Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. A multicentre prospective cohort analysis of patient, clinician and product characteristics

Abstract

Objectives: This study aimed to identify the incidence of and factors associated with peripheral intravenous catheter/cannula (PIVC) first time insertion success (FTIS) in the emergency department (ED).

Design: Prospective cohort study.

Setting: Two tertiary EDs in Western Australia.

Participants: 879 ED patients.

Primary outcome: To identify factors affecting FTIS using univariate and multivariate logistic regression modelling. We created four models: patient factors only; clinician factors only; products and technology factors only and all factors model. We assessed each model's performance using area under the receiver operating characteristic curve.

Results: A total of 1201 PIVCs were inserted in 879 patients. The mean age was 60.3 (SD 22) years with slightly more females (52%). The FTIS rate was 73%, with 128 (15%) requiring a second attempt and 83 (9%) requiring three or more attempts. A small percentage (3%) had no recorded number of subsequent attempts. FTIS was related to the following patient factors: age (for a 1-year increase in age: OR 0.99, 95% CI 0.983 to 0.998; p=0.0097); and target vein palpability: (always palpable vs never palpable: OR 3.53 95% CI 1.64 to 7.60; only palpable with tourniquet vs never palpable: OR 2.20, 95% CI 1.06 to 4.57; p=0.0014). Clinician factors related to FTIS include: clinicians with greater confidence (p<0.0001) and insertion experience (301-1000 vs <301: OR 1.54, 95% CI 1.02 to 2.34; >1000 vs <301: OR 2.07, 95% CI 1.41 to 3.04; p=0.0011). The final all factors model combining patient factors; clinician factors and product and technology factors has greater discriminative ability than specific factors models. It has a sensitivity of 74.26%, specificity of 57.69%, positive predictive value of 82.87% and negative predictive value of 44.85%.

Conclusion: A clinical decision, matching patients who have no palpable veins and are older, with clinicians with greater confidence and experience, will likely improve FTIS.

Trialregistration number: ANZCTRN12615000588594; Results.

Keywords: emergency department; first time insertion success; logistic regression; peripheral intravenous catheters; receiver-operator characteristic curve.

Conflict of interest statement

Competing interests: PJC’s research was supported by a Becton Dickinson (BD) contribution to the AVATAR group based at Griffith University. MC’s employer has received on her behalf: an unrestricted research grant from BD, during the conduct of the study; unrestricted research grants and/or educational grants from 3M, Baxter, BD, Entrotech, outside the submitted work. CMR’s employer has received on her behalf: an unrestricted research grant from BD, during the conduct of the study; unrestricted research grants and/or educational grants from 3M, Adhezion, Angiodynamics, Bard, Baxter, BBraun, BD, Carefusion, Centurion Medical Products, Cook Medical, Entrotech, Flomedical, ICU Medical, Medical Australia, Medtronic, Smiths Medical, Teleflex, outside the submitted work; consultancy payments from 3M, Bard, BBraun, BD, Smiths Medical, ResQDevices, outside the submitted work. No commercial entity had any role in the preparation of this manuscript. All other authors have no competing interest to declare.

© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

Receiver operating characteristic curves for each of the multivariate models. AUC, area under the curve.