Peripheral Intravenous Cannulation Research Articles

A retrospective clinical audit investigating the prevalence of patients experiencing difficult peripheral intravenous cannulation afterhours in a tertiary referral hospital in Australia

A retrospective clinical audit investigating the prevalence of patients experiencing difficult peripheral intravenous cannulation afterhours in a tertiary referral hospital in Australia

Challenges Faced by Non-consultant Hospital Doctors in Paediatric Peripheral Intravenous Cannulation in Ireland

Peripheral intravenous cannulation (PIVC) in children is one of the most common procedures in acute care paediatrics. This can be difficult for experienced clinicians and daunting for those with limited paediatric experience. We aimed to evaluate the level of confidence of non-consultant hospital doctors (NCHDs) in PIVC and identify factors that impact on their level of confidence. This was a cross-sectional nationwide survey of NCHDs on the level of confidence in paediatric PIVC. Self-reported questionnaires explored clinical experience with PIVC, level of confidence, and potential factors impacting on confidence. Primary outcome was the level of confidence in PIVC. A survey response rate of 45% (202/450) was received from 12 Irish hospitals. Despite 89% (180/202) of NCHDs self-reporting average or above average success rates and 76% (155/202) having inserted ≥10 cannula within the preceding 3 months, self-reported confidence was low across the entire cohort. Only 48% (97/202) of NCHDs reported confidence scores >3 on 5-point scale and 37% (75/202) reported significant anxiety proceeding with PIVC. Level of confidence was increased with previous paediatric experience (p = 0.00004) and seniority of the doctor (p < 0.00001), whilst previous unsuccessful attempts by colleagues were strongly associated with decreased confidence (p = 0.009). Our study described the levels of confidence of NCHDs in PIVC. Although the experienced paediatric NCHDs are confident in PIVC, there still exists some degree of anxiety. These have implications for workforce educational planning and training to improve level of confidence which may lead to better patient care.

Evaluation of Efficacy of Valsalva Maneuver During Peripheral Intravenous Cannulation on Pain

Background AimsThe aim of this study was to examine the effects of the Valsalva maneuver during peripheral intravenous catheter (PIVC) insertion on procedure-related pain. DesignThis work was a prospective randomized controlled study. SettingsStudy was conducted in the orthopedics clinic of a university hospital. Participants/Subjects MethodsThe sample of patients (N = 110) was allocated to the Valsalva maneuver group (n = 55) and control group (n = 55) by using blocked randomization to reduce bias and achieve balance according to age and gender. Pain was evaluated by using Numerical Rating Scale. Systolic/diastolic blood pressure and heart rate before and after the PIVC placement was recorded. ResultsThe patients in the intervention group had less severe pain during the PIVC insertion than the patients in the control group (p ˂ .001). After PIVC placement, systolic blood pressure was significantly reduced in both groups (p = .008), no other variables changed significantly. No clinical complication related to the Valsalva maneuver occurred in the intervention group. ConclusionValsalva maneuver can be used as a non-pharmacologic method to reduce pain during PIVC placement.

Ultrasound-guided cannulation for medical students.

There is growing recommendation to integrate ultrasound training into undergraduate medical curricula; with limited evidence of its implementation in the United Kingdom. Peripheral intravenous cannulation (PIVC) often has high failure rates-particularly for patients with difficult vascular access. Ultrasound-guided PIVC (US-PIVC) has been shown to increase the rates of success and may reduce dependence on seniors. Teaching US-PIVC to senior medical students may prove a clinically valuable and feasible means of introducing ultrasound into medical programmes. We initially surveyed 18 doctors to assess their perceptions and experience of ultrasound. Thirty-five final-year medical students took part in a novel US-PIVC course. Students' competence was assessed at the end of the session using an objective assessment. Students' pre- and post-course attitudes and confidence were evaluated using questionnaires. All doctors surveyed reported difficulty performing PIVC since starting work: 66% on a monthly basis. None of the students (0%) and 11% of the doctors had previously received ultrasound training. By the end of the course, all students 'agreed' or 'strongly agreed' that the session was enjoyable and that they felt confident performing US-PIVC. Thirty-four of 35 participants attained the minimum competence standard. Students' confidence performing PIVC, regardless of ultrasound guidance, increased significantly (p=0.002) following the session. As ultrasound becomes a more readily available point-of-care technology, it should be considered for inclusion in the undergraduate medical curriculum. Our course appears to be an effective model of teaching US-PIVC to final-year medical students. Similar courses could act as a pragmatic and clinically rewarding means of implementing US-PIVC teaching into the latter years of undergraduate curricula.

