Évaluation du respect des recommandations pour la mise en place des voies veineuses périphériques en médecine d’urgence préhospitalière

Lapostolle, Frédéric; Garrigue, Bruno; Houssaye, Thierry; Vecci, I.; Tréoux, Virginie; Crocheton, Nicolas; Adnet, Frédéric

doi:10.1016/j.annfar.2004.10.027

Cited by 8 publications

(1 citation statement)

References 5 publications

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“…This implies a small absolute number of unused PVAs globally. Nevertheless, as the insertion of a PVA is more complicated in the prehospital setting, especially regarding the asepsis procedure [14], the placement of such a device should be carefully assessed. EMS must consider many variables, including the clinical presentation of the patient, the paramedic's differential diagnosis, EMS protocols, "gut feeling" and anticipation of a worsening scenario.…”

Section: Discussionmentioning

confidence: 99%

Use of peripheral vascular access in the prehospital setting: is there room for improvement?

et al. 2020

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Background: Previous studies have shown that prehospital insertion of peripheral vascular access is highly variable. The aim of this study is to establish the proportion of peripheral vascular access placement and its use with regard to both the severity of cases and the main problem suspected by the paramedics involved. Over-triage was considered to have taken place where peripheral vascular access was placed but unused and these cases were specifically analysed in order to evaluate the possibility of improving current practice. Methods: This is a one-year (2017) retrospective study conducted throughout one State of Switzerland. Data were extracted from the state's public health service database, collected electronically by paramedics on RescueNet® from Siemens. The following data were collected and analyzed: sex, age, main diagnosis suspected by paramedics and the National Advisory Committee for Aeronautics score (NACA) to classify the severity of cases. Results: A total of 33,055 missions were included, 29,309 (88.7%) with a low severity. A peripheral vascular access was placed in 8603 (26.0%) cases. Among those, 3948 (45.9%) were unused and 2626 (66.5%) of these patients had a low severity score. Opiates represent 48.3% of all medications given. The most frequent diagnosis among unused peripheral vascular access were: respiratory distress (12.7%), neurological deficit without coma or trauma (9.6%), cardiac condition with thoracic pain and without trauma or loss of consciousness (9.6%) and decreased general condition of the patient (8.5%). Conclusions: Peripheral vascular access was set in 26% of patients, nearly half of which were unused. To reduce over-triage, special attention should be dedicated to cases defined by EMS on site as low severity, as they do not require placement of a peripheral vascular access as a precautionary measure. Alternative routes, such as the intranasal route, should be promoted, particularly for analgesia, whose efficiency is well documented. Emergency medical services medical directors may also consider modifying protocols of acute clinical situations when data show that mandatory peripheral vascular access, in stroke cases for example, is almost never used.

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Section: Discussionmentioning

confidence: 99%

Use of peripheral vascular access in the prehospital setting: is there room for improvement?

et al. 2020

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Évaluation de l'application des recommandations pour la mise en place des voies veineuses périphériques

Hajjar

2005

Annales Françaises d'Anesthésie et de Réanimation

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Peripheral Venous Access Catheters Placed in Emergency Care Have a Short Life Expectancy in Intensive Care Units—Voi-Réa Study

Galinski

Alhéritière

Crocheton

et al. 2015

Journal of Emergency Nursing

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Venous access is routine practice in emergency care, but there are no specific recommendations in intensive care units (ICUs) to manage peripheral venous access (PVA) catheters placed in emergency care. We studied the ICU strategy regarding PVA catheters set in the emergency department. We conducted telephone interviews with all the ICUs in the Paris (France) region. We included ICUs receiving adult patients from emergency care and prehospital settings. The way the ICU managed a previously placed PVA catheter was questioned. Four answers were proposed: absence or ignorance of ICU's strategy, maintenance of PVA catheter, immediate replacement, or deferred replacement.The 75 ICUs meeting the inclusion criteria were investigated. There was no standardized strategy or the strategy was ignored in 35 cases (23%). The usual practice was immediate replacement in 55 cases (37%), deferred replacement in 18 cases (12%), and maintenance in 42 cases (28%). The strategy was significantly different (P b .0001) if the patients were coming from emergency care or were previously managed in prehospital settings (Figure).Practice was highly variable, heterogeneous, and often not standardized. The results illustrate the consequences of the lack of guidelines for the initial management of PVA catheters placed in the emergency department.1 The maintenance of PVA catheters was unusual whereas no study has shown specific short-term risks associated with their maintenance.1 Furthermore, repeated punctures increase the risk of complications, are material and time consuming, and cause pain to the patient.PVA catheters placed in the emergency department were more often replaced than those placed in the prehospital setting, whereas optimal antiseptic conditions are probably more difficult to reach in the prehospital setting than in the emergency department. 2,3 Early replacement of PVA catheters should be limited to "at-risk" patients, when nonoptimal antiseptic conditions have been encountered. 1 Such conditions should be transmitted from the emergency team (prehospital or in hospital) to the ICU team.

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Évaluation du respect des recommandations pour la mise en place des voies veineuses périphériques en médecine d’urgence préhospitalière

Cited by 8 publications

References 5 publications

Use of peripheral vascular access in the prehospital setting: is there room for improvement?

Use of peripheral vascular access in the prehospital setting: is there room for improvement?

Évaluation de l'application des recommandations pour la mise en place des voies veineuses périphériques

Peripheral Venous Access Catheters Placed in Emergency Care Have a Short Life Expectancy in Intensive Care Units—Voi-Réa Study

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