Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices

被引:16
作者
Evison, Hugo [1 ]
Sweeny, Amy [2 ,4 ,6 ,7 ]
Ranse, Jamie [2 ,4 ]
Carrington, Mercedes [3 ]
Marsh, Nicole [4 ,5 ,8 ]
Byrnes, Joshua [9 ]
Rickard, Claire M. [4 ,5 ,8 ,11 ,12 ]
Carr, Peter J. [4 ,10 ]
Keijzers, Gerben [2 ,3 ,6 ,7 ]
机构
[1] Queensland Ambulance Serv, GPO Box 1425, Brisbane, Qld 4000, Australia
[2] Gold Coast Univ Hosp, Dept Emergency Med, 1 Hosp Blvd, Southport, Qld 4215, Australia
[3] Robina Hosp, Dept Emergency Med, 2 Bayberry Lane, Robina, Qld 4226, Australia
[4] Griffith Univ, Menzies Hlth Inst Queensland, Alliance Vasc Access Teaching & Res, G40 Griffith Hlth Ctr, Southport, Qld 4222, Australia
[5] Griffith Univ, Sch Nursing & Midwifery, N48 Hlth Sci Bldg,Level 2-06,170 Kessels Rd, Southport, Qld 4111, Australia
[6] Griffith Univ, Sch Med, Teaching Griffith Hlth Ctr, G40 Gold Coast Campus, Southport, Qld 4222, Australia
[7] Bond Univ, Fac Hlth Sci & Med, 14 Univ Dr, Robina, Qld 4226, Australia
[8] Royal Brisbane & Womens Hosp, Nursing & Midwifery Res Ctr, Level 2 Bldg 34, Herston, Qld 4209, Australia
[9] Griffith Univ, Sch Med, Ctr Appl Hlth Econ, N78 Sir Samuel Griffith Bldg,Level 2-11, Southport, Qld 4111, Australia
[10] Natl Univ Ireland Galway, Sch Nursing & Midwifery, 26 Upper Newcastle, Galway H91 E3YV, Ireland
[11] Metro North Hosp & Hlth Serv, Herston Infect Dis Inst, Herston, Qld 4006, Australia
[12] Univ Queensland, Ctr Clin Res, Sch Nursing Midwifery & Social Work, Herston, Qld 4006, Australia
关键词
Cannula; Emergency department; Idle; Pre-hospital; Vascular access device; CATHETERS; INSERTION; OUTCOMES; RISK;
D O I
10.1186/s13049-021-00941-y
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Unused ('idle') peripheral intravenous catheters (PIVC) are those not used within 24 hours of insertion. There is little data on cannulation practices and idle PIVC rates in emergency settings, especially the pre-hospital environment. Methods This was an observational cohort study set in south-east Queensland, Australia using data from a large tertiary level emergency department (ED) and the local statutory ambulance service. Demographic, clinical and PIVC data were collected over two periods; 9 February-18 March 2017 and 5 January-4 February 2018. Adult patients were included if they were allocated an Australasian triage scale (ATS) category between 2 and 5, and had a PIVC inserted in the pre-hospital setting or ED. PIVC use was defined as idle if no fluids, medications or contrast were administered intravenously within 24 hours of insertion. Comparisons between pre-hospital and ED practice and idle PIVC status were undertaken using descriptive statistics and logistic regression. Results A total of 1249 patients with a PIVC (372 pre-hospital; 877 ED) were included. Overall, 366 PIVCs (29.3%; 95% CI 26.9%-31.9%) remained idle at 24 hours. In the pre-hospital group, 147 (39.5%) PIVCs inserted were not used pre-hospital, and 74 (19.9%) remained idle. In comparison, 292 (33.3%) PIVCs placed in the ED remained idle. ED staff more frequently inserted PIVCs in the antecubital fossa than paramedics (65.5% vs. 49.7%), where forearm PIVC insertion was more common pre-hospital than in ED (13.7% vs. 7.4%). Nursing staff inserted idle PIVCs at a rate of (35.1%) compared to doctors (29.6%) and paramedics (19.9%). Having a PIVC inserted in the ED was the only factor significantly (p <= .001) predicting an idle outcome (Odds Ratio: 2.4; 95% CI 1.7-3.3). Conclusion One-third of PIVCs inserted within the emergency setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent if inserted in the ED than pre-hospital and with greater use of antecubital insertion. Reasons for these differences are not well understood and requires more targeted research.
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页数:13
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