Peripheral Intravenous Cannula Insertion Research Articles

Incidence of peripheral intravenous cannula induced phlebitis and its determinants among admitted patients in Ethiopia: systematic review and meta analysis, 2024

BackgroundPeripheral venous catheters (PVCs) are frequently used in clinical practice. Nonetheless, individuals who receive intravenous injections frequently have varying degrees of phlebitis. According to pertinent research, the catheter gauge, insertion site, and length of catheterization are strongly correlated with the incidence of phlebitis. However, no meta-analysis on the combined incidence of phlebitis and its contributing factors has been conducted. Thus, the purpose of this meta-analysis was to close the previously identified gaps.MethodA literature survey was conducted using electronic databases (CINAHL, Embassy, Google Scholar, and PubMed), and 4 studies were included they used peripheral intravenous catheters for therapeutic or volumetric infusion and reported phlebitis incidence rates. Random effects meta-analyses were performed to obtain the overall and subgroup phlebitis incidence rates and odds ratio for phlebitis incidence.ResultsThe incidence of phlebitis was 41 per 100 catheters (95% CI 0.22–0.60). There were 1584 patients in the included studies to know the incidence of phlebitis. In the subgroup analysis, the incidence of phlebitis in neonatal and infant patients was 30% (95% CI 0.25–0.34), in pediatrics patients was 34% (95% CI 0.29–0.38), and in adult patients was 50% (95% CI 0.11–0.89) respectively. Joint involvement in the PIVC (AOR: 2.44, 95% CI 1.67, 3.2), longer catheter dwell time (AOR = 3.96, 95% CI 1.59–7.33), and drug and blood administration in one vein (AOR = 1.91, 95% CI 1.67–2.15) were the most common factors associated with the incidence of phlebitis in Ethiopia.ConclusionThis meta-analysis indicates that PIVC-induced phlebitis is highly prevalent in Ethiopia. This meta-analysis identified significant risk factors for the development of phlebitis including medications and blood administered in a single vein, longer cannula dwelling times, and joint involvement in peripheral intravenous cannula insertion. Using the right interventions can lower the chance of developing phlebitis.

Using Simulation Models to Train Clinicians in the Use of Point-of-Care Ultrasound.

The use of point-of-care ultrasound (POCUS) has shown to be a beneficial non-invasive vascular access assessment method by clinicians, which can provide critical elements of visual and measurable information that proves to be useful in the context of vascular access cannulation, in combination with the practical skill of the clinician performing the cannulation. However, the use of POCUS in this context is to practically train and enable individuals who are novices in using this technique to become proficient in performing this task subsequently on patients in a careful and successful way. The simulation of these vascular conditions may be useful to help healthcare professionals learn, understand, apply, and establish such practical skills for vascular cannulation safely to achieve the desired outcomes. This project intended, through the attendance of a half-day workshop, to establish skills to use POCUS in connection with simulation models and perform specific tasks to enable clinicians to use this method in their clinical practice for vascular access cannulation in patients. A mixed-methods longitudinal study design was used to evaluate the effect of a point-of-care ultrasound workshop for peripheral intravenous cannula insertion, including specific tasks for the participants to be performed on simulation models. A total of 81 individuals participated in 11 half-day workshops through 2021 and 2022. Offering a workshop that uses simulation models in combination with various POCUS devices is useful in establishing this newly learned skill in clinicians, such as measurements of depth, caliper, and direction of a vein with POCUS prior to cannulation providing essential anatomical facts to the operator, which increases the likelihood of first-time success in cannulation.

Functional Duration of Peripheral Intravenous Cannula in Neonates with or without Splint: A Randomized Controlled Trial.

