Failure of First-attempt Insertion and Analysis of Practices Related to Peripheral Intravenous Catheters in the Emergency Department: (CATHIRU)

Failure of First-attempt Insertion and Analysis of Practices Related to Peripheral Intravenous Catheters in the Emergency Department: A Prospective Observational Study by the French "Emergency Department Research Initiative" ("Initiatives de Recherche Aux Urgences" IRU) Network

Peripheral intravenous catheters (PIVCs) are essential for the management of hospitalised patients, particularly in emergency departments, where they are used to administer intravenous treatments to more than half of all patients. However, nearly 30% of insertion attempts fail on the first attempt, causing stress and pain for patients and delaying treatment. Despite their importance, PIVC insertion and management practices remain insufficiently standardised and studied, especially in the emergency setting. The CathIRU study aims to address these gaps by investigating the incidence of first-attempt insertion failure and analysing associated practices.

The primary objectives of the study are to estimate the incidence of first-attempt PIVC insertion failure in emergency departments and to identify predictive criteria for difficult vascular access. Secondary objectives include analysing PIVC insertion and management practices, assessing the incidence of unnecessary catheters placed in emergency settings, and evaluating the use of vein access techniques and alternative approaches in cases of failed insertion.

This is a prospective, multicentre observational epidemiological study. It will include 3,000 adult patients requiring a PIVC, recruited over two consecutive days in 70 centres within the IRU network. Data collection will include patient characteristics, insertion site, catheter specifications, insertion techniques, and clinical context.

Inclusion criteria comprise adult patients requiring a PIVC who have provided verbal consent for data collection. Patients with major life-threatening distress or those who had a PIVC inserted in a prehospital setting will be excluded. Data analysis will involve bivariate and multivariate logistic regression to identify risk factors associated with insertion failure and unnecessary catheters, with continuous and categorical data summarised using appropriate descriptive statistics.

The expected benefits of this study include improving PIVC insertion and management practices by enabling early identification of patients at risk of difficult vascular access, reducing complications linked to repeated punctures and delays in diagnostic and therapeutic care, and increasing awareness and training among healthcare professionals in best practices and technologies such as ultrasound guidance. In terms of societal impact, optimising PIVC management is expected to enhance patient care quality, reduce medical costs, and minimise medical waste.

The study is funded by the Société Française de Médecine d'Urgence (SFMU).

Study Overview

• Status: Completed
• Conditions: Emergency Departments; Catheterization, Peripheral; Catheterization; Vascular Access Devices; Catheters
• Intervention / Treatment: Device: CathIRU Cohort

• Study Type: Observational
• Enrollment (Actual): 4312

Contacts and Locations

Study Locations

• France
  • Poitiers, France, 86021
    • CHU Poitiers

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

All adult patients requiring a CVP in an emergency department can participate in the study

Description

Inclusion Criteria:

• Adult over 18 years old
• Requiring peripheral vascular access
• Having provided oral consent for data collection

Exclusion Criteria:

• Patient presenting with a state of major life-threatening distress, which may justify the placement of an intraosseous line and/or prevent data collection
• Patient who received vascular access in the prehospital setting
• Patient who has already participated in the study
• Subject not covered by a social security scheme
• Subjects under enhanced protection, namely persons deprived of liberty by a judicial or administrative decision, persons residing in a healthcare or social facility, adults under legal protection (guardianship or curatorship), and patients in emergency situations

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Cohort of patients with attempted vascular access insertion	Device: CathIRU Cohort; All adult patients requiring a CVP in an emergency department can participate in the study

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Estimate the prevalence of first-attempt PIVC insertion failure	The prevalence of first-attempt insertion failure will be defined as the number of patients for whom a functional PIVC could not be successfully placed during the first puncture attempt. A functional PIVC is defined as one that allows the unrestricted injection of a solution or medication from an infusion line or a flushing syringe. It must be free from complications such as haematoma at the puncture site, extravasation, pain, or arterial reflux. We estimate that 20% of patients will experience a first-attempt PIVC insertion failure.	24 hours

Secondary Outcome Measures

Outcome Measure	Time Frame
Analyse practices related to the insertion and maintenance of PIVCs	24 hours
Identify the demographic criteria impacting vascular access and predicting failure of insertion at the first attempt	24 hours
Identify the demographic criteria of centers impacting the incidence of unnecessary catheters placed in emergency departments	24 hours
Estimate the percentage of patients presenting with criteria for Difficult Vascular Access	24 hours
Assess the association between first-attempt insertion failure and the presence of Difficult Vascular Access criteria	24 hours
Estimate the prevalence of unnecessary catheters placed in the emergency room	24 hours
Determine the frequency of use of different vein approach techniques	24 hours
Determine the frequency of use of alternative vascular access in the event of failure of installation	24 hours

Collaborators and Investigators

• Sponsor: Poitiers University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): April 3, 2025
• Primary Completion (Actual): April 5, 2025
• Study Completion (Actual): April 6, 2025

Study Registration Dates

• First Submitted: February 24, 2025
• First Submitted That Met QC Criteria: February 24, 2025
• First Posted (Actual): February 28, 2025

Study Record Updates

• Last Update Posted (Actual): June 4, 2025
• Last Update Submitted That Met QC Criteria: June 3, 2025
• Last Verified: March 1, 2025

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies
• Other Study ID Numbers: CATHIRU

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No