The Process and Outcomes of Peripheral Venous Cannulation in a Tertiary Care Center: a Prospective Completed Audit Loop Study

Peripheral venous cannulations are one of the most common procedures carried out in today’s healthcare setting. It is an invasive procedure and carries with it the risk of bloodstream infections. There are guidelines for insertion and management of peripheral venous cannulas. One such guideline is the standards of infusion therapy from the Royal College of Nursing. In this study, we aim to assess the process and outcomes of peripheral venous cannulation in our institution against these guidelines. We conducted a prospective completed audit loop study on the process and outcomes of peripheral venous cannulation in our institution. The preliminary audit was conducted in the month of December 2019. The staff were trained on various aspects of cannulation based on the guidelines in the following month. A reaudit was conducted between May and August 2020, and the data were analyzed. A total of 362 cannulations were audited for the study. Forty-seven cannulations were observed during the initial audit, and 315 cannulations were included for the reaudit. On comparative analysis, there was a statistically significant improvement in hand hygiene, use of gloves, appropriate site selection, flushing of the cannula, and documentation in the reaudit in comparison with the initial audit. There was also a statistically significant reduction in the number of recannulations. Peripheral intravenous cannulation although a simple procedure can cause significant morbidity if not performed properly. Auditing such procedures shows deficiencies in performance. Reaudit, after adequate retraining of staff, shows significant improvement in performance and outcome.

First-Attempt Success Rate of Ultrasound-Guided Peripheral IV Access using a Handheld Ultrasound Machine in a Simulation Model

Background: Although peripheral Intravenous (IV) cannulation is a routine procedure performed by nurses, IV access can be difficult to achieve, particularly in emergency patients who have critical illnesses. Ultrasound is used in this procedure to increase the success rate in novice practitioners. Objective: We aimed to determine the first-attempt success rate of ultrasound-guided peripheral IV (USGPIV) performed by emergency nurses in simulation model after having undergone training in the procedure. Materials and Methods: This was prospective descriptive study. The participants consisted of 61 emergency nurses at Srinagarind Hospital Emergency Department from January to April 2020. USGPIV cannulation training was provided by an emergency physician who is also a specialist in emergency ultrasound. After training, we calculated the number of attempts and time required to successfully complete USGPIV in a simulation model. Following this, participants responded to a questionnaire to evaluate their confidence in performing the procedure, as well as its feasibility and practical application. Data were analyzed using a Kolmogorov-Smirnov test, and p&lt;0.05 was considered to be significant. Results: Sixty-one emergency nurses were included. The first-attempt success rate of USGPIV was 85.25% (95% CI 0.761, 0.944), and the mean time required was 47.33+4.89 sec. (95% CI 37.547, 57.103). Fifty-nine participants (96.72%) completed the questionnaire. All items had a mean score of greater than 3 points, with confidence score being the highest. Conclusion: Emergency nurses with no previous experience with USGPIV were able to perform a simulated version of the procedure with a high first-attempt success rate after a short training session. Further studies should be conducted to evaluate nurses’ USGPIV competency in real patients. Keywords: Ultrasound, Peripheral IV cannulation, Emergency medicine, Emergency nurse

The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial.

Peripheral intravenous cannulation is the preferred method to obtain vascular access, but not always successful on the first attempt. Evidence on the impact of the intravenous catheter itself on the success rate is lacking. Faster visualization of blood flashback into the catheter, as a result of a notched needle, is thought to increase first attempt success rate. The current study aimed to assess if inserting a notched peripheral intravenous catheter will increase first attempt cannulation success up to 90%, when compared to inserting a catheter without a notched needle. In this block-randomized trial, adult patients in the intervention group got a notched peripheral intravenous catheter inserted, patients in the control group received a traditional non-notched catheter. The primary objective was the first attempt success rate of peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines and hospital policy. About 328 patients were included in the intervention group and 330 patients in the control group. First attempt success was 85% and 79% for the intervention and control group respectively. First attempt success was remarkably higher in the intervention group regarding patients with a high risk for failed cannulation (29%), when compared to the control group (10%). This study was unable to reach a first attempt success of 90%, although first attempt cannulation success was higher in patients who got a notched needle inserted when compared to those who got a non-notched needle inserted, unless a patients individual risk profile for a difficult intravenous access.

