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Xu HG, Corley A, Young ER, Doubrovsky A, Ware RS, Afoakwah C, Wang C, Stirling S, Marsh N. Long guidewire peripheral intravenous catheters in emergency departments for management of difficult intravenous access: A multicenter, pragmatic, randomized controlled trial. Acad Emerg Med 2024. [PMID: 39248350 DOI: 10.1111/acem.15004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 07/30/2024] [Accepted: 08/08/2024] [Indexed: 09/10/2024]
Abstract
BACKGROUND A quarter of patients who present to emergency departments (EDs) have difficult intravenous access (DIVA), making it challenging for clinicians to successfully place a peripheral intravenous catheter (PIVC). Some literature suggests that guidewire PIVC improves first-insertion success rate. AIM The aim was to determine the clinical and cost-effectiveness of a novel long PIVC (5.8 cm) with a retractable coiled guidewire (GW-PIVC) for patients with DIVA, compared with standard care PIVCs. METHODS A pragmatic randomized controlled trial was conducted in two Australian EDs. Eligible participants were adults assessed as meeting DIVA criteria. Participants were randomized (1:1 ratio; stratified by hospital) to either GW-PIVC (long) or standard care group (short or long PIVC). The use of ultrasound was discretionary in the standard care group and was recommended in the GW-PIVC group due to the pragmatic design that was primarily testing the GW-PIVC rather than the ultrasound use. Primary outcome was first-insertion success and secondary outcomes included all-cause device failure, patient and staff satisfaction, and cost-effectiveness. The analysis was intention to treat. RESULTS A total of 446 participants were randomized and 409 received PIVCs. The use of GW-PIVC, compared with standard PIVC, had a lower first-insertion success rate (68% vs. 77%, odds ratio [OR] 0.65, 95% confidence interval [CI] 0.43-0.99, p < 0.05). There was no difference in PIVC failure (134.0 per 1000 catheter days [GW-PIVC] vs. 111.8 [standard PIVC] per 1000 catheter days, hazard ratio 1.18, 95% CI 0.72-1.95). Both participant (8/10 vs. 9/10, median difference [MD] -1.00, 95% CI -1.37 to -0.63) and clinician (8/10 vs. 10/10, MD -2.00, 95% CI -2.37 to -1.63) satisfaction was lower with GW-PIVCs compared with standard PIVCs. More nurses inserted standard PIVCs than GW-PIVCs (56.9% vs. 36.5%) and had less confidence in their ultrasound skills (28.0% vs. 46.6% self-claimed as advanced/expert users). The cost per participant of GW-PIVC insertions was 2.46 times greater than standard PIVC insertions ($AU80.24 vs. $AU32.57). CONCLUSIONS GW-PIVCs had significantly lower first-insertion success and non-significantly higher all-cause catheter failure. Additional training and device design familiar to clinicians are vital factors to enhance the likelihood of successful future implementation of GW-PIVCs.
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Affiliation(s)
- Hui Grace Xu
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Amanda Corley
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
| | - Emily R Young
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Anna Doubrovsky
- School of Nursing, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
| | - Clifford Afoakwah
- Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia
- Jamieson Trauma Institute, Metro North Health, Brisbane, Queensland, Australia
| | - Carrie Wang
- Department of Emergency Medicine, Queen Elizabeth II Jubilee Hospital, Brisbane, Queensland, Australia
| | - Scott Stirling
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Nicole Marsh
- Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Australia
- School of Medicine and Dentistry, Griffith University, Brisbane, Queensland, Australia
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Xu HG, Corley A, Ware RS, Nghiem S, Stirling S, Wang C, Marsh N. Using a LOng peripheral intraVEnous catheter with retractable guidewire to optimize first-insertion success for patients with Difficult IntraVenous Access in the emergency department (LOVE-DIVA): a study protocol for a randomized controlled trial. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2024; 33:S28-S34. [PMID: 38578937 DOI: 10.12968/bjon.2024.33.7.s28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
INTRODUCTION First-insertion success rates for peripheral vascular access devices (PVADs) in patients with difficult venous access (DIVA) are low, which negatively affects staff workload, patient experience, and organizational cost. There is mixed evidence regarding the impact of a peripheral vascular access device with retractable coiled tip guidewire (GW; AccuCath™, BD) on the first-insertion success rate. The aim of this study is to investigate whether the use of long GW-PVADs, compared with standard PVADs, reduces the risk of first-time insertion failure, in patients admitted to emergency departments (EDs). METHODS AND ANALYSIS A parallel-group, two-arm, randomized controlled trial will be carried out in two Australian EDs to compare long GW-PVADs (5.8 cm length) against standard care PVADs (short or long). Patients ≥18 years of age meeting DIVA criteria will be eligible for the trial. The sample size is 203 participants for each arm. Web-based central randomization will be used to ensure allocation concealment. Neither clinicians nor patients can be blinded to treatment allocation. Primary outcome is the first-insertion success rate. Secondary outcomes include the number of insertion attempts, time to insert PVAD, all-cause failure, dwell-time, patient-reported pain, serious adverse events, complications, subsequent vascular access devices required, patient satisfaction, staff satisfaction, and healthcare costs. Differences between the two groups will be analyzed using Cox proportional hazards regression. Cost-effectiveness analysis will also be conducted. Intention-to-treat analysis will be used. ETHICS AND DISSEMINATION The study is approved by Metro South Ethics Committee (HREC/2022/QMS/82264) and Griffith University (2022/077). The findings will be published in a peer-reviewed journal. TRIAL REGISTRATION ACTRN12622000299707.
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Affiliation(s)
- Hui Grace Xu
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Amanda Corley
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Robert S Ware
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Son Nghiem
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia; School of Medicine and Dentistry, Griffith University, Brisbane, Australia
| | - Scott Stirling
- Department of Emergency Medicine, Logan Hospital, Brisbane, Australia
| | - Carrie Wang
- Department of Emergency Medicine, QEII Hospital, Brisbane, Australia
| | - Nicole Marsh
- School of Nursing and Midwifery, Griffith University, Brisbane Australia; Nursing and Midwifery Research Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia
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Duggan C, Hernon O, Dunne R, McInerney V, Walsh SR, Lowery A, McCarthy M, Carr PJ. Vascular access device type for systemic anti-cancer therapies in cancer patients: A scoping review. Crit Rev Oncol Hematol 2024; 196:104277. [PMID: 38492760 DOI: 10.1016/j.critrevonc.2024.104277] [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: 12/14/2023] [Revised: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Patients with cancer can expect to receive numerous invasive vascular access procedures for intravenous therapy and clinical diagnostics. Due to the increased incidence and prevalence of cancer globally there will be significantly more people who require first-line intravenous chemotherapy over the next ten years. METHODS Our objective was to determine the types of evidence that exist for the vascular access device (VAD) type for the delivery of systemic anti-cancer therapy (SACT) in cancer patients. We used JBI scoping review methodology to identify the types of VADs used for SACT and with a specific search strategy included articles from 2012-2022 published in the English language. We identify (i) type of VADs used for SACT delivery (ii) the type of insertion and post-insertion complications (iii) the geographical location and clinical environment (iv) and whether VAD choice impacts on quality of life (QOL). Findings were presented using the PAGER framework. MAIN FINDINGS Our search strategy identified 10,390 titles, of these, 5318 duplicates were removed. The remaining 5072 sources were screened for eligibility, 240 articles met the inclusion criteria. The most common design include retrospective study designs (n = 91) followed by prospective study designs (n = 31). We found 28 interventional studies with 21 registered in a clinical trial registry and identified no core outcome sets papers specific to VAD for SACT. The most prevalent publications were those that featured two or more VAD types (n = 70), followed by tunnelled intravenous VADs (n = 67). Of 38 unique complications identified, the most frequent catheter related complication was catheter related thrombosis (n = 178, 74%), followed by infection (n = 170, 71%). The county where the most publications originated from was China (n = 62) with one randomized controlled multicenter study from a comprehensive cancer centre. Of the thirty three studies that included QOL we found 4 which reported on body image. No QOL measurement tools specific to the process of SACT administration via VAD are available INTERPRETATION: Our findings suggest a systematic review and meta-analysis of VAD use for intravenous SACT can be considered. However, the development of a core outcome set for SACT should be prioritised. Funding for high quality programs of research for VAD in cancer are needed. Comprehensive cancer centres should lead this research agenda.
