Clinician decision making in peripheral intravenous cannulation in emergency settings

Grant ID: EMJS-326R31-2019-EVISON

Project Summary

Peripheral intravenous cannulation (PIVC) is a vital part of modern medicine, however the use of cannulas has become prolific, with many never used. The patient risks that are associated with PIVC are well documented, including pain and infections, which can be severe and lead to death.

Reducing the rate of idle PIVCs (inserted but never used) may reduce the overall rate of risks, side-effects and infections associated with PIVC, but may also lead to patients who require PIVC not receiving one.

This study aims to describe: I) the proportion of PIVCs placed that do not get used within 24 hours (idle PIVCs), II) differences between the pre-hospital setting and the emergency department and III) the factors associated with clinicians’ decision making regarding PIVC insertion.

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Outcomes

The research found one-third of PIVCs inserted within the emergency department (ED) setting remained idle, suggesting unnecessary risk and costs. Pre-hospital and ED PIVC insertion practices differed, with idle PIVCs 2.4 times more prevalent in the ED than pre-hospital and with greater use of ante-cubital insertion.

The clinical decision making around PIVC insertion across all disciplines was found to be complex, with four key themes of: (i) knowledge and experience, (ii) complicated and multifactorial, (iii) convenience, (iv) anticipated patient clinical course, as well as sub-themes identified.

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Dissemination

Publications:

- Evison, H., Carrington, M., Keijzers, G., Marsh, N.M., Sweeny, A.L., Byrnes, J., Rickard, C.M., Carr, P.J. and Ranse, J., 2022. Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study. BMJ open, 12(3), p.e054927.

- Evison, H., Sweeny, A., Ranse, J., Carrington, M., Marsh, N., Byrnes, J., Rickard, C.M., Carr, P.J. and Keijzers, G., 2021. Idle peripheral intravenous cannulation: an observational cohort study of pre-hospital and emergency department practices. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 29(1), pp.1-13.

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