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J Vasc Access. 2016 Mar-Apr;17(2):182-90. doi: 10.5301/jva.5000487. Epub 2015 Dec 4.

Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success.

Author information

1
Emergency Medicine, The University of Western Australia, Perth, Western Australia - Australia.
2
National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland - Australia.
3
Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.
4
Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia.
5
Centre for Applied Statistics, The University of Western Australia, Perth, Western Australia - Australia.
6
Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia.
7
Royal Brisbane & Women's Hospital, Brisbane, Queensland - Australia.

Abstract

BACKGROUND:

We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon.

METHODS:

A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained.

RESULTS:

A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age <40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success.

CONCLUSIONS:

Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: 'normal' body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.

PMID:
26660037
DOI:
10.5301/jva.5000487
[Indexed for MEDLINE]

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