Human factor‐designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion

Egerton-Warburton, Diana; McAllan, Fern; Ramanan, Radha; Lim, Zheng Jie; Nagle, Daniel J.; Dendle, Claire; Stuart, Rhonda L.

doi:10.1111/1742-6723.13165

Cited by 13 publications

(16 citation statements)

References 27 publications

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“…It is likely that patients, especially with less urgent ATS categories within our sample had a PIVC inserted in ED solely for the purpose of pathology collection. The large proportion of PIVCs being used for pathology collection in our study is congruent with other studies (16,29) . Egerton-Warburton et al reported a multimodal approach aimed at reducing inappropriate PIVC insertions (29) .…”

Section: Discussionsupporting

confidence: 92%

“…Egerton-Warburton et al reported a multimodal approach aimed at reducing inappropriate PIVC insertions (29) . This approach was successful in reducing unnecessary PIVCs, but not in lowering rates of PIVCs inserted for pathology collection only (29) . The nancial burden and increased patient risks of PIVC placement as opposed to venepuncture must be carefully considered prior to deciding which procedure is to be performed.…”

Section: Discussionmentioning

confidence: 99%

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WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

Evison

Sweeny²,

Ranse

et al. 2020

Preprint

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Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February - 18 March 2017 and 5 January - 4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24h. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs 7.4%). Nursing staff inserted idle PIVC at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC insertion in the ED was the only factor significantly (p=<.001) predicting an idle outcome (Odds Ratio: 2.4; 95%CI 1.7-3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of ante-cubital insertion. Reasons for these differences are not well understood and requires more targeted research.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

Evison

Sweeny²,

Ranse

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…It is likely that patients, especially with less urgent ATS categories within our sample had a PIVC inserted in the ED solely for the purpose of pathology collection. The large proportion of PIVCs being used for pathology collection in our study is congruent with other studies [ 16 , 29 ]. Egerton-Warburton et al reported a multimodal approach aimed at reducing inappropriate PIVC insertions [ 29 ].…”

Section: Discussionsupporting

confidence: 92%

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Evison¹,

Sweeny

Ranse

et al. 2021

Scand J Trauma Resusc Emerg Med

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Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

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“…Duncan, 2017, USA [47] Oral abstract presentation. Egerton-Warburton, 2015, Australia [48] Oral abstract presentation.…”

Section: Implementation Strategiesmentioning

confidence: 99%

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review

Ray‐Barruel

Marsh

et al. 2019

Infection, Disease & Health

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Background: Evidence-based bundles have reduced central line bloodstream infection rates in adult intensive care units. To tackle peripheral intravenous catheter (PIVC) bloodstream infection, many hospitals have implemented PIVC insertion and maintenance bundles. However, the efficacy of PIVC bundles in preventing PIVC complications and infection in hospital patients is uncertain. The aim of this paper is to synthesize evidence on the effectiveness of PIVC insertion and maintenance bundles on preventing adverse events. Methods: In this systematic review, we searched multiple electronic databases, trial registries, and grey literature for eligible studies published in English (January 2000eDecember 2018) to identify intervention studies evaluating PIVC insertion or maintenance bundles with two or more components. Search terms: peripheral intravenous catheter/cannula, insertion, maintenance, bundle, infection, infiltration, extravasation, dislodgement, thrombosis, occlusion, and phlebitis. Two reviewers independently conducted data extraction and quality assessments using the Downs and Black checklist. Results: Of 14,456 records screened, 13 studies (6 interrupted time-series, 7 before-and-after) were included. Insertion and maintenance bundles included multiple components (2e7 items per bundle). Despite testing different bundles, 12 studies reported reductions in phlebitis and bloodstream infection, and one study reported no change in bloodstream infection and an

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Human factor‐designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion

Abstract: Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.

Cited by 13 publications

References 27 publications

WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review

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Human factor‐designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion

Abstract: Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.

Cited by 13 publications

References 27 publications

WITHDRAWN: Idle&nbsp;peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

WITHDRAWN: Idle&nbsp;peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Effectiveness of insertion and maintenance bundles in preventing peripheral intravenous catheter-related complications and bloodstream infection in hospital patients: A systematic review

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Resources

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WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices

WITHDRAWN: Idle peripheral intravenous cannulation: An observational cohort study of pre-hospital and emergency department practices