PREDICTORS AND DELAYS ASSOCIATED WITH THE NEED FOR ADVANCED TECHNIQUES FOR INTRAVENOUS ACCESS
PREDICTORS AND DELAYS ASSOCIATED WITH THE NEED FOR ADVANCED TECHNIQUES FOR INTRAVENOUS ACCESS
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DOI：
10.1016/j.jemermed.2017.04.002
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发表时间：
2017-08-01
影响因子：
1.5
通讯作者：
Ismail, Ammar
中科院分区：
文献类型：
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作者：
Witting, Michael D.;Moayedi, Siamak;Ismail, Ammar
背景：对先进静脉通路 (ATIVA) 技术的需求可能会导致护理延误并导致急诊室 (ED) 拥挤。目标：在本文中，我们估计了与 ATIVA 需求相关的延迟和预测因素。方法：在这项病例对照研究中，我们收集了需要 ATIVA 的 ED 病例和接受静脉注射的对照患者的数据。通过传统的检查和触诊获得通路。我们纳入了两个对照组——随机回顾性样本和前瞻性有限便利样本。我们收集了所有组的时间和敏锐度数据以及来自病例和前瞻性对照的预测变量数据。我们使用四分位数回归分析时间数据，并使用列联表分析和逻辑回归分析预测变量数据。结果：我们收集了 116 个病例（其中 91 个有时间间隔数据）、98 个回顾性对照和 144 个前瞻性对照的数据。从分诊到静脉注射的中位时间病例组的线路建立时间为 199 分钟，而前瞻性对照组为 64 分钟，回顾性对照组为 81 分钟。 ATIVA 的需求与 1.1 大四分位数时间间隔相关（95% 置信区间 [CI] 0.8-1.3）。两个变量-i.v.药物使用（IVDU；比值比 3.7；95% CI 1.8-7.3）和既往需要 ATIVA（比值比 5.2；95% CI 2.7-9.8）-与对 ATIVA 的需求相关；肥胖、肾功能衰竭和糖尿病则不然。结论：ATIVA 的需求增加了静脉注射的中位时间。与传统的检查和触诊相比，置线时间缩短 118 至 135 分钟。 IVDU 和对先进技术的优先需求与 ATIVA 的需求相关。 (C) 2017 Elsevier Inc. 保留所有权利。
Background: The need for advanced techniques for intravenous access (ATIVA) can lead to delays in care and contribute to emergency department (ED) crowding. Objective: In this article, we estimate the delay and predictors associated with the need for ATIVA. Methods: In this case-control study, we collected data from ED cases requiring ATIVA and control patients in whom i.v. access was gained by traditional inspection and palpation. We included two control groups-a random retrospective sample and a prospective limited convenience sample. We collected time and acuity data from all groups and data on predictor variables from cases and prospective controls. We analyzed time data using quartile regression and predictor variable data using contingency table analysis and logistic regression. Results: We collected data from 116 cases (91 of which had time interval data), 98 retrospective controls, and 144 prospective controls. The median time from triage to i.v. line establishment was 199 min for cases vs. 64 min for prospective controls and 81 min for retrospective controls. The need for ATIVAwas associated with a 1.1-greater quartile time interval (95% confidence interval [CI] 0.8-1.3). Two variables-i.v. drug use (IVDU; odds ratio 3.7; 95% CI 1.8-7.3) and prior need for ATIVA (odds ratio 5.2; 95% CI 2.7-9.8)-were associated with a need for ATIVA; obesity, renal failure, and diabetes were not. Conclusions: The need for ATIVA increases median time to i.v. line placement by 118 to 135 min compared with traditional inspection and palpation. IVDU and prior need for an advanced technique are associated with a need for ATIVA. (C) 2017 Elsevier Inc. All rights reserved.