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INTRODUCTION: Peripheral intravenous cannulation (PIVC) insertion is challenging for some patients, leading to delays in care and workflow. A few easy-to-identify risk factors can differentiate difficult to cannulate (DIVA) patients. METHODS: A prospective observational study of adults undergoing PIVC was undertaken. Nursing and medical staff inserted PIVC using their usual practices. Patient, PIVC characteristics, number of attempts and staff characteristics were captured. Indicators of high-risk-for-DIVA were: no vein seen, and/or no vein palpable, and/or a history of difficult PIVC. The experience and outcomes for high-risk-for-DIVA patients were compared to non-DIVA. RESULTS: 1084 adults with PIVCs inserted were observed; with (378 (34.9%)) qualifying as high-risk-for-DIVA. First attempt success was achieved for 831 (76.7%) patients overall, with high-risk-for-DIVA significantly less likely to require one attempt (61.1% vs 85.0%, p

Introduction Establishing intravenous access is essential but may be difficult to achieve for patients requiring isolation for SARS-CoV-2 infection. This study aimed to investigate the effectiveness of infrared vein visualizer on the peripheral intravenous catheter therapy in COVID-19 patients. Methods A nonrandomized clinical trial was performed. One-hundred and twenty-two COVID-19 patients that required peripheral intravenous cannulation were divided into two groups with 60 in the control group and 62 in the intervention group. Conventional venipuncture method was applied to the control group while infrared vein imaging device was applied in the intervention group. The first attempt success rate, total procedure time and patients’ satisfaction score were compared between two groups using chi-square, t-test, and z-test (also known as Mann-Whitney U test) statistics. Results The first attempt success rate in the intervention group was significantly higher than that of control group (91.94% vs 76.67%, ꭓ2=5.41, P=0.02). The procedure time was shorter in the intervention group (M=211.44, SD=68.58 seconds vs M=388.27, SD=88.97 seconds, t=12.27, P

Purpose To examine nursing knowledge and confidence of peripheral intravenous catheter insertion and maintenance in pediatric patients. Design and methods An online survey using validated questionnaires was conducted in ten (tertiary and district) hospitals in Indonesia from May to September 2020. Multivariable general linear models were used to investigate associations between nurses' characteristics and knowledge and confidence on the catheter insertion and maintenance score. Results A total of 413 out of 458 pediatric nurses completed the survey (a response rate of 90%). The mean score of the nurse knowledge on insertion was 18.9(±3.3) (maximum score: 21), and the maintenance score was 6.5(±2.0) (maximum score: 12). The median score of the nurse insertion and maintenance confidence was quite high: 44 (IQR = 7) out of 50 and 37 (IQR = 4) out of 45, respectively. Initial patient assessment, catheter securement, site assessment and management of complications are areas where nurse knowledge and confidence are still lacking. Adjusted analysis indicates that training and work experience were significantly associated with the knowledge and confidence score (p Conclusion Pediatric nurses were largely confident in their skills but this was not reflected in their knowledge scores. Training and experience were important predictors for nursing knowledge and confidence in catheter insertion and maintenance. Practice implications The results provide nursing and hospital managers and educational institutions to understand areas of intravenous catheter insertion and maintenance in which nurses lack of knowledge and confidence as well as to formulate tailored and ongoing training to improve nurse knowledge, confidence, practices and optimize patients' care.

A 62-year-old man presented as a trauma alert after a farm tractor accident. He was managed according to ATLS protocol. During initial trauma resuscitation, he developed an iatrogenic air embolus. The patient was treated conservatively by positioning him head down and tilted to the left (Durant’s manoeuvre). Repeat CT scan performed 4 hours later showed resolution of the air embolus. He had no sequelae.

