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Aims and Objectives: To explore whether the risk of peripheral venous catheters failure remained constant throughout catheter use in adult patients., Background: Peripheral venous catheters, widely used in adult patients, may have a critical threshold dwell time associated with increased risk of catheter failure., Design: Prospective, observational study. We have complied with the STROBE checklist of items., Methods: This study was conducted from July-October 2018 in Hunan, China. Data on patient factors, catheter factors and catheter failure events were collected. Poisson regression was used to assess the effect of catheter dwell time on catheter failure while adjusting for other variables., Results: A total of 1,477 patients were included in the analysis. There were 854 cases (57.8%) of catheter failure. The median dwell time to catheter failure was 52 hr (interquartile range: 36-73 hr). The incidence rate of catheter failure significantly increased by 1.1%/h in the first 38 hr after catheter insertion. From 39-149 hr, the incidence rate significantly decreased, and at >149 hr, there was no significant change in the incidence rate. Meanwhile, factors such as vascular quality and infused drugs showed having an impact on catheter failure events., Conclusions: The risk of catheter failure may not remain constant throughout the dwell time. The results suggest that nurses should assess the insertion site frequently in the first 38 hr., Relevance to Clinical Practice: The significant increase in the risk of catheter failure per hour may warrant close and frequent inspection of insertion site during the first 38 hr., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To summarise the evidence about patient-related risk factors for difficult intravenous access in adults, and at identifying nurses' beliefs and their consistency with evidence., Background: Peripheral intravenous cannulation is a common procedure for nurses, but rates of failure at first attempt of peripheral intravenous cannulation range 10%-40%. Nurses' beliefs about difficult intravenous access factors might influence their clinical practice more than current evidence., Design: The study included a literature review of the evidence on patient-related risk factors for difficult intravenous access, the development of an instrument to investigate nurses' beliefs about this topic and a cross-sectional multicentre survey on clinical nurses., Methods: The quality of the studies included was evaluated through the Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies. A synthesis of evidence for each risk factor was produced. A survey instrument was developed including 26 risk factors, which were then rated by nurses as perceived predictors of difficult intravenous access. The STROBE guidelines for study reporting were followed., Results: Four hundred and fifty clinical nurses working in four hospitals in Italy were surveyed. Nurses' beliefs were in line with evidence in considering body mass index, drug abuse, lymphadenectomy and chemotherapy as difficult intravenous access factors. Beliefs about difficult intravenous access factors were influenced by nurses' work experience and frequency of peripheral intravenous cannulation. Nurses also identified as risk factors for difficult intravenous access oedema, thrombophlebitis, hypovolaemia, skin lesions and irritant therapies, which have been minimally investigated by research., Conclusions: An overall congruence between nurses' beliefs and evidence about risk factors for difficult intravenous access was found. With their expertise, nurses may fill the knowledge gap of clinical evidence and open new paths for clinically meaningful research., Relevance to Clinical Practice: Nurses' beliefs about difficult intravenous access factors can be influenced by their work experience and clinical setting. Integrating nurses' beliefs with scientific evidence can increase the quality of care., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To determine the factors affecting the first-attempt success of peripheral intravenous catheter (PIVC) placement in older emergency department patients., Background: In older patients who require intravenous treatment, establishing a PIVC as fast as possible is clinically important., Design: This is a prospective, observational, descriptive study., Methods: Using a data collection form, researchers questioned both the patient and the nurse performing the procedure in terms of patient- and operator-related factors. This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines (See Supporting Information Appendix S1)., Results: A total of 472 patients were included in the final analyses. According to the logistic regression analysis, independent factors which affected first-attempt failure were found to be: choosing a nonupper extremity site for PIVC (OR: 4.72, 95% CI: 1.35-16.45, p-value: 0.015), history of difficult intravenous access (OR: 3.02, 95% CI: 1.72-5.29, p-value: <0.001), nurse having less than 2 years of professional experience (OR: 3.45, 95% CI: 2.00-5.97, p-value: <0.001), nonpalpable veins observed after the application of tourniquet (OR: 2.21, 95% CI: 1.10-4.41, p-value: 0.025), a moderate degree of difficulty anticipated by the nurse prior to the procedure (OR: 4.32, 95% CI: 2.31-8.08, p-value: <0.001) and a high degree of difficulty anticipated by the nurse prior to the procedure (OR: 8.41, 95% CI: 4.10-17.24, p-value: <0.001)., Conclusion: Factors affecting first-attempt success rates in peripheral intravenous catheter placement in older emergency department patients may be listed as follows: the anticipated difficulty of the procedure rated by the nurse, previous history of a difficult intravenous cannulation, choosing a nonupper extremity site for cannulation, the level of experience of the nurse and the palpability of the vein., Relevance to Clinical Practice: Healthcare providers should consider alternative methods in the presence of factors affecting first-attempt success in older emergency department patients., (© 2019 John Wiley & Sons Ltd.)

