhage is the leading cause of preventable death in trauma patients, and establishment of intravenous (IV) access is essential for volume resuscitation, a key component in the treatment of hemorrhagic shock. IV access among patients in shock is generally considered more challenging, although data to support this notion are lacking. METHODS In this retrospective registry-based study, data were collected from the Israeli Defense Forces Trauma Registry (IDF-TR) regarding all prehospital trauma patients treated by IDF medical forces between January 2020 and April 2022, for whom IV access was attempted. Patients younger than 16 years, nonurgent patients, and patients with no detectable heart rate or blood pressure were excluded. Profound shock was defined as a heart rate >130 or a systolic blood pressure <90 mm Hg, and comparisons were made between patients with profound shock and those not exhibiting such signs. The primary outcome was the number of attempts required for first IV access success, which was regarded as an ordinal categorical variable: 1, 2, 3 and higher and ultimate failure. A multivariable ordinal logistic regression was performed to adjust for potential confounders. Patients' sex, age, mechanism of injury and best consciousness level, as well as type of event (military/nonmilitary), and the presence of multiple patients were included in the ordinal logistic regression multivariable analysis model based on previous publications. RESULTS Five hundred thirty-seven patients were included, 15.7% of whom were recorded as having signs of profound shock. Peripheral IV access establishment first attempt success rates were higher in the nonshock group, and there was a lower rate of unsuccessful attempts in this group (80.8% vs 67.8% for the first attempt, 9.4% vs 16.7% for the second attempt, 3.8% vs 5.6% for the third and further attempts, and 6% vs 10% unsuccessful attempts, P = .04). In the univariable analysis, profound shock was associated with requirement for an increased number of IV attempts (odds ratio [OR], 1.94; confidence interval [CI], 1.17-3.15). The ordinal logistic regression multivariable analysis demonstrated that profound shock was associated with worse results regarding primary outcome (adjusted odds ratio [AOR], 1.84; CI, 1.07-3.10). CONCLUSIONS The presence of profound shock in trauma patients in the prehospital scenario is associated with an increased number of attempts required for IV access establishment.
Collapse
Affiliation(s)
- Daniel Barsky
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Institute for Research in Military Medicine (IRMM), Faculty of Medicine, The Hebrew University of Jerusalem and the Israel Defense Forces Medical Corps, Jerusalem, Israel
| | - Irina Radomislensky
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- The National Center for Trauma and Emergency Medicine Research, The Gertner Institute for Epidemiology and Health Policy Research, Sheba Medical Center, Tel-HaShomer, Israel
| | - Tomer Talmy
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sami Gendler
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
| | - Ofer Almog
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Department of Military Medicine, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Guy Avital
- From The Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
- Division of Anesthesia, Intensive Care, and Pain Management, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel, affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Paterson RS, Schults JA, Slaughter E, Cooke M, Ullman A, Kleidon TM, Keijzers G, Marsh N, Rickard CM. Review article: Peripheral intravenous catheter insertion in adult patients with difficult intravenous access: A systematic review of assessment instruments, clinical practice guidelines and escalation pathways. Emerg Med Australas 2022; 34:862-870. [PMID: 36038953 PMCID: PMC9804581 DOI: 10.1111/1742-6723.14069] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 07/31/2022] [Accepted: 08/08/2022] [Indexed: 01/05/2023]
Abstract
The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present study aimed to critically appraise the quality of (i) assessment instruments and (ii) clinical practice guidelines (CPGs) or escalation pathways for identifying and managing patients with DIVA. Cochrane Central Register of Controlled Trials, EBSCO MEDLINE, EMBASE (OVID) and EBSCO CINAHL databases were searched on 22 March 2021. Studies describing a DIVA assessment measure, CPG or escalation pathway for PIVC insertion in adults (≥18 years of age) were included. Data were extracted using a standardised data extraction form including study design, type of resource and reported clinical outcomes. Quality of DIVA assessment instruments were reviewed using the COnsensus-based Standards for the selection of health Measurement Instruments checklist. Methodological quality of CPGs and escalation pathways was assessed using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument. Overall, 24 DIVA resources comprising 16 DIVA assessment instruments and nine CPGs or escalation pathways (including one combined assessment instrument and escalation pathway) were identified. Instruments commonly focused on vein visibility and palpability as indicators of DIVA. CPGs and escalation pathways unanimously recommended use of vessel visualisation technology for patients with or suspected of DIVA. Methodological quality of the resources was mixed. Consensus and standardisation of resources to identify DIVA and recommendations for managing patients with DIVA is limited. Adopting consistent, evidence-based CPGs, escalation pathways or DIVA assessment instruments may significantly improve clinical outcomes.
