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

Abstract

ObjectivesThis 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).DesignProspective cohort study.SettingTwo tertiary EDs in Western Australia.Participants879 ED patients.Primary outcomeTo 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.ResultsA 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 finalall factors modelcombining 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%.ConclusionA clinical decision, matching patients who have no palpable veins and are older, with clinicians with greater confidence and experience, will likely improve FTIS.Trialregistration numberANZCTRN12615000588594; Results.

Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study

“…This conclusion is in line with Rippey et al [36], who associated clinical experience with the ability to predict difficulty, based on a prior assessment of vascular access. In addition, numerous studies have found the visibility and, above all, the palpability of the vein, according to the nurse's assessment, to be of great significance [22][23][24]37,38]. In our sample, the non-identification of palpable veins after the application of a tourniquet was found to be an independent risk factor for DPIVC (OR 2.35, 95% CI 1.65 to 3.36).…”

Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients

“…To assess the A-DM’s criteria and construct validity, the total scores obtained were correlated with patient and procedural-related variables that are identified in the literature as hypothetically associated with intravenous access difficulty ( Table 4 ) [ 2 , 3 , 6 , 23 , 24 ].…”

“…Several correlation analyses were conducted to further quantify the A-DM’s validity [ 22 ], using a comprehensive list of patient and procedural-related variables described in the literature as potentially associated with difficult peripheral intravenous access [ 2 , 3 , 6 , 23 , 24 ]. Regarding patient-related variables, the A-DM total scores correlated significantly with patient’s age, body mass index, Type-2 Diabetes diagnosis, and previous antineoplastic treatment (such as chemo or radiotherapy).…”

“…While this study was one of the first to also assess PIVCs’ survival times after an initial assessment with a scale [ 12 ], larger studies are needed to further explore the A-DM’s predictive nature concerning specific PIVC-related complications. Although not consensual, current evidence suggests that variables associated with health professionals (e.g., professional experience, professional role, and experience in PIVC insertion) are likely associated with first-attempt success and diagnosis of difficult peripheral intravenous access [ 24 , 27 , 28 , 29 ]. Thus, future validation studies should analyze the association between such variables and the A-DM’s scores.…”

Reducing Risks and Improving Vascular Access Outcomes

“… 3 Success rates of SPC insertion on the first attempt ranging from 86% to 96% have been reported. 4 – 6 In the emergency department, where the procedure is frequently performed in a fast-paced clinical environment, first-attempt success tends to be lower, up to 73%. 7 Repeated needle-insertion attempts may cause patient psychological complications, such as distress and anxiety, as well as pain, vein injury, and enhanced risk of infection.…”