Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: the Vascular Access Decisions in the Emergency Room (VADER) study protocol

Abstract

IntroductionPeripheral intravenous cannula (PIVC) insertion is one of the most common clinical interventions performed in emergency care worldwide. However, factors associated with successful PIVC placement and maintenance are not well understood. This study seeks to determine the predictors of first time PIVC insertion success in emergency department (ED) and identify the rationale for removal of the ED inserted PIVC in patients admitted to the hospital ward. Reducing failed insertion attempts and improving peripheral intravenous cannulation practice could lead to better staff and patient experiences, as well as improving hospital efficiency.Methods and analysisWe propose an observational cohort study of PIVC insertions in a patient population presenting to ED, with follow-up observation of the PIVC in subsequent admissions to the hospital ward. We will collect specific PIVC observational data such as; clinician factors, patient factors, device information and clinical practice variables. Trained researchers will gather ED PIVC insertion data to identify predictors of insertion success. In those admitted from the ED, we will determine the dwell time of the ED-inserted PIVC. Multivariate regression analyses will be used to identify factors associated with insertions success and PIVC failure and standard statistical validation techniques will be used to create and assess the effectiveness of a clinical predication rule.Ethics and disseminationThe findings of our study will provide new evidence to improve insertion success rates in the ED setting and identify strategies to reduce premature device failure for patients admitted to hospital wards. Results will unravel a complexity of factors that contribute to unsuccessful PIVC attempts such as patient and clinician factors along with the products, technologies and infusates used.Trial registration numberACTRN12615000588594; Pre-results.

Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study

“…Peripheral intravenous cannulation is one of the most commonly performed invasive procedures in the emergency department (ED) . Peripheral intravenous cannulas (PIVCs) are intended for the delivery of fluid, medication, blood, or contrast during the patient's hospital stay.…”

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

“…Nurses in this area frequently encounter patients affected by different conditions and comorbidities, such as oedema, hypovolaemia or dehydration, lymphadenectomy and chemotherapy previously administered through PIVC that could lead to repeated attempts to place a PIVC, pain and delays in obtaining the care required (Guillon et al, ; Witting, ). In contrast, previous research identified as risk factors for difficult cannulation in emergency only age, BMI, drug abuse, sickle cell disease (Carr, Rippey, Cooke, et al, ) and diabetes (Fields et al, ).…”

“…The literature search found ten studies investigating 21 patient risk factors, including age, gender, race, weight/BMI, medical diseases and conditions (such as diabetes, cancer, lymphadenectomy, previous chemotherapy or radiotherapy, oedema, parenteral drug abuse) (Armenteros‐Yeguas et al, ; Bensghir et al, ; Carr, Rippey, Cooke, et al, ; Fields, Piela, Au, & Ku, ; Jacobson & Winslow, ; Juvin, Blarel, Bruno, & Desmonts, ; Lapostolle et al, ; Van Loon, Puijn, Houterman, & Bouwman, ; Piredda et al, ; Sebbane et al, ).…”

“… A = Piredda et al (); B = Armenteros‐Yeguas et al (); C = van Loon et al (); D = Carr, Rippey, Cooke, et al (); E = Fields et al (); F = Sebbane et al (); G = Bensghir et al (); H = Lapostolle et al (); I = Jacobson and Winslow (); J = Juvin et al (). …”

Hot Off the Press: Peripheral Intravenous Cannula Insertion and Use in the Emergency Department

“…Peripheral intravenous cannulation (PIVC) is a very commonly performed procedure in the emergency department (ED) . Currently there are no standardized guidelines or indications outlining when a PIVC should be inserted in an emergency setting .…”