Reasons for Removal of Emergency Department-Inserted Peripheral Intravenous Cannulae in Admitted Patients: A Retrospective Medical Chart Audit in Australia.

Abstract

It has been reported that the peripheral intravenous cannula (PIVC) is the first choice of vascular access device for patient treatment in the emergency department (ED). The number of PIVC insertions in our Australian ED is more than 35,000 per year. Concern arises when ED-inserted PIVCs are used exclusively for blood sampling because this may lead to unused PIVCs being left in situ after patients are transferred to the ward, increasing risk of infection. The rate of unused or idle PIVCs inserted in the ED has been reported at 45%-50%. PIVC insertions in the ED have been identified as a cause for phlebitis and bacteremia, leading to their premature failure. Analysis of 5 years of prospective data from 2 hospitals in Australia found a high incidence of catheter-related Staphylococcus aureus bloodstream infections with 39.6% of such infections associated with PIVCs inserted in the ED. As a result, routine PIVC replacement should be considered after 24 hours for PIVCs inserted under emergent conditions 6 and after 96 hours for those inserted under nonemergent conditions. These worrying statistics prompted the design of the current study that was performed to investigate how and why PIVCs are used in the ED, and during the subsequent hospital admission, as well as the documented rationale for removal of ED-inserted PIVCs by ward staff. To our knowledge, there is no prior study investigating this phenomenon.