Factors determining success and the cost of materials used in securing intravenous access in an emergency setting: A prospective observational study

Abstract

IntroductionMultiple failed attempts at securing intravenous catheter access cause increased patient dissatisfaction and higher costs. We aimed to identify the factors leading to multiple failed attempts and estimate the cost of resources wasted. MethodsParticipants were recruited from the emergency department for a prospective, observational study. Healthcare workers inserting peripheral intravenous catheters were observed. Patient characteristics and the number of attempts needed were recorded. ResultsThree hundred thirty-four patients were enrolled, and an average of 1.74 ± 1.026 (Range: 1 – 5) access attempts were needed per patient. Only 56.28% of the insertions were successful on the first attempt. On multivariate linear regression with attempts as the outcome variable, age (β = 0.01, 95%CI 0.004 – 0.014, p = 0.0006), catheter calibre (β 20G = -0.25, 95%CI −0.45 – −0.07, p = 0.008), visibility (β = 0.23, 95%CI 0.02 – 0.44, p = 0.026) and palpability (β = 0.44, 95%CI 0.21 – 0.66, p = 0.0001) of the vein were statistically significant predictors. The average total cost of materials required was $6.4 USD per patient, of which $1.76 USD was spent towards unsuccessfully inserted catheters that were consequently thrown away. ConclusionsOur study shows that securing IV access often requires multiple attempts, with nearly 30% of the total cost amounting towards materials wasted. The risk of multiple attempts is highest for older patients with invisible and non-palpable veins.