To determine the effect of splint on the functional duration of peripheral intravenous cannula (PIVC) in neonates. The trial was prospectively registered with the Clinical Trial Registry of India (CTRI/2021/09/036337). One-hundred-fifty cannulations in 71 neonates were randomized to splint (n = 75) and no-splint (n = 75) groups, respectively. The median (interquartile range, IQR) functional duration of PIVC was calculated from the time of PIVC insertion till removal due to the development of signs of PIVC failure or treatment completion. Kaplan-Meier survival analysis was used to compute the time to complication of PIVC.Complications related to PIVC were noted and multivariate Cox-proportion hazard analysis was done to find the predictors associated with PIVC failure. Median (IQR) functional duration of PIVC in the splint and the no-splint group was 28 (23-48) and 30 (25-48) h, respectively (p = 0.477). PIVC duration was higher in the splint group in term neonates and the no-splint group in preterm neonates; however, the differences were not statistically significant. No difference was observed in continuous vs. intermittent infusion subgroups. Time to complication development was also comparable between the groups. Splint application did not affect functional PIVC duration and its related complications in neonates.

Evaluation of a Point-of-care ultrasound (POCUS) workshop for peripheral intravenous cannulation

BackgroundPoint-of-care ultrasound (POCUS) is increasingly used as a non-invasive vascular access assessment method by clinicians from multiple disciplines worldwide, prior and during vascular access cannulations. While POCUS is a relatively new method to establish a vascular access in patients with complex vascular conditions, it is also essential to train and educate individuals who are novices in the techniques of cannulation so that they become proficient in performing this task subsequently on patients safely and successfully. A simulated environment may be a helpful tool to help healthcare providers establish skills in using POCUS safely and may also help them to successfully establish vascular access in patients. With this project, we sought to determine if participants of a simulated POCUS workshop for vascular access can use this technique successfully in their individual clinical environment after their attendance of a half-day workshop.MethodsA mixed-methods longitudinal study design was chosen to evaluate a point-of-care ultrasound workshop for peripheral intravenous cannula insertion. The workshops used simulation models for cannulation in combination with multiple ultrasound devices from various manufacturers to expose participants to a broader variety of POCUS devices as they may also vary in different clinical areas. Participants self-assessed their cannulation skills using questionnaires on a 10-point rating scale prior to and directly after the workshop.ResultsA total of 85 Individuals participated in eleven half-day workshops through 2021 and 2022. Workshop participants claimed that attending the workshop had significantly enhanced their clinical skill of using ultrasound for the purpose of cannulating a venous vessel. The level of confidence in using this technique had increased in all participants directly after conclusion of the workshop.ConclusionsGlobally, clinicians are increasingly using POCUS to establish vascular access in patients, and it is necessary that they receive sufficient and adequately structured and formal training to successfully apply this technique in their clinical practice. Offering a workshop which uses simulation models in combination with various POCUS devices to demonstrate this technique in a hands-on approach has proven to be useful to establish this newly learned skill in clinicians.

Evaluation of local inflammation associated with peripheral intravenouscatheter insertion in Quang Tri General Hospital

Introduction: Local inflammation associated with peripheral intravenous cannula insertion is an important issue in taking care of patients in Quang Tri General Hospital. Objectives: Determining the rate of local inflammation associated with using a peripheral intravenous catheter (PIC) and finding out the relevant factors of local inflammation caused by the peripheral intravenous catheter. Methodology: Cross-sectional survey was applied to 340 patients in Quang Tri General Hospital by using the questionnaire with the VIP scale (Visual Infusion Phlebitis Scale). Results: The incidence of local inflammation was 7.9% after using PIC, with local inflammation Grade. I was the highest proportion (70.4%). The relevant factors of local inflammation after using PIC include age (> 70), treatment in the intensive care unit, the number of catheter placements (> 3), time remaining in place (24 - 48 h), size 20 G, and group drug chemistry. Conclusion: The incidence of local inflammation was 7.9% after using PIC. Observe to detect local inflammation soon after using a peripheral intravenous catheter to improve the quality of patient care. Key words: local inflammation, peripheral intravenous catheter

The effect of new device on pain and comfort levels in individuals undergoing peripheral intravenous cannula insertion.

