The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study

Abstract

Aims and objectivesExplore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice.BackgroundPeripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice.DesignQualitative description.MethodsA purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi‐structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis.ResultsThere were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress—before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre‐determined theme, (4) Recommendations for good clinical practice is also described.ConclusionsMultiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people.

Comparing Midline and Peripherally Inserted Central Catheters – a Randomized Feasibility Trial

“…Our patient-reported outcome data are consistent with previous reports, that IV catheter placement generates anxiety in children and their families. 29 The STAI anxiety scores for both patients and guardians were above 6, the standard threshold for a positive anxiety score.…”

Novel Peripheral Intravenous Catheter Securement for Children and Catheter Failure Reduction

“…Difficult insertion can be defined as anatomy that results in multiple insertion attempts or increased behavioral distress in the child requiring additional staff support . The burden of PIVC failure is, therefore, not only procedural and economical, but also psychological with PIVC insertion reported by consumers as being the leading cause of procedural pain and fear in pediatrics …”

Peripheral intravenous catheter insertion, maintenance and outcomes in Indonesian paediatric hospital settings: A point prevalence study

“…The burden caused by PIVC failure significantly affects patients, families, and healthcare systems. PIVC insertion is reported as a traumatic experience for paediatric patients and their families (Cooke et al, 2018;Sharp et al, 2023). Moreover, re-insertion procedures increase medical fear, anxiety, and procedural pain perceptions (Çalbayram & Altundag, 2018).…”

“…Optimising insertion practice is important for paediatric patients to minimise physical and emotional stress and trauma (Cooke et al, 2018;Hands et al, 2010;Kleidon et al, 2021;Schults et al, 2019;Sharp et al, 2023). This includes informing and preparing patients and parents/ carers, patient assessment for identification of the optimal site, prophylactic analgesia, skin decontamination, insertion of the device under aseptic conditions, and adequate dressing and securement (ACSQHC, 2021).…”