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Affiliation(s)
- C Duggan
- Department of Oncology, Portiuncula Hospital, Ballinasloe, Galway H53 T971, Ireland; School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia.
| | - O Hernon
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
| | - R Dunne
- Library, University of Galway, Ireland
| | - V McInerney
- HRB Clinical Research Facility, University of Galway, Ireland
| | - S R Walsh
- Department of Vascular Surgery, Galway University Hospital, Ireland
| | - A Lowery
- School of Medicine, University of Galway, Ireland
| | - M McCarthy
- Department of Medical Oncology, Galway University Hospital, Ireland
| | - P J Carr
- School of Nursing and Midwifery, University of Galway, Ireland; Alliance for Vascular Access Teaching and Research (AVATAR) Group, Queensland, Australia
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Gala S, Alsbrooks K, Bahl A, Wimmer M. The economic burden of difficult intravenous access in the emergency department from a United States' provider perspective. J Res Nurs 2024; 29:6-18. [PMID: 38495321 PMCID: PMC10939017 DOI: 10.1177/17449871231213025] [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: 03/19/2024] Open
Abstract
Background Peripheral intravenous catheter placement is one of the most common invasive procedures that nurses will perform, especially in emergency departments. Aims This early analysis aimed to quantify the economic burden associated with intravenous therapy in patients presenting in emergency departments with difficult intravenous access, receiving traditional peripheral intravenous catheters. This may inform the opportunity for improvement for investment in nursing tools and services regarding difficult venous access burden reduction. Methods Model parameter data were obtained from published literature where possible via a targeted literature review for the terms including relative variations of 'Difficult Venous Access', 'burden', and 'costs', or elicited from expert clinical opinion. A simple decision tree model was developed in Microsoft® Excel 2016. Results included number of insertion attempts, number of patients requiring escalation, catheter failures due to complications, healthcare professional (e.g. nurse) time, and total costs (including/excluding health care professional time). Sensitivity analyses were performed. Results The model considers 64,000 individuals presenting in the emergency department annually, of which 75% (48,000) require a peripheral intravenous catheter; of these 22% (10,560) are estimated to have difficult venous access. The total cost burden of difficult venous access is estimated to be $890,095 per year/$84.29 per patient with difficult venous access, including the cost of clinician time. Key total cost drivers include the population size treated in the emergency department annually, the proportion of midlines placed by a specialist IV (intravenous access) nurse and the percentage of patients with difficult venous access. Conclusion This is the first formal analysis estimating the significant economic burden of difficult venous access in emergency departments via peripheral intravenous catheter placement, a task frequently performed by nurses. Further studies are needed to evaluate nursing-centric strategies for reducing this burden. Additionally, adoption of a concise definition is needed, as is routine use of reliable assessment tools so that future cost analyses can be better contextualised.
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Affiliation(s)
- Smeet Gala
- Associate Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Kim Alsbrooks
- Senior Director Medical Affairs, Becton Dickinson and Co, Franklin Lakes, NJ, USA
| | - Amit Bahl
- Emergency Medicine Physician, Emergency Medicine, Beaumont Hospital, Royal Oak, MI, USA
| | - Megan Wimmer
- Director, HEOR, Becton Dickinson and Co, Franklin Lakes, NJ, USA
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Mielke N, Xing Y, Gibson SM, DiLoreto E, Bahl A. Bridging the Gap in Traditional PIVC Placement: An Evaluation of Operation STICK Vascular Access Outcomes. Ther Clin Risk Manag 2023; 19:937-948. [PMID: 38023627 PMCID: PMC10676087 DOI: 10.2147/tcrm.s435628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/04/2023] [Indexed: 12/01/2023] Open
Abstract
Objective Education and training is core to improving peripheral intravenous access outcomes. This study aimed to show that a vascular access training program (Operation STICK) in the emergency department (ED) improves the outcomes of traditionally placed peripheral intravenous catheters (PIVC). Methods This was a pre-post quasi-experimental study of traditionally placed PIVCs at a large ED in southeastern Michigan, United States. A control group (non-OSTICK) was compared to an experimental group (OSTICK) using a 3:1 propensity score matched analysis. Groups were comprised of ED patients with traditional PIVC placements in two separate six-month periods: non-OSTICK PIVCs from April to September 2021 and OSTICK PIVCs (placed by an OSTICK graduate) from October 2022 to March 2023. The primary outcome was PIVC functionality. The secondary outcome was adherence to best practices. Results A total of 6512 PIVCs were included in the study; 4884 (75.0%) were in the non-OSTICK group, while 1628 (25.0%) were in the OSTICK group. 68.1% of OSTICK PIVCs and 59.7% of non-OSTICK PIVCs were placed by ED technicians (p < 0.001). 91.3% of OSTICK PIVCs were placed on the first attempt, and 98.5% were placed within two attempts. A subgroup analysis of admitted patients (2540 PIVCs; 553 (21.8%) OSTICK-trained and 1987 (78.2%) non-OSTICK-trained) revealed 87.6% of OSTICK PIVCs and 80.3% of non-OSTICK PIVCs were 20 gauge (p < 0.001). The median proportion of dwell time to hospital length of stay was 94% for OSTICK PIVCs, compared to 88% for non-OSTICK PIVCs (p < 0.001). Conclusion This study underscores the value of education and training in enhancing vascular access outcomes. Implementing Operation STICK, a comprehensive vascular access training program, at a large ED has led to high first-stick success, adherence to best practice recommendations for site and device selection, and improved PIVC functionality for traditionally placed catheters.
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Affiliation(s)
- Nicholas Mielke
- Department of Medicine, Creighton University School of Medicine, Omaha, NE, USA
| | - Yuying Xing
- Corewell Health Research Institute, Royal Oak, MI, USA
| | | | - Emily DiLoreto
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
| | - Amit Bahl
- Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA
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Vadgaonkar A, Kothale N, Patil P, Kothari AH, Shetty YC. Factors determining success and the cost of materials used in securing intravenous access in an emergency setting: A prospective observational study. Int Emerg Nurs 2023; 71:101338. [PMID: 37716174 DOI: 10.1016/j.ienj.2023.101338] [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: 12/02/2022] [Revised: 07/17/2023] [Accepted: 08/03/2023] [Indexed: 09/18/2023]
Abstract
INTRODUCTION Multiple failed attempts at securing intravenous catheter access cause increased patient dissatisfaction and higher costs. We aimed to identify the factors leading to multiple failed attempts and estimate the cost of resources wasted. METHODS Participants were recruited from the emergency department for a prospective, observational study. Healthcare workers inserting peripheral intravenous catheters were observed. Patient characteristics and the number of attempts needed were recorded. RESULTS Three hundred thirty-four patients were enrolled, and an average of 1.74 ± 1.026 (Range: 1 - 5) access attempts were needed per patient. Only 56.28% of the insertions were successful on the first attempt. On multivariate linear regression with attempts as the outcome variable, age (β = 0.01, 95%CI 0.004 - 0.014, p = 0.0006), catheter calibre (β 20G = -0.25, 95%CI -0.45 - -0.07, p = 0.008), visibility (β = 0.23, 95%CI 0.02 - 0.44, p = 0.026) and palpability (β = 0.44, 95%CI 0.21 - 0.66, p = 0.0001) of the vein were statistically significant predictors. The average total cost of materials required was $6.4 USD per patient, of which $1.76 USD was spent towards unsuccessfully inserted catheters that were consequently thrown away. CONCLUSIONS Our study shows that securing IV access often requires multiple attempts, with nearly 30% of the total cost amounting towards materials wasted. The risk of multiple attempts is highest for older patients with invisible and non-palpable veins.
