Nurse performed peripheral intravenous catheter first time insertion success in pediatric patients in Bhutan: An observational study

Abstract

Introduction: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions. Methods: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0-12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success. Results: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%-80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients. Discussion: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients' clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.

Factors associated with difficult intravenous access in the pediatric emergency department

“…The rate of difficult IV access decreased as age increased in many studies with consistent results. [4][5][6][7][8][9][10] Our study also showed a similar tendency with statistical significance. A history of prematurity has been evaluated in a few studies.…”

“…The correlation between vein visibility and palpability and difficult IV access has been shown in several studies. 5,7,9,10,16 Moreover, several assist devices, such as an ultrasound-guide and infrared vein visualization devices, are utilized to improve the success rate of peripheral IV catheter placement at the PED. 17,18 Although vein visibility and palpability are not significantly related to difficult IV access, the tendency of visibility and palpability toward successful IV access are present, and we still recommend using assist devices, especially in difficult cases.…”

“…Age, vein visibility, and vein palpability have been found to be significant factors in several studies. [4][5][6][7][8][9][10] In addition, the anxiety level or cooperativeness of the patients, IV insertion site, time of day, history of prematurity, and experience of the provider with successful IV catheter placement have been identified as correlated factors in some studies. 4,5,[9][10][11] However, only a few studies were performed at a PED, and even in these studies, the relationship between significant factors at the PED, such as the medical acuity of the patient or the degree of crowdedness at the PED, and difficult IV access has not been studied to date.…”

The effect of the use of the ultrasound-assisted technique versus traditional anatomic landmark approach for the saphenous venous cannulation in infants and toddlers with congenital heart disease: a randomized controlled trial

“…Nonetheless, in most situations, children with non-cyanotic congenital heart disease have good exposure of peripheral veins, which prevents the ultrasound method from showing its advantage of visualization compared with the traditional landmark method. The success rate of the rst attempt was used as one of the crucial metrics by many studies to evaluate the effectiveness of peripheral venipuncture [3,16]. But no consistent conclusions have been drawn about the in uence of the use of ultrasound on the success rate at the rst attempt of peripheral venous access.…”

“…Delayed venous access may lead to unexpected adverse events. The success rate for peripheral venipuncture had been reported with varying results in infants and toddlers using the traditional anatomical landmark approach, with the overall success rate ranging from 30-64% [1][2][3].…”