Aims and Objectives: To describe and synthesise current knowledge on the maintenance and preservation of vessels in patients who need the placement of a vascular access device., Introduction: To administer drugs, blood or intravenous fluids, nurses or doctors insert a peripheral vascular access device on the arm using the traditional approach. This approach implies that devices are blindly inserted until flow is satisfactory and all possible sites have been exhausted. A proactive approach would ensure at the outset that the best device is used for each patient, eliminating repeated attempts at cannulation., Design: An integrative review was conducted using data recorded until July 2017. Searches were conducted in PubMed, Cochrane Library, CINAHL and Scopus., Review Method: A modified version of Cooper's five-stage method and the PRISMA guidelines were used to perform the integrative review., Results: Nine papers were included in this review. The patients were active participants in a proactive approach to vessel health and preservation. The involvement of each healthcare professional in vessel health and preservation improves outcomes and expands the use of a proactive approach to vascular device management. Because nurses are directly involved in the use of such devices and support patients during the decision-making process, they should take the lead in the use of the proactive approach., Conclusion: Despite the many documented advantages of the proactive approach to preserving vessels in many settings and healthcare systems, it has not been widely tested. Future research is needed to guarantee high-quality vessel health and preservation care, thus contributing to the development and dissemination of the proactive approach., Relevance to Clinical Practice: The proactive approach preserves vessels for future needs, improves the delivery of the treatment plan and reduces length of stay, costs, risk of infection, complications and pain perceived by patients. This approach also ensures better use of nurses' time and vascular access device material., (© 2018 John Wiley & Sons Ltd.)

Objectives: To describe the characteristics, problems and interventions associated with performing peripheral intravenous catheterisation in difficult situations when registered nurses need support from critical care nurses., Background: Only a few studies have focused on peripheral intravenous catheterisation problems or interventions to promote success. There is limited research on the education, knowledge, confidence and skills of registered nurses associated with successful peripheral intravenous catheterisations., Design: A descriptive cross-sectional survey design was used., Results: A total of 101 questionnaires were completed by critical care nurses (n = 32) and 92 by registered nurses (n = 83); the total number of participants was 115. The same critical care nurses and registered nurses could participate several times on different occasions. Statistical analyses were performed using descriptive statistics. The patterns differed in part between the registered nurses who needed support and the critical care nurses who provided the support. Both registered nurses and critical care nurses used ultrasound to a very low extent (2.2% vs. 1.0%). The registered nurses indicated to a significantly higher extent (p = 0.02) that the veins were invisible and that they had performed the optional interventions. The success rate for critical care nurses was considerably high (86.1%). The most common place for successful insertion was the wrist. Critical care nurses performed fewer interventions, and they informed the patients and assessed that the veins were fragile to a higher extent., Conclusions: Superior nursing skills are required in order to adapt and assess specific situations related to peripheral intravenous catheterisation difficulties and to choose the adequate interventions. Young and newly graduated registered nurses should be offered individualised training during the post-educational period on how to assess problems and perform peripheral intravenous catheterisations in specific difficult situations., Relevance to Clinical Practice: Simulation is suggested for practical training in order to increase patient safety related to the performance of technical skills such as peripheral intravenous catheterisation., (© 2018 John Wiley & Sons Ltd.)

