Abstract
BackgroundMany patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by increasing first attempt success with ultrasound guidance. The emphasis was to provide a solution for hospitalised patients after business hours by training the after-hours clinical support team in ultrasound guided cannulation.MethodsInception cohort study of patients referred to the after-hours clinical support team including outcomes such as number of attempts at cannulation before and after referral, insertion site, type of device inserted and recorded pain score for attempts prior to referral and for attempts by the after-hours clinical support team.ResultsBetween January and December 2016, 379 patients were referred to the after-hours clinical support team for placement of a peripheral intravenous catheter under ultrasound guidance. The median number of unsuccessful attempts before referral was 2 (IQR 2, 4), this ranged between 1 attempt to 10 attempts compared to only 1 attempt (IQR 1, 1, p < 0.001) with no more than 2 attempts in total by the after-hours clinical support team. The first time success rate by the after-hours clinical support team was 93% (n = 348). The median pain score for attempts with ultrasound use was 2/10 (IQR 1–3) compared to 7/10 (IQR 5–9) for previous attempts without ultrasound (p < 0.001).ConclusionThe use of ultrasound guidance for peripheral intravenous catheter insertion by the after-hours clinical support team for patients with difficult venous access has been successful at our institution with 9 out of every 10 catheters inserted at first attempt with significantly lower recorded pain scores.
Highlights
Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure
The primary aspect of the project was training the After hours clinical support team (AHCST) in ultrasound guidance for peripheral intravenous catheter (PIVC) insertion until a more definitive vascular access could be attained by the central venous access service
Between January and December 2016, a total of 379 patients were referred for placement of a PIVC under ultrasound guidance
Summary
Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. It is estimated that over half of all patients admitted to hospital require the insertion of a peripheral intravenous catheter (PIVC) for the administration of fluids and parenteral medications [1]. It is the most common invasive clinical procedure performed in hospitals worldwide [2, 3]. It has been well described that multiple attempts at cannulation, and the placement of PIVCs in high flexion areas such as the elbow or wrist (which is typical among DiVA patients) increases the risk of phlebitis, thrombosis, and catheter related infection - all of which lead There can be many clinical implications from DiVA, namely: a delay in diagnosis, where important laboratory tests are required; delay in the commencement of treatment, or missed medication doses; and, if severe, can require escalation for insertion of a central venous access device (CVAD) [5, 8, 9].
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