title: Out-of-hospital intravenous cannulation: the perspective of patients treated by London Ambulance Service paramedics.
abstract: OBJECTIVE
  Previous research has highlighted concern about infection rates in field-placed intravenous (IV) cannulae. In a study of IV placement by London Ambulance Service (LAS) paramedics, 17% of placements were judged to be inappropriate. Large variations in rates of IV placement between LAS paramedics were found. The authors' hypothesis was that placement of an IV carries disadvantages-pain, discomfort, distress, and infection-which may be unacceptable to patients.
  
  
  METHODS
  This was a survey of all patients having an IV placed by LAS paramedics and transported to one of three London emergency departments (EDs) over a three-week period in December 1996. Patients were excluded if they had a self-inflicted injury/illness, were less than 14 years old, had no known address, or were visitors to the UK, or if their family doctor suggested it was not appropriate to contact the patient. Pain, discomfort, and distress; infection; satisfaction; understanding of the reason for cannulation; and out-of-hospital cannula use were all ascertained and analyzed with chi-square analysis.
  
  
  RESULTS
  Thirty-nine percent of the respondents experienced some discomfort, 39% some pain, and 17% some distress. No patient reported an infection. Distress was more likely to be reported if there was no understanding of why the IV cannula was placed (chi2 [1] 6.1; p < 0.05). Further unstructured information revealed satisfaction with the IV cannulation and with general care.
  
  
  CONCLUSIONS
  Despite the disadvantages of IV placement being reported by some respondents, overall levels of satisfaction were high, suggesting that these disadvantages were not unacceptable to patients. However, in the context of the 24,000 patients cannulated each year by LAS paramedics, "costs" to the patient are considerable.
authors.affiliation: Clinical Audit and Research Unit, London Ambulance Service NHS Trust, UK. mary.halter@lond-amb.sthames.nhs.uk
authors.forename: M
authors.initials: M
authors.lastname: Halter
authors.forename: S
authors.initials: S
authors.lastname: Lees-Mlanga
authors.forename: H
authors.initials: H
authors.lastname: Snooks
authors.forename: K L
authors.initials: KL
authors.lastname: Koenig
authors.forename: K
authors.initials: K
authors.lastname: Miller
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000488:Allied Health Personnel; D000552:Ambulances; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000191:economics; D016009:Chi-Square Distribution; D004180:Direct Service Costs; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008131:London; D008297:Male; D008875:Middle Aged; D010146:Pain; D017060:Patient Satisfaction; D012189:Retrospective Studies; D011795:Surveys and Questionnaires