Peripheral Intravenous Cannula Research Articles

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.

Incidence of complications of peripheral intravenous cannula use in children admitted to Port Moresby general hospital: A prospective, observational study

Peripheral intravenous cannulas (PIVCs) are used for administration of medications and fluids in sick children but their use can result in complications. This prospective study was conducted from June to October 2020 at Port Moresby General Hospital in Papua New Guinea. Children who were admitted to the paediatric wards requiring PIVC insertion were regularly monitored to check for complications. Three hundred and thirty PIVCs were inserted in 104 paediatric patients. Eighty six (83%) of the 104 children had at least one PIVC complication which occurred in 220 (67%) of the 330 PIVCs assessed. Tissue infiltration was the commonest complication, occurring in 60% of the PIVCs, followed by phlebitis (29%), cannula obstruction (6%) and leaking (4%). Skin ulceration occurred in 1%. Larger gauge cannulas were more than twice as likely to be associated with complications as smaller gauge cannulas and administration of both medications and fluids more likely to result in complications than administration of medications alone. The incidence of PIVC complications of 83% by patient and 67% by cannula is of major concern. Staff should be aware of the risks associated with PIVC, ensure that PIVS are carefully inserted and stabilized and regularly monitored to prevent, detect and manage complications appropriately.

Effectiveness of an Interventional Program on Nursing Staffs' Practices toward Prevention of Peripheral Intravenous Cannula Complications in Al-Diwaniyah Teaching Hospital

Background: A peripheral intravenous cannula is an essential tool for delivering drugs, blood products, and nutritional fluids to patients intravenously. At least 90% of all patients who enter the medical environment for care have some form of intravenous therapy. Giving medications through an intravenous cannula can be complicated due to its association with serious infections.Aims of the study: The study aimed to evaluate the effectiveness of the intervention program on the practices of the nursing staff towards preventing peripheral intravenous cannula complications in Al-Diwaniyah Teaching Hospital.Methodology: A quasi-experimental design was carried out at the medical and surgical departments of Al-Diwaniyah Teaching Hospital for the period 22 \ December \ 2020 to 1 \ May \ 2021. A non-probability (purposive) sample of 60 nursing staff who worked in the surgical and medical departments was selected, and they were divided into two groups, the study group and the control group. The study sample consisted of (30) nurses who were exposed to the intervention program, while the control group consisted of (30) nurses were not exposed to the nursing interventional program. To measure the effectiveness of the intervention program on practices of the nursing staff, the researcher used a practice checklist that included (12) items related to preventing peripheral intravenous cannula complications. To analyze the results, descriptive statistics (frequencies, percentage, arithmetic mean, standard deviation) and inferential statistics (ANOVA, t-test) were used.Results: The pretest results showed that there was no significant difference between the study group and the control group (Mean of study group=1.25 versus Mean of control group=1.21) In the posttest, the results showed a significant improvement in the practices of the study group compared to the control group (Mean of study group=2.46 versus Mean of control group=1.28).Conclusion: The study concluded that the educational program has a positive effect on the nursing staff's practices regarding Prevention of Peripheral Intravenous Cannula Complications in Diwaniyah Teaching Hospital.Recommendations: The study recommended the necessity of activating the guidelines for peripheral intravenous cannulation in health institutions, and conducting future research to improve the knowledge and practices of the nursing staff about the prevention of complications of the peripheral intravenous cannula.

Assessment of Nurses’ Knowledge towards Infections of Peripheral Intravenous Cannula in Al-Basrah Teaching Hospital

Aimed at assessing nurse’s knowledge regarding infection of the peripheral cannula. Descriptive, hospitalbased study was conducted in Al-Basrah city in Al-Basrah Teaching Hospital from October 24th, 2019, to June 11th, 2020. The study included nurses in the hospital; they were (60) nurses. The instrument used for the study was a self-administrated questionnaire; the data were presented in a pre-designed questionnaire firstly. The questionnaire consisted of two parts: socio-demographic characteristics and knowledge about the infection of a peripheral intravenous cannula. Inferential and descriptive statistics have been utilized for the analysis of data. Data were analyzed manually and then through the use of the statistical package for social science (SPSS, v. 23). The results of the study present that the high percent (61.7%) of the study sample are male, (66.7%) of them at the (20-29) year age group, ( 45.0%) of them nursing institute, (61.7% ) their years of work experience were arranged between (1-9 year), most of them (60.0%) don’t have previous training about cannula infection. There has been a significant correlation between nurses’ knowledge, previous training in infection of a peripheral cannula, and level of education, and there has not been any significant correlation between nurses’ knowledge and nurses’ gender, age group, and years of experience. Recommendation: This study recommended establishing a regular training program and workshops about infection control measures, especially for an invasive procedure

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.

