Abstract
A peripheral intravenous catheter is often inserted as part of care during labour. The catheter is inserted into the back of the hand or lower forearm vein in usual practice. There is no trial data to guide the care provider on which is the better insertion site in any clinical setting. 307 women admitted to the labour ward who required insertion of intravenous catheter were randomised to back of hand or lower forearm vein catheter insertion. Catheter insertion is by junior to mid-grade providers. We evaluated insertion success at the first attempt, pain during insertion and catheter replacement due to malfunction as main outcomes. After catheter removal, we recorded patient satisfaction with site, future site preference and insertion site swelling, bruising, tenderness, vein thrombosis and pain. Insertion of a catheter into back of hand vein is more likely to be successful at the first attempt. Insertion pain score, catheter replacement rate, patient satisfaction, patient fidelity to site in a future insertion and insertion site complications rate are not different between trial arms. In conclusion, both insertion sites are suitable; the back of the hand vein maybe easier to cannulate and seems to be preferred by our frontline providers.
Highlights
Delivery suite providers were asked to document the site of their first catheter insertion attempt and whether it succeeded
There were 81 first attempts on dorsum of the hand vein and 19 on forearm vein and insertion success rates were 72/81 (89%) and 14/19 (74%) respectively (Relative risk RR 1.2 95% CI 0.9–1.6 P = 0.188)
Our finding indicate that the success rate for inserting an intravenous catheter in a dorsum of the hand vein compared to lower forearm vein might be higher; all other findings including insertion pain, catheter malfunction and replacement, additional catheter, patient satisfaction, post-removal catheter site complications or pain and future fidelity to the allocated site were similar
Summary
Clinical trials on peripheral intravenous catheterisation have focused on catheter longevity by evaluating timing of replacement[1] and intermittent flushing or infusion with or without heparin to maintain patency[2,3,4], inline filters to reduce phlebitis[5], timing of giving set changes[6], various pain relief methods during insertion[7,8,9,10,11,12,13,14], catheter dressings[15] and even local warming to aid insertion[16]. In obstetric patients anatomic considerations can be different as distal veins are engorged counterbalanced by peripheral oedema of late pregnancy and catheters are often needed for a short period only. In these patients, insertion success, insertion pain and short-term catheter functionality are more relevant. We performed a pilot study, a powered trial to test our hypothesis on the impact of catheter site (dorsum of the hand vs. lower forearm) in delivery suite patients on insertion success, insertion pain and catheter replacement due to malfunction
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