Collapse
Affiliation(s)
- Rebecca S Paterson
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia
| | - Jessica A Schults
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Herston Infectious Diseases InstituteMetro North Hospital and Health Service, Queensland HealthBrisbaneQueenslandAustralia
| | - Eugene Slaughter
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia
| | - Marie Cooke
- Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Queensland Children's HospitalChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Tricia M Kleidon
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Queensland Children's HospitalChildren's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - Gerben Keijzers
- Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Emergency DepartmentGold Coast University HospitalGold CoastQueenslandAustralia,Faculty of Health Sciences and MedicineBond UniversityGold CoastQueenslandAustralia,School of MedicineGriffith UniversityGold CoastQueenslandAustralia
| | - Nicole Marsh
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| | - Claire M Rickard
- School of Nursing, Midwifery and Social WorkThe University of QueenslandBrisbaneQueenslandAustralia,Alliance of Vascular Access Teaching and ResearchSchool of Nursing and Midwifery, Griffith UniversityBrisbaneQueenslandAustralia,Herston Infectious Diseases InstituteMetro North Hospital and Health Service, Queensland HealthBrisbaneQueenslandAustralia,Nursing and Midwifery Research CentreRoyal Brisbane and Women's HospitalBrisbaneQueenslandAustralia
| |
Collapse
|
9
|
Learning Success and Influencing Factors in Out-of-Hospital Placement of Intravenous Catheters. Prehosp Disaster Med 2022; 37:788-793. [PMID: 36156192 DOI: 10.1017/s1049023x22001327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Placing peripheral intravenous catheters ("IV lines") is a standard procedure for health care professionals in acute and emergency medicine. The study aimed to determine the learning curve and success rates in applying IV lines during a three-year paramedic training and the factors influencing successful placement. METHODS This was a prospective and noninterventional observational study to determine the influencing factors, learning outcomes, and performance in the placement of IV lines by trainees and experienced paramedics. Trial registration: German Clinical Trials Register, ID DRKS00024631. RESULTS From February 1, 2016 through December 31, 2021, a total of 3,547 peripheral venous accesses attempts were performed: 76.5% (n = 2,712) by trainees and 23.5% (n = 835) by experienced practitioners. The trainee group had one-to-three years of training and the experienced group had 11 (SD = 11) years of work experience after training (one-to-35 years). The learning or success curve in the successful placement of peripheral venous accesses was 85.2% in the first year of training, 88.5% in the second year of training, and 92.5% in the third year (and the end of training). It was then 94.3% in the fourth year (first year of being experienced). Successful insertion of peripheral venous accesses in the experienced group was up to 97.0%. The first-attempt success rate was 90.4% across the entire trainee group versus 95.9% in the experienced group (P <.0001).Significant factors influencing successful placement of IV lines were puncture site (P = .022), catheter size (OR = 0.600; P = .002), and number of attempts (OR = 0.370; P <.001). The time of day (or night) was not influential. Work experience, patient age, or blood pressure were also not significant.
