Intravenous access placement and fluid administration appropriateness in the emergency department

  • Massimo Salvetti Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia; 2a Medicina–ASST Spedali Civili Brescia, Brescia, Italy.
  • Anna Paini 2a Medicina–ASST Spedali Civili Brescia, Brescia, Italy.
  • Efrem Colonetti Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia, Italy.
  • Claudio Mutti Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia, Italy.
  • Silvia Bonetti Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia, Italy.
  • Alberto Broggi Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia, Italy.
  • Fabio Bertacchini 2a Medicina–ASST Spedali Civili Brescia, Brescia, Italy.
  • Maria Lorenza Muiesan | marialorenza.muiesan@unibs.it Department of Clinical & Experimental Sciences and Postgraduate School of Emergency & Urgency Medicine, University of Brescia; 2a Medicina–ASST Spedali Civili Brescia, Brescia, Italy.

Abstract

The aim of this study is to assess practice and effectiveness of Peripheral Venous Catheter (PVC) insertion and intravenous fluid administration in the Emergency Department (ED). A prospective study was conducted at a single primary ED in Brescia, Italy. 455 participants were included in the analysis. PVC were placed in 88 % of patients, 18 gauge catheters were the most frequently used (63%). In 360 patients PVC placement required one attempt. In 99 % of patients PVCs were used at least once. Fluid administration was considered appropriate in 23 patients. Out of 402 PVC placements, 244 were not necessary (in 225 patients PVCs were used only for blood samples withdrawal, and in 16 patients they were used for blood samples withdrawal, and inappropriate fluid administration). We concluded that a large number of PVC placements in the ED was potentially avoidable, and, when PVCs were used for IV fluid administration, the indication was often inappropriate. Physicians should carefully assess the real need of PVC placement in patients admitted to the ED and critically assess some issues of everyday practice, like PVC placement or IV fluids prescription, with evaluation of cost savings.

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References

Dagnino J. Wren, Boyle, and the origins of intravenous injections and the Royal Society of London. Anesthesiology 2009;111:923-4. DOI: https://doi.org/10.1097/ALN.0b013e3181b56163

Ortega R, Sekhar P, Song M, et al. Videos in clinical medicine. Peripheral intravenous cannulation. N Engl J Med 2008;359:e26. DOI: https://doi.org/10.1056/NEJMvcm0706789

Decker K, Ireland S, O'Sullivan L, et al. Peripheral intravenous catheter insertion in the Emergency Department. Australas Emerg Nurs J 2016;19:138-42. DOI: https://doi.org/10.1016/j.aenj.2015.12.003

Limm EI, Fang X, Dendle C, et al. Half of all peripheral intravenous lines in an Australian tertiary emergency department are unused: pain with no gain? Ann Emerg Med 2013;62:521-5. DOI: https://doi.org/10.1016/j.annemergmed.2013.02.022

Henderson RA, Thomson DP, Bahrs BA, Norman MP. Unnecessary intravenous access in the emergency setting. Prehosp Emerg Care 1998;2:312-6. DOI: https://doi.org/10.1080/10903129808958887

Goransson KE, Johansson E. Indication and usage of peripheral venous catheters inserted in adult patients during emergency care. J Vasc Access 2011;12:193-9. DOI: https://doi.org/10.5301/JVA.2010.5967

Padhi S, Bullock I, Li L, et al. Intravenous fluid therapy for adults in hospital: summary of NICE guidance. BMJ 2013;347:f7073 DOI: https://doi.org/10.1136/bmj.f7073

Clinical Excellence Commission - Ministry of health. Peripheral Intravenous Cannula (PIVC) Insertion and Post Insertion Care in Adult Patients. 2013.

Greig JM, Ellis CJ, Smith EG. Septic discitis and other complications of peripheral venous cannulation. QJM 2002;95:412-3. DOI: https://doi.org/10.1093/qjmed/95.6.412

Yildiz A, Ozer C, Egilmez H, et al. Iatrogenic intravascular pneumocephalus secondary to intravenous catheterization. Eur Radiol 2002;12:671-2. DOI: https://doi.org/10.1007/s003300100979

Abolfotouh MA, Salam M, Bani-Mustafa A, et al. Prospective study of incidence and predictors of peripheral intravenous catheter-induced complications. Ther Clin Risk Manag 2014;10:993-1001. DOI: https://doi.org/10.2147/TCRM.S74685

