Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case–control study in 48 units of eight public hospitals in Spain

Rodríguez-Calero, Miguel Ángel; Fernández-Fernández, Ismael; Molero-Ballester, Luis Javier; Matamalas-Massanet, Catalina; Moreno-Mejias, Luis; Pedro-Gómez, Joan Ernest de; Blanco-Mavillard, Ian; Morales‐Asencio, José Miguel

doi:10.1136/bmjopen-2017-020420

Cited by 28 publications

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References 25 publications

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“…This situation is frequently referred to as 'difficult intravenous access' (DIVA), 8,9 although there is not a consensus or a generally accepted definition. In addition, the term 'difficult peripheral intravenous cannulation' (DPIVC) 10 has been suggested to differentiate peripheral from central catheterization. DPIVC causes pain and distress to patients, 11 can lead to adverse events including diagnostic delays 12 and result in catheter-related complications such as infiltration, vein collapse or nerve damage.…”

Section: Introductionmentioning

confidence: 99%

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: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Case-control study performed in accordance with a previously published protocol [6]. This report complies with the STROBE statement for the reporting of observational studies [18].…”

Section: Methodsmentioning

confidence: 82%

“…Regarding the healthcare professionals performing the IV cannulation, the variables considered were their total nursing experience, their experience in PIVC, their age and gender. A fuller description of these variables and of the measurement parameters applied is given in the above-mentioned protocol [6].…”

Section: Variablesmentioning

confidence: 99%

“…Furthermore, repeated punctures can degrade vascular walls, complicating subsequent approaches, and reducing the quality of healthcare [3]. This situation has been described as 'difficult intravenous access' (DIVA) [4,5], or as 'difficult peripheral intravenous cannulation' (DPIVC) to refer specifically to the difficulty in obtaining peripheral vascular access [6].…”

Section: Introductionmentioning

confidence: 99%

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

Rodríguez-Calero

Pedro-Gómez

Molero-Ballester

et al. 2020

JCM

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Background. Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician’s experience in this context. Methods. Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients’ clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified. Results. The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event. Conclusion: The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.

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“…Strategies to improve PIVC success include bedside techniques (venodilation, vascular visualisation and vein entry indication), pain management and involvement of expert healthcare providers, such as a nursing intravenous team (Harpel, 2013;Lapostolle et al, 2007;Sabri et al, 2013;Spina et al, 2018). Factors associated with PIVC success include operator's expertise, patient characteristics (e.g., weight, body mass index [BMI], co-existing medical conditions) and procedure-related factors such as vein palpability/visibility, insertion site and features of vascular access device (Carr, Rippey, Budgeon, et al, 2016;Rodriguez-Calero et al, 2018).…”

Section: Backg Rou N Dmentioning

confidence: 99%

Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence

Piredda

Fiorini

Facchinetti

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To summarise the evidence about patient‐related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%–40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient‐related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross‐sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

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Risk factors for difficult peripheral venous cannulation in hospitalised patients. Protocol for a multicentre case–control study in 48 units of eight public hospitals in Spain

Cited by 28 publications

References 25 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

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

Risk factors for a difficult intravenous access: A multicentre study comparing nurses' beliefs to evidence

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