Collapse
|
10
|
Pre-hospital peripheral intravenous catheter insertion practice: An integrative review. Australas Emerg Care 2022:S2588-994X(22)00067-7. [DOI: 10.1016/j.auec.2022.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 08/21/2022] [Indexed: 11/15/2022]
|
11
|
Can Non-Physician Providers Use Ultrasound to Aid in Establishing Peripheral IV Access in Patients Who are Difficult to Cannulate? A Scoping Review. Prehosp Disaster Med 2022; 37:535-546. [PMID: 35593145 PMCID: PMC9280064 DOI: 10.1017/s1049023x22000796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Introduction: Non-physician performed point-of-care ultrasound (POCUS) is emerging as a diagnostic adjunct with the potential to enhance current practice. The scope of POCUS utility is broad and well-established in-hospital, yet limited research has occurred in the out-of-hospital environment. Many physician-based studies expound the value of POCUS in the acute setting as a therapeutic and diagnostic tool. This study utilized a scoping review methodology to map the literature pertaining to non-physician use of POCUS to improve success of peripheral intravenous access (PIVA), especially in patients predicted to be difficult to cannulate. Methods: Ovid MEDLINE, CINAHL Plus, EMBASE, and PubMed were searched from January 1, 1990 through April 15, 2021. A thorough search of the grey literature and reference lists of relevant articles was also performed to identify additional studies. Articles were included if they examined non-physician utilization of ultrasound-guided PIVA (USGPIVA) for patients anticipated to be difficult to cannulate. Results: A total of 158 articles were identified. A total of 16 articles met the inclusion criteria. The majority of participants had varied experience with ultrasound, making accurate comparison difficult. Training and education were non-standardized, as was the approach to determining difficult intravenous access (DIVA). Despite this, the majority of the studies demonstrated high first attempt and overall success rates for PIVA performed by non-physicians. Conclusion: Non-physician USGPIVA appears to be a superior method for PIVA when difficulty is anticipated. Additional benefits include reduced requirement for central venous catheter (CVC) or intraosseous (IO) needle placement. Paramedics, nurses, and emergency department (ED) technicians are able to achieve competence in this skill with relatively little training. Further research is required to explore the utility of this practice in the out-of-hospital environment.
Collapse
|
12
|
Ng M, Mark LKF, Fatimah L. Management of difficult intravenous access: a qualitative review. World J Emerg Med 2022; 13:467-478. [PMID: 36636560 PMCID: PMC9807392 DOI: 10.5847/wjem.j.1920-8642.2022.104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 06/02/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. METHODS We conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESULTS We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. CONCLUSION DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques to draw upon.
Collapse
Affiliation(s)
- Mingwei Ng
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Leong Kwok Fai Mark
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| | - Lateef Fatimah
- Department of Emergency Medicine, Singapore General Hospital, Singapore 169608, Singapore
| |
Collapse
|
13
|
Skulec R, Callerova J, Vojtisek P, Cerny V. Two different techniques of ultrasound-guided peripheral venous catheter placement versus the traditional approach in the pre-hospital emergency setting: a randomized study. Intern Emerg Med 2020; 15:303-310. [PMID: 31701317 DOI: 10.1007/s11739-019-02226-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
We performed a randomized pre-hospital clinical study to compare two different techniques of ultrasound-guided peripheral venous catheter (PVC) insertion and the conventional cannulation technique in the pre-hospital emergency setting, with a specific focus on the procedural success rate and the time required to introduce PVC. This pre-hospital prospective controlled randomized clinical trial allocated patients treated by emergency medical service to undergo PVC insertion fully controlled by ultrasound (ultrasound guidance of the PVC tip until it penetrates the lumen, group A), PVC insertion partially controlled by ultrasound (target vein identification only, group B) or to receive PVC without any ultrasound guidance (group C). The study outcomes were monitored until the patient was admitted to the hospital. A total of 300 adult patients were enrolled. The success of the first attempt (group A: 88%, group B: 94%, group C: 76%, p < 0.001) and overall success rate (A: 99%, B: 99%, C: 90%, p < 0.001) were significantly higher in the group A, followed by group B when compared to group C. The number of attempts was significantly lower (A: 1.18 ± 0.54, B: 1.05 ± 0.22, C: 1.22 ± 0.57, p < 0.001) and the time required for the procedure shorter (A: 75.3 ± 60.6, B: 43.5 ± 26.0, C: 82.3 ± 100.9 s, p < 0.001) in group B compared to groups A and C. Both techniques of ultrasound-guided PVC placement were associated with higher success rates than the conventional method. However, PVC insertion partially controlled by ultrasound was superior to full ultrasound guidance in terms of time and number of cannulation attempts required.
Collapse
Affiliation(s)
- Roman Skulec
- Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, 272 01, Kladno, Czech Republic.
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic.
- Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic.
- Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, 400 96, Usti Nad Labem, Czech Republic.
| | - Jitka Callerova
- Emergency Medical Service of the Central Bohemian Region, Vancurova 1544, 272 01, Kladno, Czech Republic
| | - Petr Vojtisek
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic
- Usti and Labem Region Emergency Medical Services, Sociální péče 799/7a, 400 11, Usti and Labem, Czech Republic
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J.E. Purkinje University, Masaryk Hospital Usti Nad Labem, Socialni pece 3316/12A, 400 11, Usti Nad Labem, Czech Republic
- Department of Anesthesiology and Intensive Care, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic
- Faculty of Health Studies, J.E. Purkinje University, Pasteurova 3544/1, 400 96, Usti Nad Labem, Czech Republic
- Department of Research and Development, Charles University in Prague, Faculty of Medicine in Hradec Kralove, University Hospital Hradec Kralove, Sokolská 581, 500 05, Hradec Kralove, Czech Republic
- Department of Anesthesia, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS, B3H 4R2, Canada
| |
Collapse
|
14
|
Tanguay A, Lebon J, Hébert D, Bégin F. Intranasal Fentanyl versus Subcutaneous Fentanyl for Pain Management in Prehospital Patients with Acute Pain: A Retrospective Analysis. PREHOSP EMERG CARE 2020; 24:760-768. [PMID: 31971844 DOI: 10.1080/10903127.2019.1704323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objective: Retrospective analysis evaluating and comparing the feasibility, effectiveness and safety of intranasal fentanyl (INF) and subcutaneous fentanyl (SCF) for pain management of patients with acute severe pain in a rural/suburban Emergency Medical Services (EMS) system. Methods: Pre- and post-pain management data of all patients (aged ≥14 years) who were transported to the emergency department (January 2015-August 2017) were extracted from EMS and online medical control center records, and compared for groups receiving INF or SCF. Kaplan-Meier analysis and the log-rank test were used to describe and compare the percentage of patients in both groups who experienced relief according to their clinically significant pain relief score. Subgroup analysis was performed by patient age (<70 years, ≥70 years). Results: 94.6% (SCF = 94.8%; INF = 94.4%) of patients successfully received fentanyl and 82.7% (SCF = 81.2%; INF = 84.0%) had complete data and were included in the analysis. No difference was observed in time to administration or in the effectiveness of INF and SCF, and neither route of administration resulted in major adverse events that required intervention by paramedics. Upon subgroup analysis, INF patients ≥70 years were more likely to experience relief compared to those <70 years. Conclusion: This retrospective analysis of prehospital patients in the Chaudière-Appalaches EMS system demonstrates that both IN and SC are feasible, effective and safe routes for administering fentanyl. The observed effects of INF were found to be greater among patients ≥70 years. Further research is required to compare these routes with more conventional methods of pain management.
Collapse
|
15
|
Floriano CMDF, Avelar AFM, Peterlini MAS. Time-related factors for peripheral intravenous catheterization of critical children. Rev Bras Enferm 2019; 72:58-64. [PMID: 31851235 DOI: 10.1590/0034-7167-2017-0856] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To verify characteristics related to critical children, the catheter, and the professionals that will influence the time for the success of the puncture. METHOD Descriptive, prospective, and correlation study, collected with an unique instrument, and a sample consisting of 89 children cared for in the emergency room. Statistical analysis of the association between time and explanatory variables was performed, considering a significance of 5%. RESULT The median time for success was 193.4 seconds. Multivariate analysis showed that hypothermic patients (p=0.009) presented prolonged times for success and that the puncture was performed in a shorter time with Vialon® 22G catheters (p=0.045). CONCLUSION The median time for success was higher than recommended, being influenced by hypothermia and condition of veins the children. The Vialon® 22G catheter is the most suitable for puncturing critical patients. Thus, the incorporation of new practices and technologies is necessary for success to occur in less time.