Gupta A, Mehta Y, Juneja R, Trehan N. The effect of cannula material on the incidence of peripheral venous thrombophlebitis. Anaesthesia 2007;62:1139-42. DOI: https://doi.org/10.1111/j.1365-2044.2007.05180.x

Malyon L, Ullman AJ, Phillips N, et al. Peripheral intravenous catheter duration and failure in paediatric acute care: A prospective cohort study. Emerg Med Australas 2014;26:602-8. DOI: https://doi.org/10.1111/1742-6723.12305

Periard D, Monney P, Waeber G. et al. Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. J Thromb Haemost 2008;6:1281-8. DOI: https://doi.org/10.1111/j.1538-7836.2008.03053.x

Tandale SR, Dave N, Garasia M, et al. A Study of Morbidity and Cost of Peripheral Venous Cannulation in Neonates Admitted to Paediatric Surgical Intensive Care Unit. J Clin Diagn Res 2017;11:UC08-10. DOI: https://doi.org/10.7860/JCDR/2017/23600.9570

Tiwari MM, Hermsen ED, Charlton ME, et al. Inappropriate intravascular device use: a prospective study. J Hosp Infect 2011;78:128-32. DOI: https://doi.org/10.1016/j.jhin.2011.03.004

Carr PJ, Rippey JC, Budgeon CA, et al. Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success. J Vasc Access 2016;17:182-90. DOI: https://doi.org/10.5301/jva.5000487

Fry M, Romero B, Berry A. Utility of peripheral intravenous cannulae inserted in one tertiary referral emergency department: A medical record audit. Australas Emerg Nurs J 2016;19:20-5. DOI: https://doi.org/10.1016/j.aenj.2015.10.003

Guihard B, Rouyer F, Serrano D, et al. Appropriateness and Complications of Peripheral Venous Catheters Placed in an Emergency Department. J Emerg Med 2018;54:281-6. DOI: https://doi.org/10.1016/j.jemermed.2017.10.005

Carr PJ, Higgins NS, Cooke ML, et al. Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature. J Hosp Med 2017;12:851-8. DOI: https://doi.org/10.12788/jhm.2836

Carr PJ, Rippey JCR, Cooke ML, et al. Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. A multicentre prospective cohort analysis of patient, clinician and product characteristics. BMJ Open 2019;9:e022278. DOI: https://doi.org/10.1136/bmjopen-2018-022278

Parenti CM, Lederle FA, Impola CL, Peterson LR. Reduction of unnecessary intravenous catheter use. Internal medicine house staff participate in a successful quality improvement project. Arch Intern Med 1994;154:1829-32. DOI: https://doi.org/10.1001/archinte.1994.00420160062008

Powell AG, Paterson-Brown S. Safety through education. FY1 doctors still poor in prescribing intravenous fluids. BMJ 2011;342:d2741. DOI: https://doi.org/10.1136/bmj.d2741

Lobo DN, Dube MG, Neal KR, et al. Problems with solutions: drowning in the brine of an inadequate knowledge base. Clin Nutr 2001;20:125-30. DOI: https://doi.org/10.1054/clnu.2000.0154

Lobo DN, Dube MG, Neal KR, et al. Peri-operative fluid and electrolyte management: a survey of consultant surgeons in the UK. Ann R Coll Surg Engl 2002;84:156-60.

Gledstone-Brown L, McHugh D. Review article: Idle 'just-in-case' peripheral intravenous cannulas in the emergency department: Is something wrong? Emerg Med Australas 2018;30:309-26. DOI: https://doi.org/10.1111/1742-6723.12877

Cooke M, Ullman AJ, Ray-Barruel G, et al. Not "just" an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS One 2018;13:e0193436. DOI: https://doi.org/10.1371/journal.pone.0193436

Hawkins T, Greenslade JH, Suna J, et al. Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study. Acad Emerg Med 2018;25:26-32. DOI: https://doi.org/10.1111/acem.13335

Bregenzer T, Conen D, Sakmann P, Widmer AF. Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med 1998;158:151-6. DOI: https://doi.org/10.1001/archinte.158.2.151

Published
2021-03-18
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Original Articles
Keywords:
Peripheral venous catheter, emergency department, fluid administration
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How to Cite
Salvetti, M., Paini, A., Colonetti, E., Mutti, C., Bonetti, S., Broggi, A., Bertacchini, F., & Muiesan, M. L. (2021). Intravenous access placement and fluid administration appropriateness in the emergency department. Emergency Care Journal, 17(1). https://doi.org/10.4081/ecj.2021.9150