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Affiliation(s)
- Aditya Vadgaonkar
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India.
| | - Nikit Kothale
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Prakash Patil
- Dept of Pharmacology and Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
| | - Abhi H Kothari
- Seth GS Medical College & KEM Hospital, Acharya Donde Marg, Parel, Mumbai 400012, India
| | - Yashashri C Shetty
- Dept of Pharmacology and Therapeutics, Seth GS Medical College & KEM Hospital, Mumbai, India
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Xu HG, Rickard CM, Takashima M, Butterfield M, Pink E, Ullman AJ. Exploring Australian emergency department clinicians' knowledge, attitudes and adherence to the national peripheral intravenous catheter clinical care standard: A cross-sectional national survey. Emerg Med Australas 2023; 35:759-770. [PMID: 37062587 DOI: 10.1111/1742-6723.14214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
OBJECTIVE This study aimed to (i) capture clinicians' knowledge, attitude and adherence to the first Australian national peripheral intravenous catheter (PIVC) Clinical Care Standard, (ii) examine the instrument performance of the knowledge related questions and (iii) explore the educational needs for, and barriers to, Standard adherence among Australian ED clinicians. METHODS A cross-sectional national online survey was conducted from March to June 2022, using a snowball sampling method. The survey used 5-point Likert scales and multiple-choice questions to capture respondents' knowledge, attitude and adherence to the Standard as well as the educational needs for, and barriers to, Standard adherence. RESULTS In total, 433 ED nurses and doctors responded. Although nearly half (n = 206, 47.6%; 95% confidence interval [CI] 55.5-65.8) of respondents claimed that they were unfamiliar with the Standard, questions on PIVC knowledge yielded that most respondents had adequate knowledge of most of the key standards. Respondents' attitudes towards multiple intravenous insertion attempts and ongoing PIVC competency monitoring are not in agreement with the Standard. Self-reported practices regarding routine insertion of idle catheters (55%; 95% CI 49.9-59.9), using antecubital fossa as the first insertion site (84%; 95% CI 80-87), insertion without confidence (46%; 95% CI 41.2-51.1) and lack of routine reviewing the ongoing needs of PIVC (40%; 95% CI 35.3-45.1) were not aligned with the Standard. Unawareness of the Standard and non-practical recommendations were rated as the top barriers to Standard adherence. CONCLUSION The findings of the survey suggest that the Standard may need modification to align with the needs of ED clinicians. Future studies need to explore the applicability and relevancy of some recommendations in the ED settings as they may cause low adherence to the Standard.
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Affiliation(s)
- Hui Grace Xu
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
- School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Claire M Rickard
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- Metro North Health and School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Mari Takashima
- School of Medicine, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Michael Butterfield
- Emergency Department, Logan Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Edward Pink
- Emergency Department, Queen Elizabeth II Jubilee Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Amanda J Ullman
- NHMRC Centre of Research Excellence in Wiser Wound Care, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
- Children's Health Queensland Hospital and Health Service, Brisbane, Queensland, Australia
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Pittiruti M, Van Boxtel T, Scoppettuolo G, Carr P, Konstantinou E, Ortiz Miluy G, Lamperti M, Goossens GA, Simcock L, Dupont C, Inwood S, Bertoglio S, Nicholson J, Pinelli F, Pepe G. European recommendations on the proper indication and use of peripheral venous access devices (the ERPIUP consensus): A WoCoVA project. J Vasc Access 2023; 24:165-182. [PMID: 34088239 DOI: 10.1177/11297298211023274] [Citation(s) in RCA: 49] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Since several innovations have recently changed the criteria of choice and management of peripheral venous access (new devices, new techniques of insertion, new recommendations for maintenance), the WoCoVA Foundation (WoCoVA = World Conference on Vascular Access) has developed an international Consensus with the following objectives: to propose a clear and useful classification of the currently available peripheral venous access devices; to clarify the proper indication of central versus peripheral venous access; discuss the indications of the different peripheral venous access devices (short peripheral cannulas vs long peripheral cannulas vs midline catheters); to define the proper techniques of insertion and maintenance that should be recommended today. To achieve these purposes, WoCoVA have decided to adopt a European point of view, considering some relevant differences of terminology between North America and Europe in this area of venous access and the need for a common basis of understanding among the experts recruited for this project. The ERPIUP Consensus (ERPIUP = European Recommendations for Proper Indication and Use of Peripheral venous access) was designed to offer systematic recommendations for clinical practice, covering every aspect of management of peripheral venous access devices in the adult patient: indication, insertion, maintenance, prevention and treatment of complications, removal. Also, our purpose was to improve the standardization of the terminology, bringing clarity of definition, and classification.
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Affiliation(s)
| | | | | | - Peter Carr
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | | | | | | | - Godelieve Alice Goossens
- Nursing Centre of Excellence, University Hospitals, Leuven, Belgium and Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Belgium
| | - Liz Simcock
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Christian Dupont
- Cochin University Hospital, Assistance Publique - Hôpitaux de Paris, France
| | | | | | - Jackie Nicholson
- St George's University Hospitals NHS Foundation Trust, London, UK
| | | | - Gilda Pepe
- Catholic University Hospital 'A. Gemelli', Rome, Italy
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Kaila R, Hendrickson M, Avendano P, Davey C, Cullen R, Colbenson G, Louie J. Hyperkalemia in a Hemolyzed Sample in Pediatric Patients: Repeat or Do Not Repeat? Pediatr Emerg Care 2023; 39:e1-e5. [PMID: 36178777 DOI: 10.1097/pec.0000000000002857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aim of the study is to analyze whether repeat testing is necessary in healthy children presenting to a pediatric emergency department (ED) who are found to have hyperkalemia on a hemolyzed specimen. METHODS A 5-year retrospective analysis of pediatric ED patients found to have elevated potassium values on laboratory testing of a sample reported to be hemolyzed. All patients aged 0 to 17 years who had an elevated potassium level after an intravenous draw resulted from a serum sample that was reported as hemolyzed during an ED visit were included in the study. RESULTS One hundred eighty-seven patients with some degree of both hemolysis and hyperkalemia were included in the final analysis. The median age was 1.9 years of age. The most common race among all patients was White, followed by African American, and Asian. One hundred forty-five children had repeat sampling for hemolyzed hyperkalemia, 142 children, 97.9% (95% confidence interval, 95.6%-100%) had a normal potassium on repeat and 3 children, 2.1% (95% confidence interval, 0.0%-4.4%) had true hyperkalemia. The frequency of true hyperkalemia in our study population was 2% (3/145). All 3 of these patients had underlying conditions that would appropriately have raised clinician suspicion for hyperkalemia. CONCLUSIONS It may be unnecessary to obtain repeat samples to confirm normal potassium in a hemolyzed sample with normal blood urea nitrogen and creatinine.
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Affiliation(s)
- Rahul Kaila
- From the University of Minnesota Masonic Children's Hospital
| | | | - Pablo Avendano
- From the University of Minnesota Masonic Children's Hospital
| | - Cynthia Davey
- University of Minnesota Medical School, Minneapolis, MN
| | - Ryan Cullen
- University of Minnesota Medical School, Minneapolis, MN
| | | | - Jeffery Louie
- From the University of Minnesota Masonic Children's Hospital
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Ballard HA, Hajduk J, Cheon EC, King MR, Barsuk JH. Clinical and demographic factors associated with pediatric difficult intravenous access in the operating room. Paediatr Anaesth 2022; 32:792-800. [PMID: 35293066 PMCID: PMC9310763 DOI: 10.1111/pan.14438] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 03/08/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Pediatric intravenous catheter insertion can be difficult in the operating room due to the technical challenges of small diameter vessels and the need to rapidly gain intravenous access in anesthetized children. Few studies have examined factors associated with difficult vascular access in the operating room, especially accounting for the increased possibility to use ultrasound guidance. AIMS The primary aim of the study was to identify factors associated with pediatric difficult vascular access in the operating room. Our primary hypothesis was that Black race, Hispanic ethnicity, and ultrasound use would be associated with pediatric difficult vascular access. METHODS We performed a retrospective analysis of prospectively collected data from a cohort of pediatric patients who had intravenous catheters inserted in the operating room at an academic tertiary care children's hospital from March 2020 to February 2021. We measured associations among patients who were labeled as having difficult vascular access (>2 attempts at access) with demographic, clinical, and hospital factors. RESULTS 12 728 intravenous catheter insertions were analyzed. Multivariable analysis showed significantly higher odds of difficult vascular access with Black non-Hispanic race (1.43, 95% CI: 1.06-1.93, p = .018), younger age (0.93, 95% CI: 0.89-0.98, p = .005), overweight (1.41, 95% CI: 1.04-1.90, p = .025) and obese body mass index (1.56, 95% 95% CI: 1.12-2.17, p = .008), and American Society of Anesthesiologists physical status III (1.54, 95% CI:1.11-2.13, p = .01). The attending anesthesiologist compared to all other practitioners (certified registered nurse anesthetist: (0.41, 95% CI: 0.31-0.56, p < .001, registered nurse: 0.25, 95% CI: 0.13-0.48, p < .001, trainee: 0.21, 95% CI: 0.17-0.28, p-value <.001 with attending as reference variable) and ultrasound use (2.61, 95% CI: 1.85-3.69, p < .001) were associated with successful intravenous catheter placement. CONCLUSIONS Black non-Hispanic race/ethnicity, younger age, obese/overweight body mass index, American Society of Anesthesiologists physical status III, and ultrasound were all associated with pediatric difficult vascular access in the operating room.