Comparison of the dilatory effect of three strategies on peripheral veins of the upper extremity in adults.

Dilated veins are associated with increased success of peripheral intravenous cannulation, due to their improved visibility and palpability. We compared three strategies to achieve venodilation (tourniquet, electrical stimulation, or a combined strategy) on increase in venous size. A total of 54 volunteers participated in this cross-over observational study with healthy adults, measuring venous cross-sectional area and diameter at six different sites of the upper extremity. Measurements were performed with ultrasound after performing any dilation strategy and compared with non-dilated venous size. An increased cross-sectional area of 25 square millimeters was denoted as clinically relevant, which was detected with paired t-test, Wilcoxon signed rank test, or ANOVA. The cephalic vein was the greatest at all sites (t=12.43, df=39, P<0.001 for the cross-sectional area), but the largest increase in venous size was obtained in the basilic vein (t=12.11, df=39, P<0.001 for the cross-sectional area). The largest increase in venous size was obtained after electrical stimulation followed by tourniquet application at all measurement sites. The basilic vein increased by with 44% in cross-sectional area and 21% in diameter, which were 37% and 17% for the cross-sectional area and diameter of the cephalic vein. In general, the largest sized veins are situated in the upper arm, of which the cephalic vein has the largest cross-sectional area and diameter. The combination of electrical stimulation followed by tourniquet application resulted in the greatest increase in venous size and is therefore considered as the most effective to improve peripheral intravenous cannulation success.

The patient experience of peripheral intravenous therapy: development of a patient survey, initial findings, and next steps

Peripheral intravenous cannulation (PIVC) is one of the most commonly performed invasive procedures in healthcare and can be a stressful experience for patients. Co-creating a patient journey map of intravenous therapy (IVT) together with patients highlighted the need to better understand patient experiences of IVT and informed the development of a patient-reported experience measure of intravenous therapy (IVT). The British Columbia (BC) Lower Mainland IVT Working Group, the BC Office of Patient-Centred Measurement and the provincial supplier of IVT products, hypothesized patient feedback about their IVT experiences would garner new insights to improve both patient experiences and outcomes related to IVT. Leveraging BC's province-wide, coordinated, scientifically rigorous patient-centred measurement program (BCPCM), a module of eight questions were developed, tested and fielded with the 2018 BC Emergency Department patient survey (n=14 076). Weekly monitoring of patient responses, through the BCPCM's web-based Dynamic Analysis and Reporting Tool (the DART), showed key themes and opportunities for improvement, leading to a test of change that introduced a patient information card (Why do I need an IV, What will happen when I get an IV, Tell a nurse if the following happens). This paper outlines the development of the IVT patient experience survey, and presents initial findings and the next steps to take action on the results. Additional data collection is now underway to solicit patient feedback of IVT across BC in outpatient cancer care and acute care hospital settings.

Impact of structured simulation-based and on-job training program on nurses' competency in pediatric peripheral intravenous cannulation: Children's hospital experience

BackgroundPeripheral intravenous cannulation (PIVC) is a frequent invasive, painful procedure in children. Nursing education and competency are of great importance to decrease complications. Objectivesto evaluate the impact of structured simulation-based PIVC training and on-job assessment program on nurses' knowledge, attitudes, and performance. DesignSettings/participants: A prospective, structured, competency improvement training, assessment, feedback, and reassessment conducted on 150 pediatric nurses. They provided nursing care for in-patients at the newly open Children's hospital, Ain Shams University.Methods: PIVC insertion skills and care knowledge, structured simulation-based mannequin training arm venipuncture model and on-job assessment were conducted. In the preparatory phase, 15 nurses were interviewed to develop the assessment tools. Knowledge and attitudes were assessed quantitatively using a validated self-administered questionnaire. Structured simulation-based training, and on-job skill assessment were performed using validated observer checklist. Assessment performed at enrollment (baseline), immediate post training, and reassessment 2-months after the training, using same tools. ResultsKnowledge, performance, and attitudes were significantly improved for the 150 trained nurses. There was improvement in immediate post training assessment than the reassessment after 2-months, compared to baseline for total knowledge score; peripheral cannula insertion score; hand washing before aseptic procedure; skin antisepsis at puncture site; no puncture site palpation after disinfection; apply sterile dressing to puncture site, p = 0.00, respectively.There was improvement in the reassessment after 2-months than post training assessment, compared to baseline for the total attitude score, p = 0.02; peripheral cannula care, p = 0.00; aseptic technique, p = 0.00; wearing protective gloves, p = 0.01; total practice score, p = 0.00.Years of experience, last 6-months training course, practice level, educational level, age, and attitude influence overall performance. ConclusionsStructured simulation-based training and on-job skill assessment are effective for improvement of PIVC insertion and care. Continuous education, feedback, assessment/reassessment, and monitoring should be recommended to retain the gained improvement in attitudes, knowledge, and skills. Changing workplace structure and improve work environment should be studied as factors that might affect learning.

