Prospective evaluation of peripheral venous access difficulty in emergency care.
OBJECTIVE
Although frequently used and crucial in emergency care, peripheral intravenous access has been poorly documented. We examined whether criteria related to patient characteristics, underlying disease, devices, or environment were associated with difficult peripheral intravenous access.


METHODS
Prehospital prospective observational study.


METHODS
For each peripheral intravenous access attempt a questionnaire was filled in until final success or procedure abandonment. This questionnaire included data on the patient, operator, disease, degree of emergency, cannulation, nature of fluid infused and the use of gloves, environment, and particular medical observations such as recent peripheral intravenous access and chemotherapy. Criteria associated with peripheral intravenous access difficulty were identified comparing successful and unsuccessful attempts. A total of 671 attempts at peripheral intravenous access in 495 patients were studied.


RESULTS
The first attempt was successful in 368 cases (74%) and unsuccessful in 127 (26%). Final success was reported in all cases, including the use of central venous access in three cases. No abandonment was reported. Significantly correlated with a successful attempt were: the caliber of the catheter (OR 0.793), cannulation performed by a nurse specialized in emergency care (OR 3.959), lack of particular observations (OR 0.120), and a clean patient (OR 0.505).


CONCLUSIONS
Peripheral intravenous access was achieved in 99% of the patients in out-of-hospital settings. Improved success rate was reported when attempts were performed by a nurse specialized in emergency care using a 16- or 18-G catheter in clean patients without a particular medical history.
Lapostolle
Frédéric
F
SAMU 93, EA 3409, Hôpital Avicenne APHP, 125 rue de Stalingrad, 93009 Bobigny, France. frederic.lapostolle@avc.ap-hop-paris.fr
Catineau
Jean
J
Garrigue
Bruno
B
Monmarteau
Vincent
V
Houssaye
Thierry
T
Vecci
Isabelle
I
Tréoux
Virginie
V
Hospital
Baptistine
B
Crocheton
Nicolas
N
Adnet
Frédéric
F
D000328:Adult; D000368:Aged; D002406:Catheterization, Peripheral / Q000451:nursing* / Q000592:standards; D016529:Emergency Nursing; D005260:Female; D005602:France; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D013647:Task Performance and Analysis