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Affiliation(s)
- Heather A. Ballard
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - John Hajduk
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Eric C. Cheon
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Michael R. King
- Department of Pediatric AnesthesiologyAnn & Robert H. Lurie Children's Hospital of ChicagoChicagoIllinoisUSA
| | - Jeffrey H. Barsuk
- Department of MedicineNorthwestern University Feinberg School of MedicineChicagoIllinoisUSA
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Ruegg L, Faucett M, Clawson A, Subedi S. Reducing the prevalence of antecubital fossa peripheral intravenous cannulation. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2022; 31:S8-S14. [PMID: 35094536 DOI: 10.12968/bjon.2022.31.2.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
UNLABELLED Observational studies have found that placement of peripheral intravenous cannulas (PIVCs) in the antecubital fossa (ACF) is associated with increased risks of infection, including healthcare-associated Staphylococcus aureus bacteraemia (HA-SAB). Avoiding placement of the PIVC in the ACF area along with other preventive measures such as aseptic technique, staff education on documentation, standardised insertion packs and alerts for timely removal, may reduce the overall risk of acquiring an HA-SAB. AIM To implement a multimodal awareness programme on ACF cannulas and the risk of infection, and to reduce PIVC-associated HA-SAB in one hospital in Australia. METHOD The authors performed a baseline digital survey to identify root causes for clinical decision making related to PIVCs and to raise awareness of the project. The authors performed weekly audits and provided feedback on four key wards over 12 weeks. Simple linear regression was used to look at the trend of ACF cannulation rates over time. HA-SAB rates were calculated per 10 000 occupied bed days. FINDINGS Improved insertion documentation was observed during the intervention period. The ACF cannulation rates decreased by 0.03% per day during the study, although this did not quite reach statistical significance (P=0.06). There were no PIVC-associated SAB events during the intervention period. The SAB rates decreased by 0.02% per day over the period of the study.
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Affiliation(s)
- Leanne Ruegg
- Clinical Nurse Consultant, Vascular Access Surveillance and Education, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Mark Faucett
- Clinical Nurse, Vascular Access Surveillance and Education, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Andrew Clawson
- Resident Medical Officer, Department of Emergency Medicine, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
| | - Shradha Subedi
- Infectious Diseases Physician, Department of Infectious Diseases, Sunshine Coast University Hospital, Birtinya, Queensland, Australia
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Sweeny A, Archer-Jones A, Watkins S, Johnson L, Gunter A, Rickard C. The experience of patients at high risk of difficult peripheral intravenous cannulation: An Australian prospective observational study. Australas Emerg Care 2021; 25:140-146. [PMID: 34456181 DOI: 10.1016/j.auec.2021.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/12/2021] [Accepted: 07/26/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Peripheral intravenous cannulation (PIVC) insertion is challenging for some patients, leading to delays in care and workflow. A few easy-to-identify risk factors can differentiate difficult to cannulate (DIVA) patients. METHODS A prospective observational study of adults undergoing PIVC was undertaken. Nursing and medical staff inserted PIVC using their usual practices. Patient, PIVC characteristics, number of attempts and staff characteristics were captured. Indicators of high-risk-for-DIVA were: no vein seen, and/or no vein palpable, and/or a history of difficult PIVC. The experience and outcomes for high-risk-for-DIVA patients were compared to non-DIVA. RESULTS 1084 adults with PIVCs inserted were observed; with (378 (34.9%)) qualifying as high-risk-for-DIVA. First attempt success was achieved for 831 (76.7%) patients overall, with high-risk-for-DIVA significantly less likely to require one attempt (61.1% vs 85.0%, p < 0.001). High-risk-for-DIVA were more likely to have: PIVC aborted, multiple attemptors, ultrasound -guidance, smaller gauge PIVC, and wrist or hand placement. CONCLUSION Simple predictors for difficult PIVC are known, and were present in about one-third of adults in this cohort. Earlier identification and escalation of these patients to more experienced cannulators, those experienced with US, and/or placement in the wrist/hand with a small gauge PIVC, may assist in avoiding unnecessary cannulation attempts and delays.
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Affiliation(s)
- Amy Sweeny
- Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, Queensland, 4215, Australia; Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia; Griffith University School of Medicine, Southport, Queensland, 4215, Australia; Bond University Faculty of Medicine, Robina, Queensland 4229, Australia.
| | - Amy Archer-Jones
- Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - Stuart Watkins
- Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - Laura Johnson
- Griffith University School of Medicine, Southport, Queensland, 4215, Australia
| | - Ashleigh Gunter
- Emergency Department, Gold Coast Hospital and Health Service, 1 Hospital Blvd, Southport, Queensland, 4215, Australia
| | - Claire Rickard
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, 170 Kessels Rd, Nathan, Queensland, 4111, Australia; Bond University Faculty of Medicine, Robina, Queensland 4229, Australia; University of Queensland School of Nursing, Midwifery and Social Work St Lucia, Queensland 40299, Australia; Herston Infectious Diseases Institute, Herston Queensland 4029 Australia
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Shokoohi H, Loesche MA, Duggan NM, Liteplo AS, Huang C, Al Saud AA, McEvoy D, Liu SW, Dutta S. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open 2020; 1:1660-1668. [PMID: 33392574 PMCID: PMC7771794 DOI: 10.1002/emp2.12222] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Difficult intravenous access (DIVA) is common in the emergency department (ED). We investigated the extent to which DIVA is associated with care delay outcomes including time to first laboratory draw, therapies, imaging, and ED disposition. METHODS An observational retrospective cohort analysis of patients with DIVA treated between 2018 and 2020 at 2 urban academic EDs was performed. DIVA was defined as patients requiring ultrasound-guided intravenous access placed by physicians or advanced practice providers (APPs) as opposed to landmark-based intravenous placement by nurses. ED throughput variables and disposition time were compared. We correlated DIVA with time to administration of intravenous pain medications, fluids, imaging contrast, laboratory results, and ED disposition. RESULTS A total of 108,256 subjects with 161,122 total encounters were included. DIVA occurred in 4961 (3.1%) of ED visits. Patients with DIVA were more likely to be female (3.5% vs 2.6% for males, odds ratio [OR] 1.34, 95% confidence interval [CI]: 1.27-1.42), self-identify as black (OR 1.78, 95% CI: 1.66-1.91), and have higher acuity of illness (P < 0.001). Among pediatric patients, DIVA occurred most often in the first year of life at a rate of 3.25%. In adults, DIVA occurred in 2 age peaks; at 35 years (4.02%), and at 63 years (3.44%). In all workflow metrics, the presence of DIVA was associated with significant delays in median time to completion: 50 minutes for pain medication administration, 36 minutes for intravenous fluid administration, 29 minutes for laboratory results, 57 minutes for intravenous contrast administration, and 87 minutes for discharge orders. CONCLUSION DIVA was associated with increased time to therapies, diagnostic studies, imaging completion, and ED disposition. A more expeditious approach to achieving intravenous access in patients with predicted DIVA could improve ED throughput and patient care overall.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Michael A. Loesche
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Nicole M. Duggan
- Department of Emergency MedicineMassachusetts General HospitalHarvard Affiliated Emergency Medicine Residency ProgramBostonMassachusettsUSA
| | - Andrew S. Liteplo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Calvin Huang
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Ahad A. Al Saud
- Division of Emergency UltrasoundDepartment of Emergency MedicineMassachusetts General HospitalBostonMassachusettsUSA
| | - Dustin McEvoy
- Clinical Data AnalystPartners HealthCareSomervilleMassachusettsUSA
| | - Shan W. Liu
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
| | - Sayon Dutta
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolBostonMassachusettsUSA
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Bell JA, Spencer TR. Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes. J Vasc Access 2020; 22:81-89. [DOI: 10.1177/1129729820924554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Peripheral intravenous catheters are frequently used devices in emergency departments. Many patients now present with difficult anatomy and are labeled as difficult intravenous access patients. A common technology to address this challenge is ultrasound. While studies have examined the ability to train emergency staff, few have addressed how this should be done and the outcomes associated with such training. No studies were found with dedicated vascular access specialist teams in emergency departments. An emergency department vascular access specialist team was formed at a hospital in Bangor, Maine, United States to train, validate, and proctor clinicians with ultrasound-guided peripheral intravenous devices. A quality review of this process was compiled and determined that appropriate clinicians with dedicated training and guidance can achieve higher levels of procedural success. Furthermore, evidence substantiates that frequent practice is linked to a higher quality of care and that a significant need for such teams is present. This review examines how a team was implemented and its impact both department- and facility-wide. It is possible that hospitals benefit from the services of vascular access specialists to provide higher quality care. Successful implementation of such specialist teams requires foundational knowledge and skills in vascular access with ongoing quality measures to ensure competency and compliance with evidence-based practices.
