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

Abstract

Aims and objectives To summarise the evidence about patient‐related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence. Background Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%–40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence. Design The study included a literature review of the evidence on patient‐related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross‐sectional multicentre survey on clinical nurses. Methods The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross‐Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed. Results Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research. Conclusions An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research. Relevance to clinical practice Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care.

Translation and Validation of the Modified A-DIVA Scale to European Portuguese: Difficult Intravenous Access Scale for Adult Patients

“…Nevertheless, the A-DM can be considered a reliable and valid contribution to clinical practice in Portugal by standardizing the initial assessment of the patient’s peripheral venous network and reporting it with a common method [ 10 ]. Early assessment of difficult peripheral intravenous access can likely decrease known high rates of the first-attempt failure and need for consequent attempts [ 17 , 18 ], reducing the incidence of PIVC-related complications and premature removal [ 30 ]. Although nurses are the health professionals primarily responsible for PIVC insertion and management in Portugal [ 31 ], we believe that the A-DM scale can assist any health professional with competences in vascular access by improving early assessment of the patient’s peripheral venous network and identification of difficult peripheral intravenous access, enhancing PIVC-related care quality, continuity, and record keeping [ 12 , 14 ].…”

Difficult Intravenous Access and Its Management

“…The individual risk factors associated with DIVA are age, gender, ethnicity, body mass index, health status, medical history, and vein characteristics of the patients [7,[12][13][14].…”

“…In addition, as the number of materials used in the repetitive attempts increases and the treatment plan for the patient is delayed, the patient care costs also increase [5,6]. Therefore, it is crucial for healthcare professionals to be aware of the factors that may lead to this condition, including several negativities, to understand how to manage it [7,8]. The guidelines available for peripheral intravenous insertion mainly focus on site selection and insertion, and there is a lack of established guidelines on how to recognize or manage DIVA [1,[9][10][11].…”

Ultrasound-guided pediatric vascular cannulation by inexperienced operators: outcomes in a training model

“…Central vessel cannulation entails more difficulties in paediatric patients than in adult ones, and is not devoid of risks or complications. Obtaining vein access in paediatric patients may be a challenge for both medical and nursing staff [1][2][3][4][5][6]. Great advances were achieved using ultrasoundbased guidance [7][8][9][10][11][12][13][14][15].…”