The impact of blood sampling technique, including the use of peripheral intravenous cannula, on haemolysis rates: A cohort study.

To explore the relationship between blood sampling techniques and haemolysis. Haemolysis rates of blood samples have been thought to be influenced by the method of collection. There is a lack of research evidence available to clearly show the comparative risk of haemolysis across different blood sampling methods, including venepuncture and use of peripheral intravenous cannulas. A prospective cohort study. Reporting followed the STROBE checklist. A trained observer was used to record blood sampling techniques over a 10-week period between April and June 2019. These records were then linked to pathology haemolysis results. Multivariable logistic regression was used to model patient and blood draw characteristics affecting haemolysis. Most of the blood samples were not haemolysed (n=324, 87.1%). Multivariable analysis showed haemolysis was associated with increased tourniquet duration and if the level of tube was less than half full. Univariable analysis showed haemolysis was associated with increased age of the patient, the difficulty of cannulation/ venepuncture and increased number of attempts. No difference was found in the haemolysis rate related to the qualification of the blood collector. There was no significant difference in haemolysis rates associated with sampling blood from a PIVC compared with venepuncture. Research should be undertaken to determine whether education on the factors influencing haemolysis is useful in decreasing haemolysis rates. There was no association with increased haemolysis rates when drawing blood via venepuncture compared with a peripheral intravenous cannula. Haemolysis of blood samples was associated with increased tourniquet duration, if level of the tube was less than half-filled, increased age of the patient and difficulty of blood draw. Awareness of the risk of haemolysis associated with specific blood sampling methods may assist clinicians to improve care.

Peripheral intravenous cannulae in neonates: To splint or not?

To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates. Level II Neonatal Intensive Care Unit (NICU). Consecutive babies with presumed need of peripheral intravenous access of at least 24 h. Enrolled subjects were randomized to "splint" or "splint-less" group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter. Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) (p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome. Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.

Tissue adhesives for peripheral intravenous catheter securement: A prospective randomized controlled pilot trial.

In some patients securing the peripheral intravenous cannula (PIVC) with a standard adhesive dressing can be difficult because of sweat or other body fluids. The aim of our study was to evaluate the use of tissue adhesives alone as a means to secure PIVCs inserted in the emergency department. We performed a prospective interventional pilot study from November 2019 to May 2020 in a medical emergency department of an urban tertiary hospital. Patients were randomized to two groups: tissue adhesives (TA) or adhesive dressing (AD) group. After randomization we followed them until day 4. There were no significant differences between TA and AD groups in the rate of unplanned removal of PIVCs in the first 72h (57.1% vs. 45.8%, p=0.29), the rate of unplanned removal of PIVCs in the ED (0% vs. 2.1%, p=1.00), the rate of unplanned removal of PIVC in the first 24h (42.8% vs. 35.4%, p=0.52), as well as in the rate of phlebitis (7.1% vs. 14.6%, p=0.34) and the rate of any blood-stream infection (0% vs. 0%, p=1.00). We did not observe any significant differences when PIVCs inserted in the emergency department were secured with tissue adhesives alone, compared to standard adhesive dressings. We observed a high rate of unplanned removal of PIVCs, necessitating further research to determine more reliable ways of securing PIVCs.

Peripheral intravenous cannulas for blood drawing: Nurses' views through content analysis

BackgroundPeripheral intravenous cannulas are commonly used for blood sampling. Conflicting evidence on the safety and reliability of blood sampling from peripheral intravenous cannulas provides little support to guide practice of clinicians. AimTo elicit views of nurses working in acute care of their opinions on the safety and efficacy of obtaining blood samples from peripheral intravenous cannulas. MethodsA cross-sectional electronic survey was utilised. Participants included nurses working in Australian acute care services nationally. The STROBE checklist was followed. The survey was distributed by two professional nursing bodies to their members between September and December 2017. Content analysis was used to analyse open-ended responses. FindingsOf the 338 participants who completed the survey, 269 provided comments. Themes supporting the use of peripheral intravenous cannulas for blood sampling included ‘efficiency’, ‘patient care’, ‘last resort’, and ‘other’. Reasons for not using a peripheral intravenous cannula for sampling provided themes of ‘PIVC use’, ‘dwell time’, ‘test type required’, ‘patency/insertion site care’, ‘preference’, and ‘other’. DiscussionThe choice regarding method of blood sampling is left to the discretion of individual practitioners. Diverse rationales were provided by respondents to support their practice in sampling blood. This may be influenced by variations in hospital policies and conflicting research evidence to support or refute the practice. ConclusionBlood sampling from peripheral intravenous cannulas or venepuncture is practiced differently between nurses based on multiple rationales. Research is needed to provide evidence for safe practice and support hospital policies.

