Grade Management in Establishing Pediatric Peripheral Venous Access

Abstract

Background: Establishing venous access is a challenging job for pediatric nurses, especially in the emergency department. Measures to ensure higher success rates on the first attempt are important to provide quality nursing care. Objectives: To explore the effect of grade management on the success of establishing peripheral venous access in the child population of China and to analyze the factors influencing failed IV access on the first attempt. Methods: This is an observational study on children aged 0 -16 years old undergoing peripheral venous catheterization in a children's hospital. Patient information was collected before attempting each puncture. Logistic regression was used to identify independent factors for success prediction. Results: A total of 1,016 subjects enrolled. The success rate of intravenous puncture on the first attempt was 86.02%. This can be influenced by several factors, such as patient age, department, venous condition, and nurse experience. The success rate within two attempts was 96.85%; the number of catheters used per IV attempt was 1.21. Conclusions: To date, only a few studies have explored the success rate of peripheral IV catheterization in the pediatric population of China. Grade management of peripheral veins and pediatric nurses facilitated higher first-attempt success than in previously published reports. Failures of catheterization were multifactorial. The success rate of peripheral intravenous insertion in children can be improved through applying assistance devices or enhancing the venipuncture skills of pediatric nurses.

Difficult Peripheral Venous Access in Children: An International Survey and Critical Appraisal of Assessment Tools and Escalation Pathways

“…Studies were undertaken in the United States ( n = 3 studies; 38%; Hartman, Baker, Bena, Morrison, & Albert, ; Riker, Kennedy, Winfrey, Yen, & Dowd, ; Yen et al, ), Brazil ( n = 1 study; 12.5%; de Souza Freire, Arreguy‐Sena, Souza, & de Souza Müller, ), Ireland ( n = 1 study; 12.5%; O'Neill et al, ), Iran ( n = 1 study; 12.5%; Yan et al, ), Australia ( n = 1 study; 12.5%; Sou et al, ), and the United Kingdom ( n = 1 study; 12.5%; Hallam et al, ). Study populations were both pediatric specific (de Souza Freire et al, ; Hartman et al, ; O'Neill et al, ; Riker et al, ; Yan et al, ; Yen et al, ) and all age patients (Hallam et al, ; Sou et al, ).…”

“…Four tools were identified by the review, and these are further described in Table S3. Tools included the three‐variable (Riker et al, ), four‐variable (O'Neill et al, ; Riker et al, ; Yen et al, ), and five‐variable DIVA Score (de Souza Freire et al, ); a peripheral venous grading system (Yan et al, ); a peripheral vein assessment tool (Hallam et al, ); and a revised assessment tool for grading PIVC access (Hartman et al, ). Study designs included pre and post methods (Hartman et al, ), prospective cohort and observational (O'Neill et al, ; Yan et al, ), discussion papers (Hallam et al, ), and cross‐cultural adaption and validation (de Souza Freire et al, ).…”

“…Tools included the three‐variable (Riker et al, ), four‐variable (O'Neill et al, ; Riker et al, ; Yen et al, ), and five‐variable DIVA Score (de Souza Freire et al, ); a peripheral venous grading system (Yan et al, ); a peripheral vein assessment tool (Hallam et al, ); and a revised assessment tool for grading PIVC access (Hartman et al, ). Study designs included pre and post methods (Hartman et al, ), prospective cohort and observational (O'Neill et al, ; Yan et al, ), discussion papers (Hallam et al, ), and cross‐cultural adaption and validation (de Souza Freire et al, ). Tool development and psychometric testing were most commonly undertaken in pediatric emergency settings (O'Neill et al, ; Riker et al, ; Yen et al, ) and general pediatric hospitals (de Souza Freire et al, ; Hartman et al, ; Yan et al, ).…”

“…Study designs included pre and post methods (Hartman et al, ), prospective cohort and observational (O'Neill et al, ; Yan et al, ), discussion papers (Hallam et al, ), and cross‐cultural adaption and validation (de Souza Freire et al, ). Tool development and psychometric testing were most commonly undertaken in pediatric emergency settings (O'Neill et al, ; Riker et al, ; Yen et al, ) and general pediatric hospitals (de Souza Freire et al, ; Hartman et al, ; Yan et al, ). Tools were evaluated using various outcome measures, including first attempt success, number of attempts, overall success rate, and number of people attempting insertion.…”

“…Greater inserter confidence and skill has been shown to positively influence insertion success (Larsen et al, ). Hartman and colleagues () demonstrated that competent self‐assessment promotes early escalation to better qualified inserters, resulting in greater first attempt success (Yan et al, ). Clinicians consistently described the need for additional training and improved resources to support insertion‐related skills, perceiving insertion skills such as USG capabilities to increase the chance of first attempt success.…”