Aims and Objectives: To determine the prevalence and pattern of use of peripheral intravenous cannulae in hospital wards., Background: Peripheral intravenous cannulae are commonly used in acute health care to directly access the bloodstream for the administration of medications, intravenous fluids and blood products. Peripheral intravenous cannulae are associated with multiple adverse events including hospital-acquired bloodstream infection, thrombophlebitis and pain/discomfort. Administration of intravenous fluids is associated with impaired mobility and nocturia which may increase falls risk in the older people., Design: Observational, point prevalence study., Methods: Three private hospitals comprising a total of 1,230 beds participated in the study. Nurses recorded the presence of a peripheral intravenous cannulae, duration of insertion, state of the dressing and whether the peripheral intravenous cannulae was accessed in the previous 24 hr and for what purpose. Nurses were also asked whether they would replace the peripheral intravenous cannulae should it fail., Results: Approximately one-quarter of patients had a peripheral intravenous cannulae, the majority of which had been present for <24 hr. The major use of the peripheral intravenous cannulae was antibiotic administration. Administration of intravenous fluids occurred in the presence of normal oral fluid intake. Nurses would not replace one-third of peripheral intravenous cannulae in the event of failure. A majority of patients were at increased falls risk, and one-third of these were receiving intravenous fluids., Conclusions: There is room for improvement in the utilisation of peripheral intravenous cannulae, particularly in removal and associated use of intravenous fluids. Alternative strategies for medication administration and timely switch to the oral route may reduce the risks associated with intravenous fluids., Relevance to Clinical Practice: Vigilance is required in the use of peripheral intravenous cannulae. Consider transition of medication administration to oral intake where possible to minimise risks associated with the use of invasive devices and increased fluid intake., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: To estimate the prevalence of difficult venous access in complex patients with multimorbidity and to identify associated risk factors., Background: In highly complex patients, factors like ageing, the need for frequent use of irritant medication and multiple venous catheterisations to complete treatment could contribute to exhaustion of venous access., Design: A cross-sectional study was conducted., Methods: 'Highly complex' patients (n = 135) were recruited from March 2013-November 2013. The main study variable was the prevalence of difficult venous access, assessed using one of the following criteria: (1) a history of difficulties obtaining venous access based on more than two attempts to insert an intravenous line and (2) no visible or palpable veins. Other factors potentially associated with the risk of difficult access were also measured (age, gender and chronic illnesses). Univariate analysis was performed for each potential risk factor. Factors with p < 0·2 were then included in multivariable logistic regression analysis. Odds ratios were also calculated., Results: The prevalence of difficult venous access was 59·3%. The univariate logistic regression analysis indicated that gender, a history of vascular access complications and osteoarticular disease were significantly associated with difficult venous access. The multivariable logistic regression showed that only gender was an independent risk factor and the odds ratios was 2·85., Conclusions: The prevalence of difficult venous access is high in this population. Gender (female) is the only independent risk factor associated with this. Previous history of several attempts at catheter insertion is an important criterion in the assessment of difficult venous access., Relevance to Clinical Practice: The prevalence of difficult venous access in complex patients is 59·3%. Significant risk factors include being female and a history of complications related to vascular access., (© 2017 John Wiley & Sons Ltd.)