Evaluation of the difficulty of peripheral venous cannulation during anesthesia induction in children: Is DIVA score sufficient?

The primary objective of the present study was to determine the rate and the independent predictors of the difficult peripheral intravascular access (PIVA) in the operating room (OR). The secondary objective was to validate the ability of the difficult intravenous access (DIVA) scoring system in the detection of difficult PIVA in the operating room. In this prospective observational study, patients between 0 and 18 years old who were operated in the pediatric hospital were evaluated. Peripheral intravenous cannulation performed during inhalation induction in 1008 patients were recorded. The following data were collected: demographic characteristics, the presence of a chronic disease, the DIVA score, operating room temperature, the area of PIVA application, the duration of PIVA and the number of PIVA attempts. The independent determinants of the difficult PIVA were determined with multivariate logistic regression. A total of 1008 patients (82% boys) with a median age of 4 (range 0.04-17 years) were included in the study. The median number of PIVA attempts was 1 whereas the median duration for successful PIVA was 15 s (range 4-2100). PIVA was successful at the first attempt in 75.3% of patients. Among patients who required more than two PIVA attempts, the most common adjunctive method was to seek help from another operator (80.8%). In the multivariable logistic regression model, only the presence of chronic disease, being underweight, and DIVA score ⩾4 (OR 6.355, CI 4.57-9.486) remained to be the significant determinants of difficult PIVA. The success rate of anesthesiologist-performed PIVA at the first attempt in the OR was 75.3%. Having a chronic disease, a DIVA score ⩾4 and being underweight appeared as the independent predictors for difficult PIVA.

A study to assess the effectiveness of video assisted teaching program on knowledge and practice regarding peripheral intravenous cannulation among B.Sc. Nursing 2nd year students at selected Nursing College in Jabalpur (M.P)

A study to assess the effectiveness of video assisted teaching program on knowledge and practice regarding peripheral intravenous cannulation among B.Sc. Nursing 2nd year students at selected Nursing College in Jabalpur (M.P)

Intravenous Fracture of a Peripheral Cannula at the Dorsum of the Hand in a Patient Who Used Walking Aids after Surgery

In orthopaedic patients, peripheral intravenous (IV) cannulation is a common procedure for various clinical purposes. This patient was introduced with a 17G cannula in the basilic vein of the dorsal venous arch of the left hand prior to knee replacement surgery. Post knee surgery patients use walking aids for mobilization. Cannula which has been placed at the dorsum of the hand has a potential to bend at the neck of the cannula when the wrist bend while holding the walking aid. Repeated bending can result in fatigue fracture of the cannula neck. In this patient at the time of cannula removal, it was noted the catheter part is broken and proximal migration. Ultrasound guided localization was done and removed with a venotomy under local anesthesia. It is advisable to place peripheral venous cannulas well away from the wrist joint, which will prevent catheter bending and fracture. This is a very important point to consider when placing cannulas in orthopaedic patients who undergo surgical procedures.

Educational effect of related factors of the successful peripheral intravenous cannulation for paramedic

Educational effect of related factors of the successful peripheral intravenous cannulation for paramedic

Related factors of the successful peripheral intravenous cannulation by paramedics

Related factors of the successful peripheral intravenous cannulation by paramedics

Tricuspid valve endocarditis following peripheral venous cannulation – an unusual aetiology

Isolated tricuspid valve endocarditis is rarely seen without intravenous drug abuse, invasive cardiac procedure or previous valvular disease. Another often overlooked but rarely seen risk factor is peripheral intravenous cannulation. In such cases poor cannula line care and unhygienic practices predispose patients to right sided infective endocarditis. The patient in this case developed tricuspid valve endocarditis following treatment for Dengue Hemorrhagic fever. He had pulmonary involvement as well. Blood culture was positive with MRSA and he was treated with prolonged course of IV antibiotics without surgical interventions. Eventually, he recovered completely and was discharged after 8 weeks of hospital stay.

