title: Incidence of advanced intravenous access in 2 urban EDs.
abstract: BACKGROUND
  In an emergency department (ED), intravenous (IV) access is frequently accomplished by inspection and palpation of peripheral veins. Failure of these methods indicates severe IV access difficulty and necessitates advanced techniques. Here, we estimate the incidence of advanced IV access in 2 urban EDs with varying resident coverage.
  
  
  METHODS
  In this multiple-cohort study, we enrolled data from 2 neighboring urban EDs-a tertiary care ED and a community hospital affiliate. The 2 have similar volumes but the tertiary care ED has more resident coverage (112 vs 20 hours/d). In a prospective data collection (April 2012-2013), we enrolled consecutive patients during hours of scheduled shifts for research assistants. In a retrospective data collection (March 2011-2012), we reviewed charts of a random sample of patients from each ED for similar outcomes. We calculated the incidence of advanced IV access by dividing the number requiring advanced techniques by the number requiring IV access.
  
  
  RESULTS
  We determined IV outcomes for 790 patients in the prospective cohort and 669 patients in the retrospective cohort. Between groups, there was no difference in the incidence of advanced IV access in the prospective collection (P = .08) or in the retrospective collection (P = .7). Pooling data from both cohorts and both hospitals, the overall incidence was 3.2 [95% confidence interval, 1.9-5.2] per 100 attempts.
  
  
  CONCLUSIONS
  Advanced IV access is needed in 3.2% of IV attempts in 2 urban EDs with varying levels of resident coverage. We found similar incidence in both EDs.
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD. Electronic address: witting@umem.org.
authors.forename: M D
authors.initials: MD
authors.lastname: Witting
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: S
authors.initials: S
authors.lastname: Moayedi
authors.affiliation: Carolinas Medical Center Department of Emergency Medicine, Charlotte, NC.
authors.forename: S K
authors.initials: SK
authors.lastname: Beverly
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: B J
authors.initials: BJ
authors.lastname: Stover
authors.affiliation: Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD.
authors.forename: A C
authors.initials: AC
authors.lastname: Miller
mesh_terms: D061605:Administration, Intravenous / Q000379:methods* / Q000706:statistics & numerical data; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D014218:Triage / Q000706:statistics & numerical data