The purpose of this study is to see how ShotBlocker® affects the pain and comfort level associated with short peripheral intravenous cannula (PIV) insertion. The study was conducted on a single sample group using a pre-post design. Individuals in the sample group who underwent a brief PIV insertion procedure served as both the study's control and intervention groups. In the sample group, the same nurse inserted a peripheral intravenous catheter into the cephalic veins of the right and left forearms using a standard insertion and ShotBlocker®. The pain and comfort levels were assessed using the VAS and Comfort Scale. When the distribution of the average pain and comfort scores of the individuals treated with the peripheral intravenous catheter was examined, it was found that the average pain score of the peripheral intravenous catheter insertion using ShotBlocker® was statistically significantly lower than the peripheral intravenous catheter insertion using the standard method, and the comfort score averages were statistically higher. When the correlation between the pain and comfort score averages of individuals undergoing peripheral intravenous catheter insertions was investigated, a statistically significant and strong negative relationship (p = 0.001) was discovered. As a result, the use of ShotBlocker® during the short PIV insertion procedure is an effective method to reduce the pain caused by the peripheral intravenous catheter. It was determined that the comfort level of the individuals increased as the pain due to peripheral intravenous catheter insertion decreased.

Forearmed is forewarned: A prospective intervention observational time-series study of patient empowerment for ultrasound-guided peripheral intravenous access.

Ultrasound (US) is a valuable adjunct to improve the success rates of difficult peripheral intravenous cannula (PIVC) insertions but is usually clinician initiated. The present study assessed for any change in clinician practice resulting from interventions aimed at empowering patients to advocate for early use of US if they self-identified as having difficult PIVC access. This was a prospective observational time-series study using a rapid quality improvement (RQI) framework. Three ED waiting room intervention strategies (printed media, video and wristband) were tested over three 2-week periods at a large teaching hospital. The impact of each intervention was assessed at eight time points during each intervention and compared to a pre-intervention baseline period using trend and time-series analysis. A total of 1611 PIVC insertions were surveyed over 42 time points. The proportion of US-guided PIVC insertions was highest during Intervention 3 (wristbands; 5.5%) but all proportions remained below baseline (6.5%). Trend analysis identified an increasing frequency of US use during Intervention 1 (printed media, P=0.01). However, no statistically significant trends were observed within the periods. This is the first prospective study to assess the effect of various interventions to empower patients to self-identify as having difficult PIVC access and advocate for the use of US-guidance. The present study was indeterminate: no intervention tested in the present study noticeably influenced clinical practice, potentially attributable to the study design and confounding factors. This innovative study serves as a pilot for future research into patient empowerment, which is currently lacking in the literature.

From little things, big things grow: An exploratory analysis of the national cost of peripheral intravenous catheter insertion in Australian adult emergency care.

To estimate the total economic impact of peripheral intravenous catheter (PIVC) or cannula insertion and use in adult Australian EDs, including those cannulas that remain unused for therapeutic purposes. Searches on Australian government websites were conducted to find rates of insertion, complications and cost of cannula; following this, gaps in national data sets were filled with MEDLINE and PubMed searches to estimate the total cost of cannula use in Australian EDs. Once the data were collected, totals were combined to establish an estimated cost for the listed categories. The estimated cost of cannulation in Australia may be up to A$594 million per year, including the cost of insertion (equipment and staff), cost of complications such as Staphylococcus aureus bacteraemia and phlebitis, and patient-centred costs (lost patient productivity, infiltration, occlusion and dislodgement). Approximately A$305.9 million is attributed to unused cannulas and approximately 11 790 days of clinician time is spent annually inserting cannula that remains idle. The figures developed in the present study represent an important educational opportunity to encourage thoughtful consideration of all interventions, no matter how small. ED cannula insertion represents a large economic and health cost to Australia's health system, many of which remain unused. There are no national data sets that record complications associated with PIVCs and we highlight the urgent need for improved data.