Aims and Objectives: This study aimed to identify risk factors for difficult intravenous cannulation in relation to characteristics of patients, healthcare providers and devices in adult patients accessing a radiology service., Background: Early recognition of patients at risk for difficult peripheral intravenous catheterisation is important to adopt strategies able to increase the likelihood of success in intravenous cannulation, as well as to critically evaluate the use of alternative administration routes or venous devices., Design: A prospective observational study was conducted in the radiology service of an Italian university hospital from January to August 2013., Methods: Thirteen nurses observed 763 patients during intravenous insertion (53% were female, the mean age was 63 years and 65% had a diagnosis of cancer). For each patient, nurses collected data about potential predictors of difficult intravenous cannulation, which was defined as a procedure lasting more than one minute. Data included characteristics of patient, cannula required, venepuncture performed and operator(s) involved. Logistic regression was performed as univariate and multivariate analysis., Results: The intravenous insertion time ranged from 45 seconds to 125 minutes. Overall, variables identified as significant independent predictors were chemotherapy received via peripheral cannula (OR = 1·42), veins with many valves (OR = 3·67), fragility (OR = 3·29), visibility (OR = 0·87) and palpability (OR = 0·79) as perceived by nurses., Conclusions: Although many risk factors were identified, the overall success rate was very high, suggesting that nurses' attention during cannulation protected at-risk patients from multiple attempts. Multicentre studies should further investigate risk factors across different radiology services and clinical settings., Relevance to Clinical Practice: These results can help nurses to recognise risk factors for difficult intravenous access and pay appropriate attention when attempting a venepuncture to preserve patients' peripheral veins., (© 2016 John Wiley & Sons Ltd.)

Aims and Objectives: To evaluate nurses' knowledge of guidelines for preventing infections associated with peripheral venous catheters., Background: Guidelines for the prevention of intravascular catheter-related infections are an important tool to help healthcare professionals minimise the risk of infection. However, they are not always applied by nurses. The literature on this topic is limited, and no study examined this matter for peripheral venous catheters., Design: This cross-sectional study was carried out from November 2011-June 2012., Methods: The nurses' knowledge of peripheral venous catheter guidelines and its association with gender, experience, education and the ward membership was assessed using a validated questionnaire., Results: Sixteen hospitals from six regions of Italy participated, and 933 questionnaires were collected. Most participants were female (70·1%), undergraduate (51·8%), worked in medical (35·8%) and surgical departments (28·0%), and had >10 years of experience (55·0%). The median score on 10 questions was 6 of 10. A majority of nurses knew it is recommended to replace peripheral venous catheters routinely (90·0%), to perform an aseptic technique during connecting/disconnecting the infusive lines (55·2%), and to replace the administration set <24 hour when lipid emulsions have been infused (88·4%). Of note, 52·6% of nurses advocated the use of steel needles, a potentially dangerous practice. In multivariate analysis, a higher level of education and the area of work were associated with better test scores., Conclusion: The sample of nurses' knowledge to some recommendations is frequently low. This could be a potential risk factor for patient safety. The results should sensitise healthcare managers to improve nursing training and education, according to clinical risk management perspectives., Relevance to Clinical Practice: These data request for more emphasis on international guidelines in infection prevention initiatives., (© 2013 John Wiley & Sons Ltd.)

Aim: To study nurses' compliance to national guidelines (Sweden) for peripheral venous catheters and to establish the complication frequency connected to time in situ and bore size., Background: Worldwide, there are no standard peripheral venous catheters guidelines, and the need for elective replacement has been challenged. Furthermore, the time interval and need for elective change of peripheral venous catheters has cost implications for hospitals., Design: Prospective register study., Methods: The health care professionals in one surgical ward in a university hospital in the south of Sweden prospectively registered peripheral venous catheters parameters. Four hundred and thirteen peripheral venous catheters were registered for time in situ, size and complications. A cost analysis was performed. Non-parametric statistics were used, and p<0.05 was regarded as significant., Result: Compliance to the guideline of time in situ was 30.2%, and the frequency of thrombophlebitis was 6.5%. Peripheral venous catheters left in situ for more than 72 hours caused more thrombophlebitis (p=0.03). There was no difference in thrombophlebitis rate when peripheral venous catheters were changed within 24 hours compared with peripheral venous catheters that were changed within 72 hours. No difference was seen regarding complications between peripheral venous catheters sized 0.9 mm/22 gauge or 1.1 mm/20 gauge., Conclusion: The present Swedish national guidelines, advocating peripheral venous catheter change every 24 hours, should be altered since peripheral venous catheters left in situ for up to 72 hours were not found to be related to a greater risk of developing thrombophlebitis. Nor is it compatible with a greater risk to use a peripheral venous catheter of 1.1 mm/20 gauge instead of 0.9 mm/22 gauge. The change in guidelines would decrease money spent, 250 100 Euro in Sweden, thus allowing time for the nurses to do other tasks and save discomfort for the patients., Relevance to Clinical Practice: National guidelines should be based on evidence and current facts, and evaluation of guidelines should be given priority., (© 2010 Blackwell Publishing Ltd.)

