title: Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success.
abstract: BACKGROUND
  We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon.
  
  
  METHODS
  A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained.
  
  
  RESULTS
  A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age &lt;40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success.
  
  
  CONCLUSIONS
  Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: 'normal' body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.
authors.affiliation: Emergency Medicine, The University of Western Australia, Perth, Western Australia - Australia.|National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland - Australia.|Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carr
authors.affiliation: Emergency Medicine, The University of Western Australia, Perth, Western Australia - Australia.|Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.|Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia.
authors.forename: James C R
authors.initials: JC
authors.lastname: Rippey
authors.affiliation: Centre for Applied Statistics, The University of Western Australia, Perth, Western Australia - Australia.|Department of Research, Sir Charles Gairdner Hospital, Perth, Western Australia - Australia.
authors.forename: Charley A
authors.initials: CA
authors.lastname: Budgeon
authors.affiliation: National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland - Australia.|Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.
authors.forename: Marie L
authors.initials: ML
authors.lastname: Cooke
authors.affiliation: Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.|Royal Brisbane & Women's Hospital, Brisbane, Queensland - Australia.
authors.forename: Niall
authors.initials: N
authors.lastname: Higgins
authors.affiliation: National Health and Medical Research Council, Centre of Research Excellence in Nursing, and Centre for Health Practice Innovation, Griffith University, Brisbane, Queensland - Australia.|Alliance for Vascular Access Teaching & Research Group, Griffith University, Brisbane, & Menzies Health Institute, Queensland - Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002406:Catheterization, Peripheral / Q000009:adverse effects / Q000295:instrumentation*; D002408:Catheters, Indwelling; D062905:Central Venous Catheters; D004636:Emergency Service, Hospital; D004867:Equipment Design; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure