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

Gonvers, Erin; Spichiger, Thierry; Albrecht, Éric; Dami, Fabrice

doi:10.1186/s12873-020-00340-z

Cited by 13 publications

(5 citation statements)

References 15 publications

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“…The prevalence of prehospital IV access was higher in CTAS level 1 patients compared to CTAS level 2 patients and in trauma cases compared to medical cases. Our findings are consistent with a Swiss study that reported peripheral vascular access placement in 26% of cases transported [ 15 ]. Another study conducted in the United States in 2014 focused on the prehospital management of patients with severe sepsis and found that 23% received prehospital IV catheter and fluid administration, while 7% had a catheter alone, and 70% had neither a catheter placed nor fluid administered [ 20 ].…”

Section: Discussionsupporting

confidence: 93%

“…Comparing that with another study conducted in France on the feasibility of IV line placement, the figure was only 29% [ 22 ]. In this study, we found that half of the prehospital IV lines were unutilized, which is closely comparable to a study in Switzerland in which 45.9% were unutilized [ 15 ]. Furthermore, we found that most CTAS level 1 patients had their IV access utilized.…”

Section: Discussionsupporting

confidence: 88%

“…Despite that, IV access placement is associated with a higher delivery delay compared to no access, which in turn is associated with increased mortality [11][12][13][14]. Many IV accesses were not utilized, which may result in wasting valuable minutes that could be the difference between life and death [15][16][17].…”

Section: Introductionmentioning

confidence: 99%

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The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department

Khan,

Alojayri,

Alhoseini

et al. 2023

Cureus

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Background: Despite the pivotality of emergency medical services (EMS) in prehospital care for patient stabilization, prehospital intravenous (IV) access, a standard practice, remains an ambiguity in Saudi Arabia in terms of its prevalence of placement, justification, and utilization. Objectives: In this study, we aim to estimate the prevalence and utilization rate of prehospital IV access placement in patients transported to King Khalid University Hospital (KKUH) Emergency Medicine Department in Riyadh by EMS and determine the relationship between the prevalence and utilization rate of prehospital IV access in Canadian Triage and Acuity Scale (CTAS) levels 1 and 2 in trauma and non-trauma patients. Methods: This observational cross-sectional study was conducted over six months. A total of 181 cases of CTAS levels 1 and 2 adult patients were included. Data were collected by trained nurses using convenient sampling through an author-developed questionnaire. Results: The prevalence of prehospital IV line placement was 28.7%, with a utilization rate of 50%, and was notably higher among CTAS level 1 cases (69.2%). Additionally, trauma cases had a higher prevalence of prehospital IV access (53.5%) compared to medical cases (odds ratio (OR): 4.73, 95% confidence interval (CI): 4.73, 4.73, p<0.05). Among patients with prehospital IV lines, the majority (92.3%) were patent and functional. Upon arrival, 73.1% of patients had their prehospital IV line replaced, with hospital protocol being the most common reason for the replacement (73.7%). Conclusion: A minority of the patients had prehospital vascular access, and of those, half remained unused. Trauma cases and CTAS level 1 patients had a higher prevalence and utilization of prehospital IV access. Furthermore, trauma cases were more associated with prehospital IV access establishment and utilization.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 88%

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The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department

Khan,

Alojayri,

Alhoseini

et al. 2023

Cureus

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“…Over-use of peripheral vascular access in regions where paramedics conduct prehospital care has been reported in another study. 18 Finally, both the MMT and PIT perform many non-urgent interventions. It has also been recognized in other studies that non-urgent prehospital interventions have increased in all European countries.…”

Section: Discussionmentioning

confidence: 99%

Mobile Medical Teams are Often Over-Qualified

Van Biesen,

Devue,

Van Laere

et al. 2023

Prehosp. Disaster med.

