Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success
Insertion of peripheral intravenous cannulae in the Emergency Department: factors associated with first-time insertion success
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DOI：
10.5301/jva.5000487
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发表时间：
2016-03-01
影响因子：
1.9
通讯作者：
Rickard, Claire M.
中科院分区：
文献类型：
--
作者：
Carr, Peter J.;Rippey, James C. R.;Rickard, Claire M.
背景资料：我们试图确定在急诊科（艾德）插入外周静脉插管的原因，以及首次插入成功率，沿着影响这一现象的患者和临床医生因素。方法：对三级ED中需要插入外周静脉插管的患者进行前瞻性队列研究。获得临床和临床医生数据。结果：本研究共纳入734例外周静脉插管（PIVC）插入，分析了460例插入。首次插入成功率为86%。肘前窝（ACF）部位占插入的50%以上。多变量逻辑回归模型预测患者因素的首次插入成功率，发现：年龄< 40岁与80岁以上，消瘦与正常患者体型，具有可见或可触及的静脉，ACF与前臂插入部位具有统计学显著性。预测成功的具有统计学意义的临床医生因素为：既往进行的插管手术次数较多，临床医生对成功插入可能性的感知增加。当患者和临床医生因素在逻辑回归模型中结合时，消瘦与正常、可见静脉、ACF与前臂部位、先前进行的PIVC手术次数较多以及临床医生感知的成功可能性增加与首次插入成功在统计学上相关。如果由具有更丰富手术经验的临床医生进行，对成功可能性的感知。一些患者因素预测插管成功：“正常”体重，可见静脉和肘窝放置;如果静脉内治疗不是必须的，静脉穿刺可能是其他人更便宜的选择。
Background: We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon.Methods: A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained.Results: A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age < 40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success.Conclusions: Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: 'normal' body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.