Utility of peripheral intravenous cannulae inserted in one tertiary referral emergency department: A medical record audit

Abstract

Introduction:Peripheral intravenous cannulation is a common intervention performed within the Emergency Department by medical staff to assist in the delivery of care. However, previous studies have shown Emergency Department patients that have cannula device inserted are often not used. Across Australia, it is unclear the utility and frequency of use of peripheral intravenous cannulae within the emergency setting. Method: This is a random retrospective cohort study. Clinical information was retrieved from the Emergency Department Database, FirstNet and the paper medical record. Data from FirstNet included: patient demographic (age, gender) and clinical information (time of arrival, triage category, presenting problem, discharge diagnostic code, and disposition). Data from the patient medical record included: demographic (age, gender) and clinical information (Cannula usage and time of fluids, pharmacological agents, complications, pathology radiological investigations, other diagnostic uses). Results: Of the 357 randomised patients, 189 (52.9%) had 209 peripheral intravenous cannula inserted. Of these cannulae 186 (88.9%) were used within 72 hours. The majority of cannulae (70.4%; n=131) had more than one medical intervention. Conclusion:The majority of peripheral intravenous cannulae inserted during the Emergency Department visit were subsequently used for medical treatment. Further, the majority of devices were used for intravenous fluids and or medications and accessed for multiple interventions. For future audit purposes improved documentation of this procedure is needed.

Review article: Idle ‘just‐in‐case’ peripheral intravenous cannulas in the emergency department: Is something wrong?

“…The 21 publications were categorised against the NHMRC criteria: Level II : one randomised controlled trial and four prospective cohort studies Level III‐2 : two non‐randomised experimental trials and three retrospective cohort studies Level IV : three cross‐sectional analyses …”

“…Third, authors employed minor variants along the lines of ‘cannulas left in situ without any medication or fluid infusion’ combined with a time descriptor. Time conditions varied from no specified time to ‘that day,’ ‘24 h’, ‘36 h’, ‘48 h’, ‘72 h’ or ‘until the time of discharge’ . Sample size ranged from 102 to 3829 and data collection from 1 day to 3 months …”

“…Eight peer‐reviewed studies were performed across a range of subspecialty wards and five in EDs ranging from small urban to large tertiary departments (Table ) . For NHMRC II studies, prevalence (%) of PIVC insertion within medical wards or EDs ranged from approximately 25% to 81%, whereas idle PIVCs ranged from 17% to 49% (Tables ,).…”

“…A total of 4017 articles were reduced to a final total of 21 (Fig. , Table , Appendix S2) . Relevant observational, interventional and qualitative studies were included, as well as letters‐to‐the‐editor or author perspectives.…”

“…A frequent reason to insert an i.v. cannula is because the patient requires blood tests . Opponents of ‘just‐in‐case’ cannulas argue that if a patient only requires bloods (i.e.…”