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Background and Importance: Emergency department (ED) staff in Belgium is simultaneously involved in patient care in the ED and in prehospital interventions as part of a Mobile Medical Team (MMT) or a Paramedic Intervention Team (PIT). There is a growing concern that the MMT is often over-qualified for the prehospital interventions they are dispatched to, while their absence from the ED results in insufficient human resources there. Objective: The current study aims to investigate whether this perception is correct in the EDs of two different regions, while also examining the differences between a two-tiered (2T) and a three-tiered (3T) Emergency Medical Services (EMS) region. Methods: A specially developed and pre-tested registration form was completed by physicians and nurses before and after each MMT intervention. The form included information on the composition of the MMT, the perceived need for MMT intervention pre-departure from the ED, the subjective appreciation of the need for the MMT after an intervention, and the therapeutic intervention(s) performed, in order to obtain a more objective appreciation of the actual need for an MMT. Data from a 2T and a 3T region were analyzed to rate the appropriateness of the interventions. Results: Although the 2T and 3T regions showed differences regarding MMT composition, dispatching, and logistics, the outcome of the study was identical in both regions. Before the intervention, physicians and nurses estimated that the MMT intervention would not be necessary in 37.7% of cases. However, following the intervention, it was subjectively deemed unnecessary in 65.7% of cases. Based on therapeutic interventions performed, the MMT was viewed as being over-qualified for carrying these out in 85.6% of cases. Post-intervention, the initial prediction that the MMT was over-qualified for the call was confirmed by the same physicians and nurses in 87.6% of cases, whilst their prediction was correct in 92.8% of cases in terms of the intervention that was carried out. Conclusion: In two different Belgian regions, the MMT is over-qualified in a vast majority of interventions. Physicians and nurses within the MMT can generally already predict that the MMT is over-qualified when leaving the ED. These findings suggest that there may be significant opportunities to improve the efficacy of human resources in the ED once there are less interventions carried out by an over-qualified MMT.

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“…A global multicentre point prevalence study revealed widespread problems with PIVCs, including idle catheters (no indication for use), missing documentation in patient records, devices placed in non‐recommended sites of flexion such as the wrist or antecubital fossa and phlebitis and other PIVC malfunctions such as extravasation and leakage (Alexandrou et al., 2018). Nearly half of the PIVCs inserted in the prehospital setting remain idle (Gonvers et al., 2020), and emergently inserted catheters in a non‐aseptic environment are associated with later development of sepsis or BSI (Hughes et al., 2014). The incidence of BSIs due to PIVCs may represent 4.8%–19% of hospital‐acquired bacteraemia (Mermel, 2017).…”

Section: Introductionmentioning

confidence: 99%

Aligning peripheral intravenous catheter quality with nursing culture—A mixed method study

Høvik,

Gjeilo,

Ray‐Barruel

et al. 2024

Journal of Clinical Nursing

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AimTo explore barriers and facilitators that influence adherence to evidence‐based guidelines for peripheral intravenous catheter care in different hospital wards.DesignSequential explanatory mixedmethod study design, with qualitative data used to elaborate on quantitative findings.MethodData were collected between March 2021 and March 2022 using the previously validated Peripheral Intravenous Catheter mini questionnaire (PIVC‐miniQ) on each ward in a tertiary hospital in Norway. Survey completion was followed by individual interviews with nurses from selected wards. The Pillar Integration Process was used to integrate and analyse the quantitative and qualitative findings.ResultsThe PIVC‐miniQ screening assessed 566 peripheral intravenous catheters in 448 patients in 41 wards, and we found variation between wards in the quality of care. Based on the quantitative variation, we interviewed 24 nurses on wards with either excellent or not as good quality. The integration of the quantitative and qualitative findings in the study enabled an understanding of factors that influence nurses' adherence to the care of peripheral venous catheters. One main theme and four subthemes emerged. The main finding was that ward culture affects education practice, and this was evident from four subthemes: (1) Deviation from best practice, (2) Gaps in education and clinical training, (3) Quality variation between wards and (4) The importance of supportive leadership.ConclusionThis mixed method study is the first study to explore reasons for variability in peripheral intravenous catheter quality across hospital wards. We found that ward culture was central to catheter quality, with evidence of deviations from best practice correlating with observed catheter complications. Ward culture also impacted nursing education, with the main responsibility for learning peripheral intravenous catheter management left to students' clinical training placements. Addressing this educational gap and fostering supportive leadership, including champions, will likely improve peripheral intravenous catheter care and patient safety.Implications for the Profession and/or Patient CareNurses learn good peripheral intravenous catheter care in wards with supportive leaders and champions. This implies that the quality of nursing practice and patient outcomes are situational. Nurses need a strengthened emphasis on peripheral catheter quality in the undergraduate curriculum, and nurse leaders must emphasize the quality of catheter care in their wards.ImpactThe study findings impact nurse leaders who must commit to quality and safety outcomes by appointing and supporting local ward champions for promoting peripheral intravenous catheter care. This also impacts nursing education providers, as the emphasis on catheter care must be strengthened in the undergraduate nursing curriculum and continually reinforced in the hospital environment, particularly when guidelines are updated.Reporting MethodThe study adhered to the Good Reporting of A Mixed Method Study (GRAMM).Patient or Public ContributionA patient representative has been involved in planning this study.

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

Cited by 13 publications

References 15 publications

The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department

The Prevalence and Utilization of Prehospital IV Access in Critically Ill Patients in the Emergency Department

Mobile Medical Teams are Often Over-Qualified

Aligning peripheral intravenous catheter quality with nursing culture—A mixed method study

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