Pre-operative peripheral intravenous cannula insertion failure at the first attempt in adults: Development of the VENSCORE predictive scale and identification of risk factors

Study objectiveOur objective was to develop a clinical scale (the VENSCORE) to predict pre-operative peripheral intravenous cannula (PIVC) insertion failure at the first attempt in adults. DesignThis was a prospective multicenter cohort study that included internal validation with bootstrapping. SettingThe operating rooms of 14 hospitals in southern France from June 2016 to June 2018. PatientsConsecutive adult patients aged 18 years or older were recruited upon arrival to the operating room, regardless of American Society of Anaesthesiology (ASA) physical status. InterventionsPIVC insertion on arrival to the OR. MeasurementsPIVC insertion failure at the first attempt was the outcome of interest. Data collected included the number of PIVC insertion attempts and potential predictors of the risk of failure (including pre-operative patient characteristics and data relative to the procedure). Uni- and multivariable logistic analyses were performed. Based on these results, the VENSCORE scale was developed to predict the risk of failure of the first PIVC insertion. Main resultsIn total, 3394 patients were included, and 27 were excluded because of protocol violations. The PIVC insertion failure rate at the first attempt was 20.3%. Based on multivariable analysis, a history of difficult PIVC insertions, high-risk surgery, poor vein visibility, and moderate to poor vein palpability were identified as risk factors for insertion failure at the first attempt. The area under the curve of the predictive model was 0.82 (95% confidence interval: 0.80–0.84). A VENSCORE value of 0 points was associated with a failure rate of 7%, versus 97% for a score of 6. ConclusionsThe four-item VENSCORE scale could be useful for prospectively identifying adults at risk of first PIVC insertion attempt failure.

A Quality Improvement Initiative to Reduce Blood Culture Contamination in the Neonatal Unit.

The QI team focused on standardizing processes to align with best practices using process mapping and cause and effect diagrams. Plan-Do-Study-Act (PDSA) 1: inoculation of blood culture bottles with the introduction of transfer device; PDSA 2: preparation of the skin for peripheral intravenous cannula insertion; PDSA 3: aseptic technique education package; and PDSA 4: optimizing blood volume of blood collected for culture. The team used statistical process control methodology to detect special cause variation. Compliance with the standard processes as part of PSDA 1 improved from a mean level of 50% to 100% and for PDSA 2 improved from a mean level of 50% to 95%. After implementation of PDSA 3, scores on a relevant knowledge test increased from a mean of 39% (pretraining test; n = 10) to 92% (posttraining test; n = 10) (P < 0.001). Postimplementation of the processes for PDSA 4, a minimum of 1 mL was collected in 94% of blood culture collection events (n = 450) (mean 1.1 mL; range 0.5-3.5 mL). Special cause variation occurred after the implementation of the PDSA cycles. During the baseline period, the BCC rate was 2.0% and decreased to 1.0% postinterventions implementation. Interventions focused on standardizing practices around collection of blood cultures in neonates were associated with fewer contaminants.This study is reported according to the SQUIRE 2.0 guidelines.

Prevalence of and factors associated with difficult peripheral venipuncture in adult surgical patients.

To determine the prevalence of difficult venous access in adult patients admitted to a surgical unit. This observational prospective cohort study included 235 patients from a Brazilian hospital. Clinical data were collected by direct observation and analyzed by descriptive, inferential statistics, and multiple binomial logistic regressions. Odds ratios were also calculated. Most of the patients (66.4%) were men and self-reported as white (59.2%). The prevalence of difficult intravenous access was 32.8%. Predictors of peripheral intravenous cannula insertion failure were history of difficult intravenous access and nonvisibility of the vein. History of difficult intravenous access and a nonvisible venous network were significant predictors of peripheral cannula insertion failure in adults undergoing clinical surgery. The prevalence of difficult intravenous access was 32.8%.