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15
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Barth D, Sanchez A, Thomsen AM, Garcia A, Malachowski R, Weldon R, Mayhew M, Mudie K, Faller D, Schwartz J. Peripheral vascular access for therapeutic plasma exchange: A practical approach to increased utilization and selecting the most appropriate vascular access. J Clin Apher 2020; 35:178-187. [PMID: 32191358 DOI: 10.1002/jca.21778] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 02/20/2020] [Accepted: 02/28/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Therapeutic plasma exchange (TPE) is used in the treatment of many diseases. At present, peripheral vascular access (PVA) is an underutilized method of vascular access in TPE. It should be considered more frequently due its relatively low risk for adverse events, particularly infections. METHODS The Advancing Vascular Access in Apheresis Working Group met in December 2017 for an extensive review and discussion of vascular access for TPE and developed a "road map" providing detailed information regarding clinical situations in which PVA-based TPE would and would not be appropriate. RESULTS The road map is consistent with current recommendations that PVA should be used in combination with TPE whenever possible. PVA should be considered for patients who do not have existing central lines and who are stable. The patient should have peripheral veins that will allow for adequate treatment and must be able to comply with the process of achieving and maintaining peripheral access. There should be expert clinical assessment of veins, and this evaluation may include ultrasound and/or near infrared evaluation. Conditions that would prompt a switch from PVA to an alternate method of venous access include loss of venous access, patient preference, or development of a requirement for very frequent treatment over a long period of time. CONCLUSIONS While PVA is not suitable for all patients requiring TPE, it has significant safety advantages over other approaches and should be employed whenever possible.
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Affiliation(s)
- David Barth
- Department of Laboratory Medicine and Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - Amber Sanchez
- Department of Medicine, University of California, San Diego, California, USA
| | - Anna-Marie Thomsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Alicia Garcia
- USCF Children's Hospitals, Oakland and San Francisco, California, USA
| | - Roman Malachowski
- Department of Hematology, Copernicus Memorial Hospital, Łódź, Poland
| | - Rebecca Weldon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | | | - Kari Mudie
- Royal Brisbane & Women's Hospital, Herston, Queensland, Australia
| | | | - Joseph Schwartz
- Colombia University Medical Centre, New York City, New York, USA
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Rodriguez-Calero MA, de Pedro-Gomez JE, Molero-Ballester LJ, Fernandez-Fernandez I, Matamalas-Massanet C, Moreno-Mejias L, Blanco-Mavillard I, Moya-Suarez AB, Personat-Labrador C, Morales-Asencio JM. Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study. J Clin Med 2020; 9:E799. [PMID: 32183475 PMCID: PMC7141318 DOI: 10.3390/jcm9030799] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician's experience in this context. METHODS Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients' clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified. RESULTS The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event. CONCLUSION The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.
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Affiliation(s)
- Miguel Angel Rodriguez-Calero
- Nurse Director Office, Health System of the Balearic Islands (Ib-Salut), Carrer de la Reina Esclaramunda, 9. Piso 3, 07003 Palma Mallorca, Spain
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Joan Ernest de Pedro-Gomez
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
| | - Luis Javier Molero-Ballester
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ismael Fernandez-Fernandez
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Catalina Matamalas-Massanet
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Luis Moreno-Mejias
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ian Blanco-Mavillard
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
- Balearic Islands Health Research Institute (IdISBa), Ctra Valldemossa, 79. Hospital Universitari Son Espases, edifici S, 07120 Palma de Mallorca, Spain
- Hospital Manacor, Ctra Manacor-Alcudia s/n, 07500 Manacor (Mallorca), Spain; (L.J.M.-B.); (I.F.-F.); (C.M.-M.); (L.M.-M.)
| | - Ana Belén Moya-Suarez
- Costa del Sol Hospital, Endoscopy & digestive medicine unit. Autovia A-7, Km. 187, 29603 Marbella, Spain;
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
| | - Celia Personat-Labrador
- Department of Nursing and Physiotherapy, University of the Balearic Islands (UIB), Ctra Palma-Valldemossa km 7.5, 07121 Palma Mallorca, Spain; (J.E.d.P.-G.); (I.B.-M.); (C.P.-L.)
| | - José Miguel Morales-Asencio
- Instituto de Investigación Sanitaria de Málaga (IBIMA), Universidad de Málaga, C/ Arquitecto Francisco Peñalosa, 3, 29071 Málaga, Spain;
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Archer-Jones A, Sweeny A, Schults JA, Rickard CM, Johnson L, Gunter A, Watkins S. Evaluating an ultrasound-guided peripheral intravenous cannulation training program for emergency clinicians: An Australian perspective. Australas Emerg Care 2020; 23:151-156. [PMID: 31926958 DOI: 10.1016/j.auec.2019.12.008] [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] [Received: 11/07/2019] [Revised: 12/04/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The primary objective of this study was to identify the proportion of clinicians using ultrasound guidance (USG) to insert peripheral intravenous cannulas (PIVCs) in the emergency department (ED) following attendance at a hospital-based USG PIVC training program. METHODS Over 12-months, USG cannulation training sessions were offered to nurses and doctors competent in standard PIVC insertion (landmark technique), working in the ED. Surveys pre and post-training captured participants' self-reported confidence with cannulation and USG cannulation using a 5-point Likert scale. Supplemental data from observation periods before and after the trainings assessed departmental cannulation practices overall. Data were analysed using descriptive statistics and associations analysed using chi-square tests. RESULTS Overall, 195 participants attended training; 58% completed follow-up surveys. Forty-three percent reported using USG cannulation the following month. The median confidence score amongst workshop participants increased from 1 to 3 (p<.001). Post-implementation, use of USG cannulation increased from 0.7% to 6.0% post-training (p<.001), although the overall number of attempts at PIVC placement did not change. CONCLUSIONS USG cannulation training increased this practice in the short-term. However, no significant difference in the number of attempts was observed. Further investigation in controlled settings is needed to inform the widespread implementation of USG cannulation training packages.
