Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician ‘gestalt’ wins again

Rippey, James; Carr, Peter; Cooke, Marie; Higgins, Niall; Rickard, Claire M

doi:10.1111/1742-6723.12695

Cited by 44 publications

(46 citation statements)

References 24 publications

(53 reference statements)

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“…Professional expertise in cannulation technique seem to be associated, not with a higher success of the technique, but with a more accurate capacity to predict difficulty based on the assessment of the vessel previous to puncture. 57 These findings, if confirmed, would reinforce the idea that multiple puncture is an avoidable adverse event and interventions to avoid it are in our hands.…”

Section: Discussionmentioning

confidence: 58%

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

et al. 2020

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Peripheral venous catheterization is a common technique in hospitals which is not always successful, resulting in multiple punctures and degradation of the vessels. This scenario, which we have termed 'difficult peripheral venous access', is associated to delays in care, obtention of samples or diagnosis, as well as a higher use of central catheters. This study intends to identify risk factors associated to the incidence of 'difficult peripheral venous access' in adults at hospital. We designed a systematic review of published studies (protocol PROSPERO 2018 CRD42018089160). We conducted structured electronic searches using key words and specific vocabulary, as well as directed searches in several databases. After validity analysis, we selected 7 studies with observational methodology. We found great variability in the definition of 'difficult peripheral venous access' and in the variables proposed as risk factors. Statistically significant factors through studies include demographic and anthropometric variables (gender, Body Mass Index), as well as medical and health conditions (diabetes, renal insufficiency, parenteral drug abuse, cancer chemotherapy), together with variables related to the vein or vascular access (vein visibility and palpability, vessel diameter, previous history of difficulty). Some studies have also considered variables related to the professional performing the technique. Meta-analyses were carried out for gender and obesity as potential risk factors. Only obesity appeared as a statistically significant risk factor with OR of 1.48; 95% CI (1.03 to 1.93; p = 0.016). Methodological heterogeneity prevented the development of further meta-analyses. It is essential to design future studies with diverse hospital populations, in which a wide selection of potential risk factors can be studied in a unique analysis. Our work identifies the most relevant variables that should be included in those studies.

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Section: Discussionmentioning

confidence: 58%

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

et al. 2020

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“…Foi destacado pelos artigos que a visibilidade e a palpabilidade da veia são consideradas cruciais no sucesso da PVP 3,7,9,18,20,24 .…”

Section: Discussionunclassified

“…Foram considerados os resultados identificados na literatura, como variáveis profissionais (tempo de experiência e categoria profissional), clínicos (comorbidades, estado nutricional, visibilidade e palpabilidade da rede venosa), do dispositivo (calibre e modelo) e a habilidade do profissional. Foram encontradas publicações de 2003 a 2017 3,5,6,8,9,[16][17][18][19][20][21][22] , segundo a Figura 2. Os países de origem dos estudos foram Austrália, Espanha, Itália e Holanda com um estudo em cada país, totalizando 4 (33,3%); França e EUA com quatro estudos cada, perfazendo 8 (66,7%).…”

Section: Metodologiaunclassified

“…Quanto aos fatores demográficos e clínicos foram indicados: sexo 8,9 , cor da pele 3 , idade 3,8,9,16 , obesidade 9,17,18 ou desnutrição 6,18 , higiene do paciente 19 , complexidade clínica 6 , desidratação 3,18 , visibilidade e/ou palpabilidade da veia 3,9,18,20 , doenças crônicas 5,8,18 e histórico de PVPD 3,9,20 , entre outras condições.…”

Section: Metodologiaunclassified

“…Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: clinician 'gestalt' wins again 18 Austrália 2016…”

Section: Estados Unidos Da América 2005mentioning

confidence: 99%

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Punção venosa periférica difícil: revisão integrativa

et al. 2019

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Objetivo: identificar os fatores que dificultam a punção venosa periférica em adultos. Método: revisão integrativa da literatura, sem recorte temporal. A busca dos artigos ocorreu no mês de janeiro de 2018 nas seguintes bases de dados: PubMed, LILACS, CINAHL, SciELO, Web of Science e Scopus, com inclusão de 12 artigos. Foram analisados quanto ao ano, país de publicação, fatores associados e nível de evidência. Resultados: foram encontradas publicações de 2003 a 2017. A prevalência da punção venosa periférica difícil variou entre 17% e 59,3%. Entre os fatores que dificultam a punção, os mais frequentes foram: demográficos (sexo, idade) , clínicos (comorbidades, estado nutricional, visibilidade e palpabilidade da rede venosa), do dispositivo (calibre e modelo) e a habilidade do profissional. Conclusão: a dificuldade para punção é variável de acordo com a complexidade assistencial. Fatores demográficos e clínicos, do dispositivo e a habilidade do profissional devem ser considerados.

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A survey of paediatric difficult peripheral intravenous access in the emergency department and use of point‐of‐care ultrasound

Lam

Dunstan

Sweeny

et al. 2023

Australas J Ultrason Med

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Introduction/PurposePeripheral intravenous catheter (PIVC) insertion can be challenging in children, with point‐of‐care ultrasound (POCUS) known to increase success rates. The objective of this study was to survey how emergency department (ED) clinicians identify and escalate paediatric patients with difficult intravenous access (DIVA), specifically the use of POCUS.MethodsThis cross‐sectional study was conducted in an Australian academic mixed ED that surveyed resident medical officers (RMOs), registrars, consultants and senior paediatric nurses. A 15 multiple‐choice questionnaire evaluated clinicians experience with paediatric PIVC insertion, approach to identifying and managing DIVA and the use of POCUS or other adjuncts.ResultsEighty clinicians (34.2% response rate) completed the survey. Poor vein palpability was rated the highest predictor of DIVA. Of the respondents, 19 consultants (86.4%), 28 registrars (90.3%) and 16 RMOs (64.0%) used POCUS as an adjunct for paediatric DIVA patients but 16 consultants (72.8%), 21 registrars (67.8%) and 20 RMOs (80.0%) would use this less than 25% of the time in clinical practice.DiscussionThis survey suggests more clinicians to prefer using objective factors when identifying paediatric DIVA patients, rather than subjectively using gestalt, which relies on clinician experience. Whilst clearly recognised as a useful tool in our study, POCUS was used infrequently for paediatric DIVA patients.ConclusionsThere is currently no consistent process for the identification and escalation of paediatric DIVA patients, including the use of adjuncts such as POCUS. Clinician awareness for these issues should be addressed, which should include the development of guidelines and clinician training in POCUS for PIVC insertion in children.

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Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician ‘gestalt’ wins again

Abstract: When applied to our sample population, an algorithm relying on clinician gestalt to identify patients at high risk of PIVC failure had the greatest potential impact. These patients would be referred to expert PIVC inserters prior to, rather than after, failed attempts.

Cited by 44 publications

References 24 publications

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

Defining risk factors associated with difficult peripheral venous Cannulation: A systematic review and meta-analysis

Punção venosa periférica difícil: revisão integrativa

A survey of paediatric difficult peripheral intravenous access in the emergency department and use of point‐of‐care ultrasound

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