Collapse
|
16
|
Lee SU, Jung JY, Ham EM, Wang SW, Park JW, Hwang S, Kim DK, Kwak YH. Factors associated with difficult intravenous access in the pediatric emergency department. J Vasc Access 2019; 21:180-185. [DOI: 10.1177/1129729819865709] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Background: Successful intravenous catheter placement plays a vital role in the pediatric emergency department. We assessed pediatric emergency department–related factors associated with difficult intravenous catheter placement. Method: We retrospectively reviewed the electronic medical records of patients younger than 18 years who had an intravenous catheter placement attempt during their pediatric emergency department stay. Difficult intravenous access was defined as intravenous catheter placement requiring more than one attempt. The demographic-, clinical- and procedure-related factors were collected, and a logistic regression analysis was used to evaluate the factors associated with difficult intravenous access. Result: In total, 925 patients were enrolled, and 77 (8.32%) cases had difficult intravenous access. The median age of the patients was 3.0 (interquartile range = 1–9) years, and 496 (53.6%) patients were male. After adjustment, we found that age (odds ratio = 0.91, 95% confidence interval = (0.85–0.98), p = 0.01); a history of prematurity (odds ratio = 2.31, 95% confidence interval (1.08–4.98), p = 0.03); the intravenous catheter insertion site (foot versus hand odds ratio = 5.65, 95% confidence interval = (2.97–10.75); p < 0.001); and the experience of the provider (<6 months versus ⩾12 months odds ratio = 4.59, 95% confidence interval = (1.92–11.01), p = 0.01) were associated with difficult intravenous access. However, the acuity of disease, crowdedness at the pediatric emergency department, sex, vein visibility, vein palpability, intravenous catheter size, patients’ experience with intravenous access, and time of day were not significantly correlated with difficult intravenous access. Conclusion: The success rate of intravenous catheter placement at the pediatric emergency department could be improved by experienced providers. The acuity of disease and crowdedness at the pediatric emergency department were not significantly associated factors.
Collapse
Affiliation(s)
- Se Uk Lee
- Department of Emergency Medicine, Seoul Metropolitan Government—Seoul National University Boramae Medical Center, Seoul, South Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Eun Mi Ham
- Department of Emergency Medicine, Seoul Medical Center, Seoul, South Korea
| | - Sang Won Wang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea
| |
Collapse
|
17
|
Does it matter who places the intravenous? An inter-professional comparison of prehospital intravenous access difficulties between physicians and paramedics. Eur J Emerg Med 2018; 24:443-449. [PMID: 26974324 PMCID: PMC6110621 DOI: 10.1097/mej.0000000000000386] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Supplemental Digital Content is available in the text. Objectives Depending on the specific national emergency medical systems, venous cannulations may be performed by physicians, paramedics or both alike. Difficulties in the establishment of vascular access can lead to delayed treatment and transport. Our study investigates possible inter-professional differences in the difficulties of prehospital venous cannulation. Methods Paramedics were interviewed for their personal attitudes towards and experiences in venous access. We analysed 47 candidate predictor variables in terms of cannulation failure and exceedance of a 2 min time threshold. Multivariable logistic regression models were fitted for variables of potential predictive value (P<0.25) and evaluated by the area under the curve (AUC>0.60) of their respective receiver operating characteristic curve. Results were compared with previously published data from emergency physicians. Results A total of 552 cannulations were included in our study. All 146 participants voted that paramedics should be eligible to perform venous catheterizations. Despite ample experience in the task, almost half of them considered prehospital venous cannulations more difficult than those performed in hospital. However, the multivariable logistic regression found only patient-related and puncture site factors to be predictive of cannulation failure (patient age, vein palpability with tourniquet, insufficient ambient lighting: model AUC: 0.72) or cannulation delay (vein palpability with tourniquet: model AUC: 0.60). Conclusion Our study shows that venous cannulation is well established among paramedics. It presents itself with similar difficulties across medical professions. Not the numerous specific circumstances of prehospital emergency care, but universal factors inherent to the task will influence the success at venous catheterization.
Collapse
|
18
|
Aydin A, Bilge S, Eryilmaz M. Safest light in a combat area while performing intravenous access in the dark. J ROY ARMY MED CORPS 2018; 164:343-346. [DOI: 10.1136/jramc-2017-000898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/02/2018] [Accepted: 03/05/2018] [Indexed: 11/04/2022]
Abstract
IntroductionCannulation for the administration of intravenous fluids is integral to the prehospital management of injured military patients. However, this may be technically challenging to undertake during night-time conditions where the use of light to aid cannulation may give the tactical situation away to opponents. The aim of this study was to investigate the success and tactical safety of venepuncture under battlefield conditions with different colour light sources.MethodThe procedure was carried out with naked eye in a bright room in the absence of a separate light source, with a naked eye in a dark room under red, white, blue and green light sources and under an infrared light source while wearing night vision goggles (NVGs). The success, safety, degree of difficulty and completion time for each procedure were then explored.ResultsAll interventions made in daylight and in a dark room were found to be 100% successful. Interventions performed under infrared light while wearing NVGs took longer than under other light sources or in daylight. Interventions performed under blue light were tactically safer when compared with interventions performed under different light sources.ConclusionBlue light offered the best tactical safety during intravenous cannulation under night-time conditions and is recommended for future use in tactical casualty care. The use of NVGs using infrared light cannot be recommended if there is the possibility of opponents having access to the technology.