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Affiliation(s)
- Amy Archer-Jones
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
| | - Amy Sweeny
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia; Griffith University School of Medicine, Gold Coast, Queensland, Australia.
| | - Jessica A Schults
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Anaesthesia and Pain Management, Queensland Children's Hospital, Queensland, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research Group (AVATAR), Menzies Health Institute Queensland, Griffith University, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Queensland, Australia
| | - Laura Johnson
- Griffith University School of Medicine, Gold Coast, Queensland, Australia
| | - Ashleigh Gunter
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
| | - Stuart Watkins
- Gold Coast Hospital and Health Service, Emergency Department, Southport, QLD, Australia
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Ravik M. Using "Knowing That" and "Knowing How" to Inform Learning of Peripheral Vein Cannulation in Nursing Education. Int J Nurs Educ Scholarsh 2019; 16:ijnes-2018-0078. [PMID: 31734657 DOI: 10.1515/ijnes-2018-0078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Accepted: 10/31/2019] [Indexed: 11/15/2022]
Abstract
Background Peripheral vein cannulation is one of the most common invasive practical nursing skills performed by registered nurses. However, many registered nurses lack competence in this practical skill. Learning peripheral vein cannulation associated with successful placement and maintenance is not well understood. Framework Ryle's ways of knowing, "knowing that" and "knowing how", can be used during peripheral vein cannulation learning to guide development and competence in this practical skill. Aim The aim of the article was to provide an overview of Ryle's ways of knowing and to make recommendations for best practices for nurse teachers and nurses teaching students peripheral vein cannulation. Conclusion Ryle's ways of knowing can assist nursing students in their learning and development of peripheral vein cannulation.
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Affiliation(s)
- Monika Ravik
- University of South-Eastern Norway, Porsgrunn, Norway
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Saju AS, Prasad L, Reghuraman M, Karl Sampath I. Use of vein‐viewing device to assist intravenous cannulation decreases the time and number of attempts for successful cannulation in pediatric patients. ACTA ACUST UNITED AC 2019; 1:39-44. [PMID: 35548377 PMCID: PMC8975231 DOI: 10.1002/pne2.12009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 08/27/2019] [Accepted: 09/28/2019] [Indexed: 12/21/2022]
Abstract
Every child who contacts a healthcare setting has a potential for intravenous cannulation (IV) procedure and related pain, fear, and distress. Many of the healthcare professionals recognize that there is a lack of intervention to prevent multiple cannulation attempts and to reduce pain and distress inflicted to children during IV cannulation. A quasi‐experimental study was undertaken in pediatric patients to study the effect of a vein‐viewing device (VTorch) on IV cannulation procedure. The number of cannulation attempts and time taken for successful cannulation were assessed with the use of this device (experimental group, n = 159) and compared it with the standard procedure (control group, n = 159). The effect of this device in cannulation associated pain, fear, and behavioral distress were also evaluated among these children. Using Vein‐viewing device as an aid for IV cannulation significantly reduced the time taken for cannulation (P = .003) and the number of cannulation attempts (P = .03). In addition, there was a significant increase in the first‐attempt cannulation success rate with the use of this device (P = .04). The use of vein‐viewing device did not have any direct effect on cannulation associated pain, fear, or behavioral distress among the study participants. The results of this study may aid in improving the quality of intravenous access procedure in pediatric patients.
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Affiliation(s)
- Alka Sara Saju
- Department of Paediatric Nursing Christian Medical College Vellore Tamil Nadu India
| | - Lilly Prasad
- Department of Paediatric Nursing Christian Medical College Vellore Tamil Nadu India
| | - Menaka Reghuraman
- Department of Paediatric Nursing Christian Medical College Vellore Tamil Nadu India
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Shokoohi H, Boniface KS, Kulie P, Long A, McCarthy M. The Utility and Survivorship of Peripheral Intravenous Catheters Inserted in the Emergency Department. Ann Emerg Med 2019; 74:381-390. [DOI: 10.1016/j.annemergmed.2019.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/28/2019] [Accepted: 02/01/2019] [Indexed: 01/02/2023]
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Cost-Effectiveness Analysis of Low-Cost, Domestic Short Peripheral Catheters Versus Higher-Priced, Imported Short Peripheral Catheters. JOURNAL OF INFUSION NURSING 2019; 42:209-214. [PMID: 31283664 DOI: 10.1097/nan.0000000000000336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This prospective study has been designed with the hypothesis that low unit price does not necessarily mean cost-effectiveness. Low-cost, domestic short peripheral catheters (SPCs) and higher-priced, imported SPCs were compared in 2 different time periods. With the use of the higher-priced, imported SPCs, the rate of successful insertion on first attempt was increased (P < .001), and the development of complications was reduced (P < .001). The study revealed that $345 was saved per 1000 catheters when the catheter with the higher unit price was chosen. Although the domestic SPCs had a low unit price, their use resulted in greater health care expenses.
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Torossian K, Benayoun S, Ottenio M, Brulez AC. Guidelines for designing a realistic peripheral venous catheter insertion simulator: A literature review. Proc Inst Mech Eng H 2019; 233:963-978. [DOI: 10.1177/0954411919864786] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A literature review was conducted to develop more realistic medical simulators that better prepare aspiring health professionals to perform a medical procedure in vivo. Thus, this review proposes an approach that might assist researchers design improved medical simulators, particularly new materials that would enhance the sensation of touch for skin substitutes. By targeting the current needs in the field of simulation learning, we concluded that peripheral venous catheter insertion simulators lack realistic haptic feedback. Enhanced peripheral venous catheter insertion simulators will accelerate the mastery of the medical procedure, thus decreasing the number of failures in patients and costs related to this procedure.
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Affiliation(s)
- Kevin Torossian
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Écully, France
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Stéphane Benayoun
- Laboratoire de Tribologie et Dynamique des Systèmes, UMR CNRS 5513, Ecole Centrale de Lyon, Écully, France
| | - Mélanie Ottenio
- Univ Lyon, Université Claude Bernard Lyon 1, IFSTTAR, LBMC UMR_T9406, Lyon, France
| | - Anne-Catherine Brulez
- Laboratoire de Génie de la Fonctionnalisation des Matériaux Polymères, Institut Textile et Chimique de Lyon, Écully, France
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Carr PJ, Rippey JCR, Cooke ML, Trevenen ML, Higgins NS, Foale AS, Rickard CM. Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. A multicentre prospective cohort analysis of patient, clinician and product characteristics. BMJ Open 2019; 9:e022278. [PMID: 30944127 PMCID: PMC6500093 DOI: 10.1136/bmjopen-2018-022278] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVES This study aimed to identify the incidence of and factors associated with peripheral intravenous catheter/cannula (PIVC) first time insertion success (FTIS) in the emergency department (ED). DESIGN Prospective cohort study. SETTING Two tertiary EDs in Western Australia. PARTICIPANTS 879 ED patients. PRIMARY OUTCOME To identify factors affecting FTIS using univariate and multivariate logistic regression modelling. We created four models: patient factors only; clinician factors only; products and technology factors only and all factors model. We assessed each model's performance using area under the receiver operating characteristic curve. RESULTS A total of 1201 PIVCs were inserted in 879 patients. The mean age was 60.3 (SD 22) years with slightly more females (52%). The FTIS rate was 73%, with 128 (15%) requiring a second attempt and 83 (9%) requiring three or more attempts. A small percentage (3%) had no recorded number of subsequent attempts. FTIS was related to the following patient factors: age (for a 1-year increase in age: OR 0.99, 95% CI 0.983 to 0.998; p=0.0097); and target vein palpability: (always palpable vs never palpable: OR 3.53 95% CI 1.64 to 7.60; only palpable with tourniquet vs never palpable: OR 2.20, 95% CI 1.06 to 4.57; p=0.0014). Clinician factors related to FTIS include: clinicians with greater confidence (p<0.0001) and insertion experience (301-1000 vs <301: OR 1.54, 95% CI 1.02 to 2.34; >1000 vs <301: OR 2.07, 95% CI 1.41 to 3.04; p=0.0011). The final all factors model combining patient factors; clinician factors and product and technology factors has greater discriminative ability than specific factors models. It has a sensitivity of 74.26%, specificity of 57.69%, positive predictive value of 82.87% and negative predictive value of 44.85%. CONCLUSION A clinical decision, matching patients who have no palpable veins and are older, with clinicians with greater confidence and experience, will likely improve FTIS. TRIALREGISTRATION NUMBER ANZCTRN12615000588594; Results.