Peripheral intravenous cannula insertion and use in a tertiary hospital emergency department: A cross-sectional study

IntroductionPeripheral intravenous cannula is often a first line invasive intervention for patients in the emergency department. It is used to facilitate blood sampling, deliver essential fluids, blood products and medication. However, the insertion and use of the peripheral intravenous cannula is not without complication. This study surveyed the number of peripheral intravenous cannulas inserted in the emergency department and identify the level of and reason for use. MethodsA cross-sectional study was conducted in the emergency department of a large tertiary hospital in Queensland. Descriptive and inferential statistics were used to describe peripheral intravenous cannula use and to explore associations. ResultsOf the 224 patients assessed, 159 (71%) had at least one peripheral intravenous cannula inserted in emergency department. Of the 159 peripheral intravenous cannulas inserted, 54 (34%) remained unused while the patient was in the emergency department. For patients classified as Australasian Triage Scale categories 3, 4 and 5, 40% of peripheral intravenous cannulas remained unused. Overall, poor documentation was observed with 29% of peripheral intravenous cannulas insertions not documented at all. ConclusionThis study identified a high proportion of unused peripheral intravenous cannulass in the emergency department and inadequate documentation. An intervention to promote best practice, raise awareness of the risks of peripheral intravenous cannulas use, possible alternatives therapies, and improve documentation is required.

Comparison of Subclavian and Peripheral Intravenous Cannula Insertion in Critically Ill Patients Arriving in Emergency Department.

Introduction: Peripheral intravenous cannulation (PIVC) is a universal procedure to get venous access in hospital emergency settings. Sometimes, for critically ill patients in an emergency department, when we cannot get peripheral venous access, a central venous access could be established by percutaneous subclavian vein cannula insertion through a supraclavicular approach. This study will compare PIVC and percutaneous subclavian vein cannula insertion through supraclavicular approach, and determine which method is more effective and fast in critically ill patients arriving in the emergency department.Methods: This prospective, randomized clinical trial involved a total of 98 patients arriving in the emergency department in critical condition. Percutaneous subclavian vein cannula insertion through supraclavicular approach was attempted in 49 patients, and PIVC was attempted in other 49 patients. The timing of cannula insertion and the number of attempts for successful cannulation were compared for the two methods.Results: Percutaneous subclavian vein cannula insertion through supraclavicular approach was successful in 47 out of 49 patients (96%), and PIVC was successful in 38 out of 49 patients (78%). Average time of percutaneous subclavian vein cannula insertion through supraclavicular approach was 27.7 seconds (range 15-90 seconds), and the average time of PIVC was 68.64 seconds (range 25-150 seconds).Conclusion: Compared with PIVC, percutaneous subclavian vein cannula insertion through supraclavicular approach is faster and more effective to gain venous access in critically ill patients arriving in emergency department.

Incidence, severity and risk factors of peripheral intravenous cannula-induced complications: An observational prospective study.

To determine the incidence, severity and risk factors of peripheral intravenous cannula-induced complications. Peripheral venous cannulation in hospitalised patients may cause complications such as phlebitis, infiltration, occlusion and dislodgement. A review of the literature reveals the discrepancy in their incidence and identification of a wide range of risk factors, whereas the data on the occurrence and degree of severity are insufficient. An observational prospective study. The study observed 1,428 peripheral intravenous cannula insertion among 368 adult patients hospitalised at the tertiary healthcare clinics. The data collection and analysis included patients' medical data and the data related to each cannula (including placement, monitoring and the reasons for removal), as well as the data on the type of administered medications and solutions. Reporting of this research adheres to the STROBE guidelines. Phlebitis ranked first among complications with occurrence of 44%, followed by infiltration of 16.3%, while the incidence of occlusion and catheter dislodgement was 7.6% and 5.6%, respectively. In assessing the occurrence of phlebitis, multivariate analysis highlighted the presence of comorbidity, current infection, catheter size, time in situ and the number of administrations of infusion solutions associated with risk, whereas 20-gauge catheter, two or more attempts at cannulation and administration of a high-risk solutions during the first day have been singled out with regard to infiltration. As for the severity, the most common was medium stage of phlebitis, whereas grade 2 was most commonly observed for infiltration. The incidence of infiltration, occlusion and dislodgment is almost congruent with the average incidence of previous studies. However, the incidence and degree of severity associated with the occurrence of phlebitis were significantly higher. The results of the study draw attention to vulnerable groups of patients, cannula-specific and pharmacological risk factors for the development of peripheral intravenous cannula-induced complications.

