Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

Nicole Marsh¹  Claire M. Rickard²  Peter J. Carr³  Joshua Byrnes⁴  Jamie Ranse⁵  Amy Sweeny⁶  Gerben Keijzers⁷  Mercedes Carrington⁸  Hugo Evison⁹ 

[1] Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, 4111, Southport, QLD, Australia;Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Level 2 Building 34 Royal Brisbane and Women’s Hospital, 4209, Herston, QLD, Australia;Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;School of Nursing and Midwifery, Griffith University, N48 Health Sciences Building, Level 2.06, 170 Kessels Road, 4111, Southport, QLD, Australia;Nursing and Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Level 2 Building 34 Royal Brisbane and Women’s Hospital, 4209, Herston, QLD, Australia;Herston Infectious Diseases Institute, Metro North Hospitals and Health Service, 4006, Herston, QLD, Australia;School of Nursing Midwifery and Social Work, The University of Queensland Centre for Clinical Research, 4006, Herston, QLD, Australia;Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;School of Nursing and Midwifery, National University of Ireland Galway, 26 Upper Newcastle, H91 E3YV, Galway, Ireland;Centre for Applied Health Economics, School of Medicine, Griffith University, N78 Sir Samuel Griffith Building, Level 2.11, 170 Kessels Road, 4111, Southport, QLD, Australia;Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, 4215, Southport, QLD, Australia;Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, 4215, Southport, QLD, Australia;Alliance for Vascular Access Teaching and Research, Menzies Health Institute Queensland, Griffith University, G40 Griffith Health Centre, Level 8.86 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, 4226, Robina, QLD, Australia;Department of Emergency Medicine, Gold Coast University Hospital, 1 Hospital Boulevard, 4215, Southport, QLD, Australia;Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, 4226, Robina, QLD, Australia;School of Medicine, Griffith University, Teaching Griffith Health Centre - G40 Gold Coast Campus Griffith University, 4222, Southport, QLD, Australia;Faculty of Health Sciences and Medicine, Bond University, 14 University Dr, 4226, Robina, QLD, Australia;Department of Emergency Medicine, Robina Hospital, 2 Bayberry Lane, 4226, Robina, QLD, Australia;Queensland Ambulance Service, GPO Box 1425, 4000, Brisbane, QLD, Australia;

关键词: Cannula;    Emergency department;    Idle;    Pre-hospital;    Vascular access device;   

DOI  :  10.1186/s13049-021-00941-y

来源: Springer

【 摘 要 】

BackgroundUnused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment.MethodsThis was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February–18 March 2017 and 5 January–4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression.ResultsA total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%–31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p ≤ .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7–3.3).ConclusionOne-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.

【 授权许可】

CC BY