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Affiliation(s)
- Peter J Carr
- Health Research Board, Clinical Research Facility, National University of Ireland, Galway, University Hospital Galway, Ireland, Galway, Ireland
- Emergency Medicine, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - James C R Rippey
- Emergency Medicine, School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, Western Australia, Australia
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- Sir Charles Gairdner Hospital, QEII Medical Centre, Perth, Western Australia, Australia
| | - Marie L Cooke
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
| | - Michelle L Trevenen
- Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia
| | - Niall S Higgins
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Aileen S Foale
- Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Claire M Rickard
- Alliance for Vascular Access Teaching and Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Queensland, Australia
- The Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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Carr PJ, Rippey JCR, Cooke ML, Higgins NS, Trevenen ML, Foale A, Keijzers G, Rickard CM. Derivation of a clinical decision-making aid to improve the insertion of clinically indicated peripheral intravenous catheters and promote vessel health preservation. An observational study. PLoS One 2019; 14:e0213923. [PMID: 30901370 PMCID: PMC6430401 DOI: 10.1371/journal.pone.0213923] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 03/04/2019] [Indexed: 11/18/2022] Open
Abstract
Background It is well established that the idle peripheral intravenous catheter (PIVC) provides no therapeutic value and is a clinical, economic and above all, patient concern. This study aimed to develop a decision aid to assist with clinical decision making to promote clinically indicated peripheral intravenous catheter (CIPIVC) insertion in the emergency department (ED) setting. Providing evidence for a uniform process could assist clinicians in a decision-making process for PIVC insertion. This could enable patients receive appropriate vascular access healthcare. Methods We performed a secondary analysis of data from a multicentre cohort of emergency department clinicians who performed PIVC insertion. We defined CIPIVC a priori as one used for a specific clinical treatment and or procedure such as prescribed intravenous (IV) fluids; prescribed IV medication; or IV contrast (for computerized tomography scans). We sought to refute or validate an assumption if the clinician performing or requesting the insertion decided the patient was >80% likely to need a PIVC. Using logistic regression, we derived a decision aid for CIPIVCs. Results In 817 patients undergoing PIVC insertion, we observed 68% of these to be CIPIVCs. Admitted patients were significantly more likely to have a CIPIVC, Odds Ratio (OR) = 3.05, 95% confidence interval (CI) = 2.17–4.30, p = <0.0001. Before insertion, patients who definitely needed IV fluids/medicines OR = 3.30, 95% CI = 2.02–5.39, p = <0.0001 and who definitely needed a contrast scan OR = 3.04, 95% CI = 1.15–8.03, p = 0.0250 were significantly more likely to have a device inserted for a clinical indication. Patients who presented with an existing vascular access device were more likely to have a new CIPIVC inserted for use OR = 4.35, 95% CI = 1.58–11.95, p = 0.0043. The clinician’s pre-procedural judgment of the likelihood of therapeutic use >80% was independently associated with CIPIVC; OR 3.16, 95% CI = 2.06–4.87, p<0.0001. The area under the receiver operating characteristic curve was 0.81, and at the best cut-off, the model had a specificity of 0.81, sensitivity of 0.71, a positive predictive value of 0.89 and negative predictive value of 0.57. Conclusions Using the derived decision aid, clinicians could ask:- “Does this patient need A-PIVC?” Clinicians can decide to insert a CIPIVCs when: (i) Admission to hospital is anticipated and when (ii) a Procedure requires a PIVC, e.g., computerised tomography scans and where an existing suitable vascular access device is not present and or; (iii) there is an indication for IV fluids and or medicines that cannot be tolerated enterally and are suitable for dilution in peripheral veins; and, (iv) the Clinician’s perceived likelihood of use is greater than 80%.
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Affiliation(s)
- Peter J. Carr
- Health Research Board, Clinical Research Facility, National University of Ireland Galway, Galway, Ireland
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Perth, Australia
- * E-mail:
| | - James C. R. Rippey
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Western Australia, Nedlands, Perth, Australia
- Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, Perth, Western Australia
| | - Marie L. Cooke
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
| | - Niall S. Higgins
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
- Queensland University of Technology, Brisbane, Australia
| | - Michelle L. Trevenen
- Centre for Applied Statistics, The University of Western Australia, Nedlands, Australia
| | | | - Gerben Keijzers
- Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast
- Australia School of Medicine, Bond University, Gold Coast, Australia
- School of Medicine, Griffith University, Gold Coast, Australia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, School of Nursing and Midwifery, Griffith University, Brisbane, Australia
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The Modified A-DIVA Scale as a Predictive Tool for Prospective Identification of Adult Patients at Risk of a Difficult Intravenous Access: A Multicenter Validation Study. J Clin Med 2019; 8:jcm8020144. [PMID: 30691137 PMCID: PMC6406455 DOI: 10.3390/jcm8020144] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 01/21/2019] [Accepted: 01/22/2019] [Indexed: 12/14/2022] Open
Abstract
Peripheral intravenous cannulation is the most common invasive hospital procedure but is associated with a high failure rate. This study aimed to improve the A-DIVA scale (Adult Difficult Intra Venous Access Scale) by external validation, to predict the likelihood of difficult intravenous access in adults. This multicenter study was carried out throughout five hospitals in the Netherlands. Adult participants were included, regardless of their indication for intravenous access, demographics, and medical history. The main outcome variable was defined as failed peripheral intravenous cannulation on the first attempt. A total of 3587 participants was included in this study. The first attempt success rate was 81%. Finally, five variables were included in the prediction model: a history of difficult intravenous cannulation, a difficult intravenous access as expected by the practitioner, the inability to detect a dilated vein by palpating and/or visualizing the extremity, and a diameter of the selected vein less than 3 millimeters. Based on a participant’s individual score on the A-DIVA scale, they were classified into either a low, moderate, or high-risk group. A higher score on the A-DIVA scale indicates a higher risk of difficult intravenous access. The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of difficult intravenous access.
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From insertion to removal: A multicenter survival analysis of an admitted cohort with peripheral intravenous catheters inserted in the emergency department. Infect Control Hosp Epidemiol 2018; 39:1216-1221. [PMID: 30196798 DOI: 10.1017/ice.2018.190] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Most patients admitted to the hospital via the emergency department (ED) do so with a peripheral intravenous catheter/cannula (PIVC). Many PIVCs develop postinsertion failure (PIF). OBJECTIVE To determine the independent factors predicting PIF after PIVC insertion in the ED. METHODS We analyzed data from a prospective clinical cohort study of ED-inserted PIVCs admitted to the hospital wards. Independent predictors of PIF were identified using Cox proportional hazards regression modeling. RESULTS In 391 patients admitted from 2 EDs, the rate of PIF was 31% (n=118). The types of PIF identified were infiltration, occlusion, pain and/or peripheral intravenous assessment score >2 (ie, the hospital's assessment of PIVC phlebitis), and dislodgement (ie, accidental securement device failure or purposeful removal). Of the PIVCs that failed, infiltration and occlusion combined were the most common causes of PIF (n=55, 47%). The median PIVC dwell time was 28.5 hours (interquartile range [IQR], 17.4-50.8 hours). The following variables were associated with increased risk of PIF: being an older patient (for a 1-year increase, hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.01-1.03; P=.0001); having an Australian Triage Scale score of 1 or 2 compared to a score of 3, 4, or 5 (HR, 2.04; 95% CI, 1.39-3.01; P=.0003); having an ultrasound-guided PIVC (HR, 6.52; 95% CI, 2.11-20.1; P=.0011); having the PIVC inserted by a medical student (P=.0095); infection prevention breaches at insertion (P=.0326); and PIVC inserted in the ante cubital fossa or the back of hand compared to the upper arm (P=.0337). CONCLUSION PIF remains at an unacceptable level in both traditionally inserted and ultrasound-inserted PIVCs.Clinical trial registrationAustralian and New Zealand Trials Registry (ANZCTRN12615000588594).