Human factor‐designed multimodal intervention reduces the rate of unused peripheral intravenous cannula insertion

Our objective was to examine the impact of a human factor-designed multimodal intervention on the proportion of unused peripheral i.v. cannula (PIVC) insertion in our ED. A pre- and post-multimodal intervention retrospective cohort study was conducted using a structured electronic medical record review within a single adult tertiary ED in Australia. Pre-intervention data was collected 30 days prior to the multimodal intervention, with 30 day post-intervention data collected 3 months after the intervention commenced. The rates of PIVC inserted, the unused rate and the unused but appropriately inserted cannulas were the main outcome measures. Intravenous cannula insertion rates decreased by 12.9% (95% confidence interval [CI] 12.19-13.61) between the pre-intervention (1413/4167 [33.9%]; 95% CI 32.5-35.4) and post-intervention cohort (928/4421 [21.0%]; 95% CI 19.8-22.2). An analysis of 754 cases (376 pre-intervention and 378 post-intervention) showed that 139 of 376 (37.0%; 95% CI 32.1-42.1) i.v. cannulas were unused pre-intervention, while 73 of 378 (19.3%; 95% CI 15.4-23.7) was unused post-intervention; an absolute reduction of 17.7% (95% CI 14.98-20.42). The relative risk of an unused i.v. cannula was 0.52 (95% CI 0.41-0.67). The proportion of unused but appropriately inserted i.v. cannulas remained unchanged in both cohorts, with a relative risk of 0.91 (95% CI 0.58-1.42). Our multimodal intervention successfully reduced the number of unused PIVCs inserted in the ED, with a reduction in overall and unused PIVC insertions without any change in appropriate insertions.

Elective replacement of intravenous cannula in neonates-a randomised trial.

Peripheral intravenous cannula (PIVC) insertion is one of the most common invasive procedures performed in neonates and is frequently associated with adverse events. There are no studies in the neonatal population looking at the possibility of reducing the risk of PIVC-related complications by elective replacement of PIVC. A randomised, non-blinded, control trial was conducted in a tertiary level neonatal unit in Melbourne, Australia, to examine rates of extravasation in neonates with elective replacement of PIVC as compared to standard practice. Neonates born at 32weeks of gestation or more were randomly assigned to have their PIVC replaced electively (every 72-96h) or when clinically indicated in a 1:1 allocation ratio after parental consent. Primary outcome studied was rate of extravasation. Secondary outcomes included rates of phlebitis, leakage or spontaneous dislodgement of PIVC. One hundred thirteen infants were enrolled. Extravasation was noted in 33 (60%) of standard practice group vs. 28 (48.3%) of elective replacement (RR 0.80, CI 0.57-1.13, p = 0.21) infants. Time to first extravasation was similar between the groups (hazard ratio 0.69, CI 0.42-1.15). Extravasation events per 1000 IV hours were also similar between groups. Similar results were seen by both intention to treat and per protocol analyses. There was an increase in leaking rates (HR1.98, CI 1.03-3.81, p = 0.04) in the elective group, while phlebitis and spontaneous dislodgement rates were similar to standard group.Conclusion: Elective replacement of PIVC in neonates is not associated with reduction in extravasation rates.Trial registration: This trial has been registered with the Australian and New Zealand Clinical Trials Register. Identifier: ACTRN12615000827538. What is Known: • The reported incidence of extravasation injury is as high as 70% in the neonatal and paediatric population and has an association with cannula dwell time. • Adult studies have done to look at the possibility of reducing intravenous cannula-related complications with routine replacement of the cannulas but no similar studies have been done in the neonatal population. What is New: • Routine replacement of intravenous cannula in neonates between 72 and 96h of use does not reduce the rate of extravasation injuries. • There might be some added complications associated with such a practice.

'What the hell is water?' How to use deliberate clinical inertia in common emergency department situations.