Aim: To compare prothrombin time and activated partial thromboplastin time values in concurrent blood samples obtained by direct venipuncture and from a peripheral venous catheter., Method: Concurrent blood samples obtained from catheters and by direct venipuncture were studied. Venipuncture samples were labelled as the reference (control) group and the peripheral venous catheter samples as the experimental group. A 21-gauge needle was used in the venipuncture method and 18G, 20G, 22G catheters were used in the peripheral venous catheters method. In each case, after the blood samples were drawn by venipuncture and peripheral venous catheter the needles were drawn out, 1.8 ml of blood was added to 0.2 ml of citrate to give a 2 ml sample. The tube was shaken gently to mix the blood and citrate well., Results: No clinically significant difference between prothrombin time and activated partial thromboplastin time values were seen in the blood samples drawn by venipuncture and peripheral venous catheter methods., Discussion: It is recommended that peripheral venous catheter can be used for patients with high bleeding risk if they have a long hospital stay and frequent blood samples are needed., Relevance to Clinical Practice: In clinical applications, nurses may prefer the use of peripheral venous catheter to venipuncture both for the comfort of the patients who get anticoagulation therapy and for the prevention of the risks as a result of venipuncture. Application of peripheral venous catheter eliminates the risks of superficial bleeding, irritation, pain and anxiety caused by venipuncture.

Intravenous cannulation is a nursing procedure carried out in some clinical units that may induce trauma and discomfort. Nurses should be well prepared before practising the procedure with clients. Conventionally, a plastic arm was used for practice but, with innovative developments in technology, a computer program called the CathSim Intravenous Training System (CathSim ITS) is available for this purpose. This study was conducted to compare the effectiveness of learning using a plastic arm with the CathSim ITS. Twenty-eight nurses were divided into two groups and randomly assigned to the two different methods: plastic arm (control group) or CathSim ITS (experimental group). Both groups were provided with 1 hour of theory input and 2 hours of nursing laboratory work. When the nurses felt ready to practise on clients, their performances were assessed by researchers with an intravenous cannulation qualification using a validated checklist. Prior to the assessment, trait and state anxiety levels were measured using the State-Trait Anxiety Inventory (Hong Kong Chinese adaptation) to check whether anxiety would affect the performance. Following the assessment, a semi-structured interview was conducted to reveal my knowledge acquired through using the selected method. Both the control and CathSim ITS groups demonstrated a high success rate, scoring 100% and 92.86%, respectively, with their first client. The semi-structured interviews revealed that the CathSim ITS group appreciated several features of their assigned method. However, there is room for further development.

Deficient routines in use, care, handling and documentation of peripheral intravenous vein cannulae (PIV) have previously been reported, and complications have been noted in 50-75% of the patients. The aim of the study was to examine whether specially trained nurses change their actions to decrease complications when using cannulae. The study included 36 nurses assigned to experimental and control groups. The experimental group followed an education programme explaining how to use and take care of a PIV. To evaluate the intervention document analysis, observations and patient interviews were performed in 99 patients with 172 PIVs in situ for less than 24 h. After the education programme, fewer complications, more carefully performed care and handling, and better documentation and information were found in the experimental group. Nurses in the control group followed current routines, which resulted in a greater degree of complications. Education in evidence-based care and handling gives nurses the opportunity to improve their ability to use theoretical knowledge in clinical problems.