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van Loon F, Buise M, Claassen J, Dierick-van Daele A, Bouwman A. Comparison of ultrasound guidance with palpation and direct visualisation for peripheral vein cannulation in adult patients: a systematic review and meta-analysis. Br J Anaesth 2018; 121:358-366. [DOI: 10.1016/j.bja.2018.04.047] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 04/06/2018] [Accepted: 05/21/2018] [Indexed: 12/11/2022] Open
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Rangarajan S, Morgenstern J, Milne WK, Heitz C. Hot Off the Press: Peripheral Intravenous Cannula Insertion and Use in the Emergency Department. Acad Emerg Med 2018; 25:668-671. [PMID: 29450938 DOI: 10.1111/acem.13390] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Accepted: 02/09/2017] [Indexed: 11/29/2022]
Abstract
This is a prospective before-after study comparing peripheral intravenous cannulation (PIVC) placement and usage rates following a 10-week-long multimodal intervention provided to medical and nursing staff working in a tertiary emergency department (ED). The intervention focused on improving appropriate use of PIVCs in an emergency setting by emphasizing to clinicians that a PIVC should only be placed if it was believed there was more than an 80% chance that it would be used. Patients were eligible for the study if they presented to the ED and were >18 years of age. Patients were excluded from the study if they were triage category 1, already had a PIVC placed in an ambulance, or were transferred from another hospital. Among the 4,172 patients included in the analysis, there was a 9.8% reduction in the number of PIVCs inserted (95% confidence interval [CI] = 6.8-12.87) and a 12% increase in PIVC usage (95% CI = 8.7%-17.0%) in the postintervention cohort.
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Affiliation(s)
- Sahaana Rangarajan
- Department of Emergency Medicine Markham Stouffville Hospital Markham OntarioCanada
| | - Justin Morgenstern
- Department of Emergency Medicine Markham Stouffville Hospital Markham OntarioCanada
| | - William K. Milne
- Department of Emergency Medicine University of Western Ontario Goderich OntarioCanada
| | - Corey Heitz
- Department of Emergency Medicine Carilion Clinic Roanoke VA
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Rodriguez-Calero MA, Fernandez-Fernandez I, Molero-Ballester LJ, Matamalas-Massanet C, Moreno-Mejias L, de Pedro-Gomez JE, Blanco-Mavillard I, Morales-Asencio JM. Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case-control study in 48 units of eight public hospitals in Spain. BMJ Open 2018; 8:e020420. [PMID: 29439080 PMCID: PMC5829883 DOI: 10.1136/bmjopen-2017-020420] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patients with difficult venous access experience undesirable effects during healthcare, such as delayed diagnosis and initiation of treatment, stress and pain related to the technique and reduced satisfaction. This study aims to identify risk factors with which to model the appearance of difficulty in achieving peripheral venous puncture in hospital treatment. METHODS AND ANALYSIS Case-control study. We will include adult patients requiring peripheral venous cannulation in eight public hospitals, excluding those in emergency situations and women in childbirth or during puerperium. The nurse who performs the technique will record in an anonymised register variables related to the intervention. Subsequently, a researcher will extract the health variables from the patient's medical history. Patients who present one of the following conditions will be assigned to the case group: two or more failed punctures, need for puncture support, need for central access after failure to achieve peripheral access, or decision to reject the technique. The control group will be obtained from records of patients who do not meet the above conditions. It has been stated a minimum sample size of 2070 patients, 207 cases and 1863 controls.A descriptive analysis will be made of the distribution of the phenomenon. The variables hypothesised to be risk factors for the appearance of difficult venous cannulation will be studied using a logistic regression model. ETHICS AND DISSEMINATION The study was funded in January 2017 and obtained ethical approval from the Research Ethics Committee of the Balearic Islands. Informed consent will be obtained prior to data collection. Results will be published in a peer-reviewed scientific journal.
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Affiliation(s)
- Miguel Angel Rodriguez-Calero
- Quality, Teaching and Research Unit, Hospital Manacor, Manacor, Balearic Islands, Spain
- Department of Nursing, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | | | | | | | - Luis Moreno-Mejias
- Hospitalisation area, Hospital Manacor, Manacor, Balearic Islands, Spain
| | - Joan Ernest de Pedro-Gomez
- Department of Nursing and Physiotherapy, University of the Balearic Islands, Palma, Balearic Islands, Spain
| | - Ian Blanco-Mavillard
- Quality, Teaching and Research Unit, Hospital Manacor, Manacor, Balearic Islands, Spain
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Hawkins T, Greenslade JH, Suna J, Williams J, Rickard CM, Jensen M, Donohue M, Cho E, Hise CV, Egerton‐Warburton D, Cullen L. Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study. Acad Emerg Med 2018; 25:26-32. [PMID: 29044739 DOI: 10.1111/acem.13335] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Revised: 09/12/2017] [Accepted: 09/27/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVES The objective was to examine cannulation practice and effectiveness of a multimodal intervention to reduce peripheral intravenous cannula (PIVC) insertion in emergency department (ED) patients. METHODS A prospective before and after study and cost analysis was conducted at a single tertiary ED in Australia. Data were collected 24 hours a day for 2 weeks pre- and post implementation of a multimodal intervention. PIVC placement and utilization within 24 hours were evaluated in all eligible patients. RESULTS A total of 4,173 participants were included in the analysis. PIVCs were placed in 42.1% of patients' pre intervention and 32.4% post intervention, a reduction of 9.8% (95% confidence interval [CI] = 6.8 to -12.72%). PIVC usage within 24 hours of admission was 70.5% pre intervention and 83.4% post intervention, an increase of 12.9% (95% CI = 8.8% to 17.0%). Sixty-six patients were observed in the ED for cost analysis. The mean time per PIVC insertion was 15.3 (95% CI = 12.6 to 17.9) minutes. PIVC insertion cost, including staff time and consumables per participant, was A$22.79 (95% CI = A$19.35 to A$26.23). CONCLUSIONS The intervention reduced PIVC placement in the ED and increased the percentage of PIVCs placed that were used. This program benefits patients and health services alike, with potential for large cost savings.
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Affiliation(s)
- Tracey Hawkins
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
| | - Jaimi H. Greenslade
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
- School of Medicine University of Queensland Herston QueenslandAustralia
| | - Jessica Suna
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
- School of Nursing Queensland University of Technology Kelvin Grove QueenslandAustralia
| | - Julian Williams
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
- School of Medicine University of Queensland Herston QueenslandAustralia
| | - Claire M. Rickard
- Alliance for Vascular Access Teaching and Research Griffith University Nathan QueenslandAustralia
| | - Matthew Jensen
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
- Emergency Department Sentara Norfolk General Hospital Norfolk VA
| | - Maria Donohue
- Centre for Applied Health Economics Griffith University Mount Gravatt Queensland Australia
| | - Elizabeth Cho
- School of Medicine University of Queensland Herston QueenslandAustralia
| | | | - Diana Egerton‐Warburton
- School of Clinical Sciences Monash Health Monash University Melbourne VictoriaAustralia
- Emergency Department Monash Medical Centre Monash Health Clayton VictoriaAustralia
| | - Louise Cullen
- Department of Emergency Medicine Royal Brisbane and Women's Hospital Brisbane QueenslandAustralia
- School of Medicine University of Queensland Herston QueenslandAustralia
- Faculty of Health Queensland University of Technology Kelvin Grove QueenslandAustralia
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Conditions Affecting the Performance of Peripheral Vein Cannulation during Hospital Placement: A Case Study. Nurs Res Pract 2017; 2017:9748492. [PMID: 29238617 PMCID: PMC5697389 DOI: 10.1155/2017/9748492] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Accepted: 10/15/2017] [Indexed: 01/12/2023] Open
Abstract
Learning practical nursing skills is an important part of the baccalaureate in nursing. However, many newly qualified nurses lack practical skill proficiency required to ensure safe patient care. The invasive skill peripheral vein cannulation (PVC) is particularly challenging to learn and perform. This study explored conditions influencing nursing students' learning and performance of the technical implementation of a PVC during their clinical placement period. A qualitative and descriptive case study design with two students in Norway practicing PVC during their clinical placement was conducted. One student who mastered the vein cannulation was compared with one student who did not. Data were collected in late 2012 using multiple data sources: semistructured interviews, ad hoc conversations, and video recordings. Video recordings of the two students' cannula implementations were used to help clarify and validate the descriptions and to identify gaps between what students said and what they did. Thematic analysis of the transcribed text data enabled identifying themes that influenced skill performance. There were two overall themes: individual and contextual conditions influencing the technical implementation of a peripheral vein cannula. These findings were evaluated in terms of Benner's work on scientific and practical knowledge, defined as “knowing that” and “knowing how.”
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