Peripheral intravenous catheter management in childbirth (PICMIC): A multi‐centre, prospective cohort study

Abstract

Background: Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decisionmaking during insertion and perceptions of women.Methods: This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated nonparticipant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time.Results: Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18-gauge catheter was considered more painful than a 16-gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established.Participant clinicians were predominantly midwives, who selected and placed 18gauge catheters mostly in hand or wrist (66%). Decision-making about site, catheter gauge, dressing and attempts varied. Thirty-four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred nondominant arm as key reasons for the location of PIVC.Conclusions: Regular use of a large-gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.

The effects of intravenous hydration regimens in nulliparous women undergoing induction of labor: A systematic review and meta‐analysis

“…As the prevalence of induction of labor for nulliparous women continues to rise internationally, this is becoming a more urgent concern. Most women birthing in high‐resource settings have some intervention during labor and birth requiring a peripheral intravenous catheter, 14 allowing ready access to IVT administration. Yet, the clinical variation in this practice is testament to a clear gap in our understanding regarding optimization of maternal physiology during labor and birth, pertaining to both hydration assessment and management.…”

“…Compared with those laboring spontaneously, nulliparous women undergoing induction of labor generally have a longer first stage of labor. 13 The majority also have peripheral intravenous catheters in situ, 14 for the administration of synthetic oxytocin infusions to stimulate uterine contractility in addition to a “maintenance” IV fluid line for hydration 7 —thus creating an environment for prolonged IV fluid administration. Chantry et al., 15 further identified that the administration of maternal IV fluids during labor was associated with fetal volume expansion and greater neonatal weight loss early in the postpartum period.…”