Appropriate deliberate clinical inertia refers to the art of doing nothing as a positive clinical response. It includes shared decision-making to improve patient care with the use of clinical judgement. We discuss common clinical scenarios where the use of deliberate clinical inertia can occur. The insertion of peripheral intravenous cannulae, investigating patients with suspected renal colic and the investigation of low risk chest pain are all opportunities for the thoughtful clinician to 'stand there' and use effective patient communication to avoid low value tests and procedures. Awareness is key to identifying these opportunities to practice deliberate clinical inertia, as many of the situations may be so much a part of our environment that they are hidden in plain view.

Hot Off the Press: Peripheral Intravenous Cannula Insertion and Use in the Emergency Department.

This is a prospective before-after study comparing peripheral intravenous cannulation (PIVC) placement and usage rates following a 10-week-long multimodal intervention provided to medical and nursing staff working in a tertiary emergency department (ED). The intervention focused on improving appropriate use of PIVCs in an emergency setting by emphasizing to clinicians that a PIVC should only be placed if it was believed there was more than an 80% chance that it would be used. Patients were eligible for the study if they presented to the ED and were>18 years of age. Patients were excluded from the study if they were triage category 1, already had a PIVC placed in an ambulance, or were transferred from another hospital. Among the 4,172 patients included in the analysis, there was a 9.8% reduction in the number of PIVCs inserted (95% confidence interval [CI]= 6.8-12.87) and a 12% increase in PIVC usage (95% CI= 8.7%-17.0%) in the postintervention cohort.

Use of 8-cm 22G-long peripheral cannulas in pediatric patients.

Medium-term intravenous access in children is normally achieved by means of repeated multiple peripheral intravenous cannula insertions or peripherally inserted central catheters. Long peripheral cannulas might offer an alternative to these devices in children. Our aim was to clarify whether long peripheral cannulas provide reliable medium-term intravenous access avoiding the need for multiple peripheral intravenous cannulations or peripherally inserted central catheter insertion in children undergoing surgery. Following ethical approval, we prospectively collected data in children requiring medium-term intravenous access. The 22G-8-cm-long peripheral cannulas were inserted with a Seldinger technique in a peripheral vein. Position was checked by flushing and aspirating the catheter. Results are reported as mean ± standard deviation. A total of 18 children were included. Indications for medium-term intravenous therapy included perforated appendicitis (n = 14), infected central venous port (n = 2), fungal infection (n = 1) and septic arthritis (n = 1). In all, 15 (83%) patients underwent the procedure under general anaesthetic. The procedure failed in an 8-year-old patient. Insertion time was 8 ± 3.7 min. Age at insertion was 6.3 ± 4.9 years. Duration of intravenous therapy was 6.4 ± 5.1 days. About 13 (76%) patients completed the treatment with no complications. Three (17%) lines occluded by day 3 needed removal; one (7%) line needed removal on day 3 because of redness/pain noted around the insertion site. Long peripheral cannulas represent a valid option for medium-term intravenous access in children undergoing surgery. Majority of patients will be successfully treated with one long peripheral cannula for the duration of their treatment without the need for further cannulation.

Review article: Idle 'just-in-case' peripheral intravenous cannulas in the emergency department: Is something wrong?

Peripheral intravenous cannula (PIVC) placement is often an essential emergency medicine precursor to lifesaving treatment, but it is not harmless. Patients frequently and without proper consideration of the consequences receive a 'just-in-case' PIVCs as part of their assessment and admission, which, in a not insignificant number of patients, remains unused or idle in situ. We reviewed the literature and performed a thematic analysis of data collated from 21 articles published in the past 24 years regarding redundant PIVCs. The following five common themes emerged: heterogeneous prevalence data on post-insertion PIVC usage, preventable intravascular complications, financial burden, loss of time and a culture of over-investigating. The prevalence of PIVC insertions and idle PIVCs was heterogeneous among these publications; the median ED idle PIVC prevalence value was 32.4%. This practice is associated with compromised patient safety, squandered finances and misdirected practitioner time. Cultures of convenience and shortfalls in PIVC-related education facilitate the prevalence of idle PIVCs.