Peripheral Intravenous Cannula Usage in the Emergency Department

Over a billion Peripheral Intra-Venous Cannulas (PIVC) are used globally every year with at least 25 million sold annually in the UK.1,2 The NHS spends an estimated £29m of its annual acute sector budget on PIVC procurement3 and around 70% of all hospitalised patients require at least one PIVC during their stay.4 Despite their extensive and routine use, PIVC failure rates are reported as high as 50-69%.5-7 In addition, many PIVCs remain unused following insertion, particularly in the Emergency Department (ED).8,9 The risk factors for PIVC failure are not well understood and the literature has found extensive regional variation in practice when it comes to PIVC insertion and management.1,7,10 While various technologies have been developed to address these issues, there remains a need for standardised, evidence-based guidelines.

Efficacy of Buzzy® on pain and anxiety during catheterization in children.

The use of a peripheral intravenous cannula is a common clinical practice, and it is known to be a major source of pain and anxiety in children. The aim of this study was to examine the effect of the use of the Buzzy® on pain and anxiety in children during peripheral cannula application. The research sample consisted of 60 children between the ages of 8 and 16. For children in the experimental group, external cold and vibration were applied by means of the Buzzy® device. Before and during the peripheral intravenous cannula procedure, the levels of fear and anxiety relating to the procedure of the child patients in both the experimental and control groups were assessed by the children themselves and by an independent observer. Immediately after the vein entry procedure had been carried out, the level of pain felt by the children was determined. The results of the statistical analysis showed no statistically significant difference between the anxiety levels of the groups before and after the procedure (P > 0.05). The results of the statistical analysis also showed no statistically significant difference between the postprocedural mean pain scores of the children as reported by the children themselves and by the observer (P > 0.05). In this study, unlike most studies in the literature, the conclusion was reached that the use of the Buzzy® to reduce pain and anxiety during the application of a peripheral intravenous cannula in children was not effective.

Are current clinical guidelines on the use of Peripheral Intravenous Cannula for blood draws supported by evidence? An organizational case study.

AimTo examine the quality of evidence used to inform health policies. Policies on peripheral intravenous cannulas were used as exemplars.DesignAn organizational case study design was used, using the STROBE reporting guidelines.MethodsPolicy guidelines were sourced between June and September 2018 from health departments in Australia. Seven documents were compared regarding intravenous cannula dwell times and blood collection use. Evidence used in the documents was critiqued using assessment guideline from the Oxford Centre for Evidence Based Medicine.ResultsLarge variations exist between policies regarding blood sampling and dwell time. Evidence used a variety of sources. Few references received an A evidence rating and policies differed in their interpretation of evidence.

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%.

Evaluating the sustained effectiveness of a multimodal intervention aimed at influencing PIVC insertion practices in the emergency department

IntroductionMultimodal interventions (MMI) are frequently used in various healthcare settings to encourage change in healthcare personnel practices and improve patient safety. In 2013, an MMI conducted in an Australian metropolitan...

Blood sampled from existing peripheral IV cannulae yields results equivalent to venepuncture: a systematic review.

SummaryObjectivesTo establish whether blood samples taken from used peripheral intravenous cannulae are clinically interchangeable with venepuncture.DesignSystematic review. PubMed, Web of Science and Embase were searched for relevant trials.SettingTrials which compared blood samples from used peripheral intravenous cannulae to venepuncture and provided limits of agreement or data which allowed calculation of limits of agreement.ParticipantsSeven trials with 746 participants. Blood tests included 13 commonly ordered biochemistry, haematology and blood gas measurements.Main outcome measures95% limits of agreement. Data were pooled using inverse variance weighting and compared to a clinically acceptable range estimated by expert opinion from previous trials.ResultsLimits of agreement for blood samples from used peripheral intravenous cannulae were within the clinically acceptable range for sodium, chloride, urea, creatinine and haematology samples. Limits of agreement for potassium were ±0.47 mmol/L which exceeded the clinically acceptable range. Peripheral intravenous cannula samples for blood gas analysis gave limits of agreement which far exceeded the clinically acceptable range.ConclusionsBlood sampling from used peripheral intravenous cannulae is a reasonable clinical practice for haematology and biochemistry samples. Potassium samples from used peripheral intravenous cannulae can be used in situations where error up to ±0.47 mmol/L is acceptable. Peripheral intravenous cannula samples should not be used for blood gas analysis.

Pictorial Flashcard Regarding Self-Care of Peripheral Intravenous Cannula (PIVC): Is it Effective in Terms of Indwelling Time and Related Complications?

Pictorial Flashcard Regarding Self-Care of Peripheral Intravenous Cannula (PIVC): Is it Effective in Terms of Indwelling Time and Related Complications?

Risk Factors for Difficult Peripheral Intravenous Cannulation. The PIVV2 Multicentre Case-Control Study.

Background. Difficult peripheral intravenous cannulation (DPIVC) is associated with serious complications related to vascular access. These complications might be avoided if the risk factors were identified previously, enabling the detection of potentially difficult situations at an early stage. The aim of this study is to consider these risk factors, to determine the influence of the hospital setting, to examine the association between DPIVC and the different techniques of catheter insertion and to analyse the importance of the clinician’s experience in this context. Methods. Case-control study following a previously published protocol, conducted in 48 units of eight public hospitals in Spain. Adult patients requiring a peripheral intravenous cannula were prospectively included in the study population during their hospital stay. Over a period of 11 months, for consecutive eligible patients, nurses in each participating unit recorded data on their assessment of the vascular access performed and the technique used. Variables related to these medical personnel were also recorded. One of the researchers reviewed the patients’ clinical history to compile the relevant health variables and to characterise the healthcare process. The statistical analysis included association tests among the main study variables. The risk factors were analysed using bivariate logistic regression. The variables found to be statistically significant were included in a multivariate logistic regression model incorporating each of the healthcare environments identified. Results. The study population was composed of 2662 patients, of whom 221 (8.3%) presented with DPIVC. A previous history of difficulty, the presence of non-palpable veins, acute upper limb alterations and punctures in the ante-cubital fossa were found to be independent risk factors for DPIVC. Differences were found in the frequency of occurrence of DPIVC and in some risk factors, according to the healthcare context. The variables related to the characteristics of the hospital personnel did not influence the study event. Conclusion: The present study identifies four independent risk factors for DPIVC that can be incorporated into algorithms aimed at preventing its occurrence and facilitating the referral of patients to vascular access specialist teams.

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.

Prospective safety evaluation of automated iomeprol 400 injections for CT through peripheral venous cannulas

To evaluate prospectively the safety of contrast medium injection through standard peripheral intravenous cannulas at standard injection sites during clinical routine using iomeprol 400, a contrast agent with high viscosity. Three thousand, five hundred and fourteen clinical CT examinations undertaken at Saarland University Medical Center were included in this prospective observational trial. The size and site of the cannula as well as the contrast medium injection rate and volume were assessed for each patient. In addition, the ability to aspirate blood though the cannula and the occurrence of complications, such as extravasation or abortion of injection by the automated injector, were recorded. The overall complication rate was 30/3,514 (0.85%). With 22 G cannulas, the complication rate was 8/541 (1.48%) applying flow rates of 1-3.5 ml/s (mean 2.1 ml/s). With 20 G cannulas, complications occurred in 21/2,601 cases (0.81%) with flow rates of 1.5-5 ml/s (mean 3 ml/s). The complication rate using 18 G cannulas was 1/377 (0.26%) for flow rates of 2-6 ml/s (mean 3.5 ml/s). No relationship between the site and size of the cannula to the occurrence of complications was found. The inability to aspirate blood correlated with the development of extravasation. The injection of contrast agent using standard peripheral venous cannulas is a safe and reliable procedure yielding diagnostic image contrast, even when using highly viscous contrast agents such as iomeprol 400; an aspiration test should be performed before each injection.

Evaluating an ultrasound-guided peripheral intravenous cannulation training program for emergency clinicians: An Australian perspective

ObjectiveThe primary objective of this study was to identify the proportion of clinicians using ultrasound guidance (USG) to insert peripheral intravenous cannulas (PIVCs) in the emergency department (ED) following attendance at a hospital-based USG PIVC training program. MethodsOver 12-months, USG cannulation training sessions were offered to nurses and doctors competent in standard PIVC insertion (landmark technique), working in the ED. Surveys pre and post-training captured participants’ self-reported confidence with cannulation and USG cannulation using a 5-point Likert scale. Supplemental data from observation periods before and after the trainings assessed departmental cannulation practices overall. Data were analysed using descriptive statistics and associations analysed using chi-square tests. ResultsOverall, 195 participants attended training; 58% completed follow-up surveys. Forty-three percent reported using USG cannulation the following month. The median confidence score amongst workshop participants increased from 1 to 3 (p<.001). Post-implementation, use of USG cannulation increased from 0.7% to 6.0% post-training (p<.001), although the overall number of attempts at PIVC placement did not change. ConclusionsUSG cannulation training increased this practice in the short-term. However, no significant difference in the number of attempts was observed. Further investigation in controlled settings is needed to inform the widespread implementation of USG cannulation training packages.