The prehospital intravenous access assessment: a prospective study on intravenous access failure and access delay in prehospital emergency medicine

Abstract

Our study offers a simple assessment to identify cases of difficult intravenous access in prehospital emergency care. Of the numerous factors subjectively perceived as possibly exerting influences on cannulation, only the universal - not exclusive to emergency care - factors of lighting, vein visibility and palpability proved to be valid predictors of cannulation failure and exceedance of a 2 min threshold.

Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature

“…The opposite can occur when the veins are small and poorly visualized; hence, one may select a small gauge catheter. This argument is supported by Prottengeier et al 42 in a prehospital study that excluded PIVC size in a multivariate analysis because of confounding. However, gauge size is very likely to influence postinsertion complications.…”

Can Non-Physician Providers Use Ultrasound to Aid in Establishing Peripheral IV Access in Patients Who are Difficult to Cannulate? A Scoping Review

“…4,19 Peripheral IV access is one of the most commonly performed skills by paramedics and nurses in both the out-of-hospital and in-hospital environments. [1][2][3] Difficulty achieving PIVA is frequently encountered and alternative methods must be sought to establish venous access. 13,25 This often requires the input of a more senior clinician or physician.…”

“…Peripheral intravenous (IV) catheterization is one of the most commonly performed procedures by non-physicians in both the emergency department (ED) and out-of-hospital environment. [1][2][3] Presently, most providers employ the conventional peripheral intravenous access (PIVA) method, with difficulty often encountered in both anatomically challenging and critically unwell patients. 1,2 The overall failure of PIVA is reportedly from 10% through 40% in EDs, intensive care units, and in the out-of-hospital setting.…”

“…[1][2][3] Presently, most providers employ the conventional peripheral intravenous access (PIVA) method, with difficulty often encountered in both anatomically challenging and critically unwell patients. 1,2 The overall failure of PIVA is reportedly from 10% through 40% in EDs, intensive care units, and in the out-of-hospital setting. 4 Failure of the first attempt has been reported to occur in up to 67% of patients requiring subsequent or multiple punctures.…”

Management of difficult intravenous access: a qualitative review

“…[2] A perennial challenge faced by clinicians, DIVA impacts patient outcomes adversely by causing downstream delays in both diagnoses (difficulty in obtaining blood specimens and administering intravenous contrast for advanced imaging) and therapy (provision of parenteral fluids, blood products or drug administration to facilitate procedures such as sedation or rapid-sequence intubation). [3] Failed cannulation attempts often cause patient and clinician alike considerable frustration and distress and may lead to complications like thrombophlebitis, infection and haematoma. [4] Moreover, time-to-cannulation averages 2.5-13.0 min for most patients but can take up to 30 min to hours in DIVA cases.…”