title: Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician 'gestalt' wins again.
abstract: OBJECTIVE
  Failed attempts at peripheral i.v. cannula (PIVC) insertion in the ED are common. The psychological, physical and economic impact of these failures is significant. We sought to explore whether clinicians of differing experience levels can predict their own likelihood (clinician 'gestalt') of first-time cannula insertion success on any given patient.
  
  
  METHODS
  Data analyses from a prospective self-reported study assessing risk factors for first-time insertion success in a tertiary adult ED. We constructed and compared two simple theoretical clinical decision algorithms in an attempt to improve first-time PIVC insertion success rates.
  
  
  RESULTS
  This best algorithm identified a subgroup of 18% of the total PIVC population at higher risk of failure. This 18% comprised 57% of all PIVC failures, and implementation would result in a relative risk reduction of PIVC failure by 31%.
  
  
  CONCLUSIONS
  When applied to our sample population, an algorithm relying on clinician gestalt to identify patients at high risk of PIVC failure had the greatest potential impact. These patients would be referred to expert PIVC inserters prior to, rather than after, failed attempts.
authors.affiliation: Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Services, The University of Western Australia, Perth, Western Australia, Australia.|Emergency Department, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.|Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: James Cr
authors.initials: JC
authors.lastname: Rippey
authors.affiliation: Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Services, The University of Western Australia, Perth, Western Australia, Australia.|Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre for Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Carr
authors.affiliation: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre for Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Cooke
authors.affiliation: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre for Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Niall
authors.initials: N
authors.lastname: Higgins
authors.affiliation: Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.|NHMRC Centre for Excellence in Nursing, Centre for Health Practice Innovation, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.
authors.forename: Claire M
authors.initials: CM
authors.lastname: Rickard
mesh_terms: D000328:Adult; D000368:Aged; D000465:Algorithms; D000072601:Cannula; D002406:Catheterization, Peripheral; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital; D005260:Female; D005863:Gestalt Theory; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014904:Western Australia
keywords: catheter; failure; insertion; intravenous; prevention