title: Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: the Vascular Access Decisions in the Emergency Room (VADER) study protocol.
abstract: BACKGROUND
  Peripheral intravenous cannula (PIVC) insertion is one of the most common clinical interventions performed in emergency care worldwide. However, factors associated with successful PIVC placement and maintenance are not well understood. This study seeks to determine the predictors of first time PIVC insertion success in emergency department (ED) and identify the rationale for removal of the ED inserted PIVC in patients admitted to the hospital ward. Reducing failed insertion attempts and improving peripheral intravenous cannulation practice could lead to better staff and patient experiences, as well as improving hospital efficiency.
  
  
  METHODS
  We propose an observational cohort study of PIVC insertions in a patient population presenting to ED, with follow-up observation of the PIVC in subsequent admissions to the hospital ward. We will collect specific PIVC observational data such as; clinician factors, patient factors, device information and clinical practice variables. Trained researchers will gather ED PIVC insertion data to identify predictors of insertion success. In those admitted from the ED, we will determine the dwell time of the ED-inserted PIVC. Multivariate regression analyses will be used to identify factors associated with insertions success and PIVC failure and standard statistical validation techniques will be used to create and assess the effectiveness of a clinical predication rule.
  
  
  BACKGROUND
  The findings of our study will provide new evidence to improve insertion success rates in the ED setting and identify strategies to reduce premature device failure for patients admitted to hospital wards. Results will unravel a complexity of factors that contribute to unsuccessful PIVC attempts such as patient and clinician factors along with the products, technologies and infusates used.
  
  
  BACKGROUND
  ACTRN12615000588594; Pre-results.
authors: Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors: Peter J
authors: PJ
authors: Carr
authors: Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, Perth, Western Australia, Australia.
authors: James C R
authors: JC
authors: Rippey
authors: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors: Marie L
authors: ML
authors: Cooke
authors: Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia.
authors: Chrianna
authors: C
authors: Bharat
authors: Centre for Applied Statistics, University of Western Australia, Perth, Western Australia, Australia.
authors: Kevin
authors: K
authors: Murray
authors: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors: Niall S
authors: NS
authors: Higgins
authors: Medical Student, The University of Western Australia, Perth, Western Australia, Australia.
authors: Aileen
authors: A
authors: Foale
authors: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
authors: Claire M
authors: CM
authors: Rickard
mesh_terms: D002406:Catheterization, Peripheral; D015331:Cohort Studies; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D006801:Humans; D011446:Prospective Studies; D012307:Risk Factors; D017211:Treatment Failure
keywords: ACCIDENT & EMERGENCY MEDICINE; VASCULAR MEDICINE