Assessment of Knowledge and Practice of Peripheral Intravenous Cannulation in Government Cardiology Hospital in Pakistan

Insertion of peripheral cannula is very commonly used procedure world-wide in hospital settings. Aim of the study is to assess the nurses knowledge about care of intravenous cannulation and to observe their practices during cannula insertion. The current cross sectional study assesses the knowledge and practice of peripheral intravenous cannulation among the nurses of Government hospital, Lahore Pakistan. The data was collected by 170 nurses from the nurses of government hospital Lahore, Pakistan through convinent sampling technique. The results of the study represent that nurses have good understanding about care of cannula but there is lacking in practices. Keywords: Cannula, nurses, practices, peripheral intravenous DOI: 10.7176/JHMN/84-06 Publication date: December 31 st 2020

Assessment of Knowledge and Practice of peripheral intravenous cannulation in Government Cardiology Hospital in Pakistan

Insertion of peripheral cannula is very commonly used procedure world-wide in hospital settings. Aim of the study is to assess the nurses knowledge about care of intravenous cannulation and to observe their practices during cannula insertion. The current cross sectional study assesses the knowledge and practice of peripheral intravenous cannulation among the nurses of Government hospital, Lahore Pakistan. The data was collected by 170 nurses from the nurses of government hospital Lahore, Pakistan through convinent sampling technique. The results of the study represent that nurses have good understanding about care of cannula but there is lacking in practices. Key Words : Cannula, nurses, practices, peripheral intravenous DOI: 10.7176/JHMN/82-13 Publication date: November 30 th 2020

Knowledge and Practices on Intra Venous Cannulation among Student Nurses

Back ground: The study is generally concerned about the care and maintenance of peripheral intravenous(IV) cannulation and to assess the knowledge and practice of student nurses towards care and maintenanceof IV cannula. Intravenous cannulation is a commonest procedure performed by student nurses and staffnurses in hospitals and the procedure is closely associated with the risk of nosocomial infections if standardcare is not provided. Design: Non experimental descriptive study design was carried out and non-probabilityconvenience sampling method used for data collection. Methods: Nurses knowledge and practice towardsintravenous cannulation were assessed using a validated semi?structured self-administered questionnaire.Reliability was assessed using Cronbach’s ? coefficient method.Data were analysed through SPSS programand Microsoft excel. Result :The findings revealed that 54% respondents were doing correct practices andonly 6% shown poor practices in IV cannulation. Most student nurses (68%) has good subject knowledgeof caring and maintaining peripheral intravenous cannulation but there were some(8%) without properknowledge. None of the demographic variables and scores of knowledge and practice has an associationexcept education and the practice score. Education and practice score showed the significant relation.Conclusion: Only 6-8% of total sample expressed poor practices and knowledge . Anyhow this can bedangerous also as student nurses are dealing with patients in hospital. Further education need to be given tothe student nurses before practicing on patients.

Assessment of Alternative Personal Protective Equipment by Emergency Department Personnel During the SARS-CoV-2 Pandemic: A Simulation-Based Pilot Study.

Shortage of personal protective equipment (PPE) for frontline healthcare workers managing the current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is a major, global challenge. In this pilot study, we describe a simulation-based method for evaluating the suitability and acceptability of an alternative biological isolation garment (BIG, a gown or a suit) for clinical use by emergency department (ED) personnel. Using a high-fidelity simulator, participants provided airway management according to the SARS-CoV-2 protocol. A nonvisible fluorescent marker was used as a surrogate marker of contamination. We assessed ultraviolet light visualization of the fluorescent marker after doffing and satisfaction with donning, use during simulation, and doffing. We found that after doffing, markers were not visualized on any of the participants and that the median satisfaction scores of the alternative and standard BIG (sBIG) were 4 [interquartile range (IQR) = 1-5] and 4 (IQR = 2-4), respectively. The results suggest the suitability and acceptability of the alternative BIG (aBIG) for use by ED personnel.