Collapse
|
19
|
de Freitas Floriano CM, Machado Avelar AF, Sorgini Peterlini MA. Difficulties Related to Peripheral Intravenous Access in Children in an Emergency Room. JOURNAL OF INFUSION NURSING 2018; 41:66-72. [PMID: 29293200 DOI: 10.1097/nan.0000000000000262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This prospective study examined the characteristics of children admitted to a pediatric emergency department and the factors that influenced the successful establishment of peripheral intravenous (IV) access. Descriptive and correlational analysis was completed using a convenience sample of 89 patients. Peripheral IV access was successful in 95.7% of the children, and the first attempt at insertion was successful in 53% of the procedures. Factors influencing the success of peripheral IV access were the patient's gender, skin color, presence of difficult-to-see veins, small veins, presence of fever, and a lack of palpable veins.
Collapse
Affiliation(s)
- Claudia Maria de Freitas Floriano
- Escola Paulista de Enfermagem, Universidade Federal de São Paulo, São Paulo, Brazil (Drs Machado Avelar and Sorgini Peterlini and Ms de Freitas Floriano). Claudia Maria de Freitas Floriano, MSc, is a pediatric emergency nurse at the Escola Paulista de Enfermagem of the Universidade Federal de São Paulo, in São Paulo, Brazil. Ariane Ferreira Machado Avelar, PhD, MSc, RN, is an adjunct professor at the Escola Paulista de Enfermagem of the Universidade Federal de São Paulo in São Paulo, Brazil. Maria Angélica Sorgini Peterlini, PhD, MSc, RN, is an associate professor at the Escola Paulista de Enfermagem of the Universidade Federal de São Paulo in São Paulo, Brazil
| | | | | |
Collapse
|
20
|
Carr PJ, Higgins NS, Cooke ML, Rippey J, Rickard CM. Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature. J Hosp Med 2017; 12:851-858. [PMID: 28991954 DOI: 10.12788/jhm.2836] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND First-time peripheral intravenous catheter (PIVC) insertion success is dependent on patient, clinician, and product factors. Failed PIVC insertion are an under-recognized clinical phenomenon. OBJECTIVE To provide a scoping review of decision aids for PIVC insertion including tools, clinical prediction rules, and algorithms (TRAs) and their findings on factors associated with insertion success. METHODS In June 2016, a systematic literature search was performed using the medical subject heading of peripheral catheterization and tool* or rule* or algorithm*. Data extraction included clinician, patient, and/or product variables associated with PIVC insertion success. Information about TRA reliability, validity, responsiveness, and utility was also extracted. RESULTS We screened 36 studies, and included 13 for review. Seven papers reported insertion success ranging from 61%-90% (4030 insertion attempts), 6 on validity, and 5 on reliability, with none reporting on responsiveness and utility. Failed insertions were associated with obesity (odds ratio [OR], 0.71-1.7; 2 studies) and smaller gauge PIVCs (OR, 6.4; 95% Confidence Interval [CI}, 3.4-11.9). Successful inser tions were associated with visible veins (OR, 0.87-3.63; 3 studies) or palpable veins (OR, 0.79-5.05; 3 studies) and inserters with greater procedural volume (OR, 4.4; 95% CI, 1.6-12.1) or who predicted that insertion would be successful (OR, 1.06; 95% CI, 1.04-1.07). Definitions of insertion difficulty are heterogeneous such as time to insert to a number of failed attempts. CONCLUSIONS Few well-validated reliable TRAs exist for PIVC insertion. Patients would benefit from a validated, clinically pragmatic TRA that matches insertion difficulty with clinician competency.
Collapse
Affiliation(s)
- Peter J Carr
- Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia.
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Niall S Higgins
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Marie L Cooke
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - James Rippey
- Emergency Medicine, Faculty of Health and Medical Sciences, The University of Western Australia
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Sir Charles Gairdner Hospital, Queen Elizabeth II Medical Centre, Nedlands, Perth, Western Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| |
Collapse
|