title: Peripheral intravenous catheter insertion in the Emergency Department.
abstract: BACKGROUND
  Growing research suggests that a large number of peripheral intravenous catheters (PIVCs) inserted in the Emergency Department (ED) are unused. The aim of this study was to assess the proportion of unused ED inserted PIVCs in a before-and-after interventional study. Additional aims were to ascertain indications for PIVC insertion in the ED and to increase the appropriateness of PIVC insertion.
  
  
  METHODS
  A prospective interventional study was conducted. Data were collected on 150 cases in the pre- and a further 150 cases in the post-intervention phase. During the intervention phase strategies were implemented to increase appropriate PIVC insertion in the ED. Interventions included introduction of insertion and removal stickers, new venepuncture devices, changing the intravenous (IV) trolley layout, and an educational campaign.
  
  
  RESULTS
  Results from this study demonstrate that the number of PIVCs used (50 vs. 28) remained unchanged, however the number of PIVC insertions initiated by nursing staff reduced significantly (p=0.049). With regard to the indication for PIVC insertion, the implementation of the interventions was associated with significantly fewer PIVCs being inserted for routine blood collection (p=0.006) and for PIVCs inserted for a potential need of medication and intravenous fluid administration (p=0.03). There was a significant reduction in the number of PIVCs inserted following the intervention (74 vs. 50: p=0.005).
  
  
  CONCLUSIONS
  This study demonstrated a high proportion of unused PIVCs in the ED. A composite intervention strategy was developed and significantly reduced the "just-in-case" PIVCs inserted.
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Monash University, School of Nursing and Midwifery, Peninsula Campus, McMahons Road, Frankston, Victoria 3199, Australia. Electronic address: k.decker@alfred.org.au.
authors.forename: Kelly
authors.initials: K
authors.lastname: Decker
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia; La Trobe University, School of Nursing and Midwifery, Plenty Road and Kingsbury Drive, Melbourne, Victoria 3086, Australia.
authors.forename: Sharyn
authors.initials: S
authors.lastname: Ireland
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
authors.forename: Lorna
authors.initials: L
authors.lastname: O'Sullivan
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
authors.forename: Sue
authors.initials: S
authors.lastname: Boucher
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia; La Trobe University, School of Nursing and Midwifery, Plenty Road and Kingsbury Drive, Melbourne, Victoria 3086, Australia.
authors.forename: Lauren
authors.initials: L
authors.lastname: Kite
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia.
authors.forename: Deb
authors.initials: D
authors.lastname: Rhodes
authors.affiliation: Emergency & Trauma Centre, Alfred Health, 55 Commercial Road, Melbourne, Victoria 3004, Australia; Monash University, Department of Epidemiology & Preventive Medicine, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
authors.forename: Biswadev
authors.initials: B
authors.lastname: Mitra
mesh_terms: D000328:Adult; D001315:Australia; D002406:Catheterization, Peripheral / Q000379:methods* / Q000706:statistics & numerical data; D065187:Controlled Before-After Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D004638:Emergency Treatment / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
keywords: Catheterization, peripheral; Emergency Service, hospital; Emergency treatment