Background: Peripheral intravenous cannulation is a frequent procedure nurses perform that causes pain and anxiety to patients. The valsalva maneuver performed during venous cannula insertion can effectively reduce the incidence and severity of venipuncture pain in adults. Aim: This study was designed to evaluate the effectiveness of valsalva maneuver in reducing pain among adult patients undergoing peripheral intravenous cannulation. Method: A quasi-experimental research design was adopted in this study, which was conducted at the surgical and medical departments of Mansoura University Hospital. A purposive sample of 60 patients who were randomly classified into two groups: The study group consisted of 30 patients who underwent peripheral intravenous cannulation during valsalva maneuver, and the control group comprised 30 patients who were punctured using the routine method. The patients’ pain scores were evaluated 2 min after cannulation using the numerical rating scale for pain, and the Pain Anxiety Symptoms Scale-20 was used to assess the level of anxiety. Results: In the control group, 40% of the patients had severe pain, whereas, in the study group, 43.3% had mild pain. A statistically significant difference was observed between the control and study groups (p = 0.0023). Moreover, statistically significant differences in pain level and anxiety symptoms were observed between the control and study groups (p < 0.05). Conclusion: The valsalva maneuver is a simple cost-effective method for decreasing pain and level of anxiety during Peripheral intravenous cannulation. Recommendation: we recommend the use of the Valsalva maneuver before performing the Peripheral intravenous cannulation for reducing pain and related stress during venous cannulation in adults.

Purpose Obtaining vascular access in the pediatric population can be challenging, with insertion success rates varying widely based on patient and practitioner associated factors. Difficulty establishing peripheral intravenous access can delay treatment, which can be detrimental in emergent situations. Nurses who are trained in vascular access yield a much higher first attempt success rate, which decreases resource utilization, time to intervention, and complication rate. Fewer insertion attempts can also result in improved outcomes including decreased length of stay and better patient and family perception of pain. Design and methods The Vascular Access Service at our institution developed an extensive training program, which included three stages: didactic learning, simulation training, and insertion validation. Results During the first three months of 2020, there were 54 ultrasound-guided peripheral IVs placed in the pediatric intensive care units, 100% of which were placed by the vascular access service. In the first three months of 2021, 63 ultrasound-guided peripheral IVs were placed, 100% of which were placed by pediatric intensive care unit nurses. Of those placed by pediatric intensive care unit nurses, 52 (82.5%) were placed following their ultrasound-guided peripheral IV training. First time insertion success rates were 86.5% with competency in a diverse patient population of widely varying ages. Conclusions Programs that include repeated simulation experiences may facilitate greater learning and thus increase the confidence of the nurses trained. Improving staff skills for vascular access has promoted independent bedside practice and contributed to a culture of quality and safety for the pediatric patient population.

Vascular access is critical in the perioperative arena and is a requirement for most surgical procedures. The goals of this project were to increase knowledge among certified registered nurse anesthetists (CRNAs) by providing a focused didactic and simulation course on ultrasound-guided peripheral intravenous access and to assess the confidence and comfort levels of performing ultrasound-guided peripheral intravenous access before and after the course. A combined didactic and simulation ultrasound-based education course was developed to train CRNAs in ultrasound-guided peripheral intravenous access. The training module consisted of a didactic presentation followed by a simulation with fabricated and human models. All participants showed competency during the training course by identifying upper extremity and lower extremity sonographic vascular anatomy on a human model and performing ultrasound-guided intravenous access on fabricated models. Mean correct pretest response was 1.57 (95% confidence interval) compared with 3.53 (95% confidence interval) on the posttest. The findings show improvement in performance of ultrasound-guided peripheral intravenous access by CRNAs after a focused ultrasound education session. [ J Contin Educ Nurs. 2021;52(10):489–492.]

OBJECTIVES Difficult intravenous (IV) access (DIVA) is a prevalent condition in the hospital setting and increases utilization of midline catheters (MCs) and peripherally inserted central catheters (PICCs). Ultrasound-guided peripheral intravenous (USGPIV) insertion is effective at establishing intravenous access in DIVA but remains understudied in the inpatient setting. We evaluated the effect of an USGPIV simulation-based mastery learning (SBML) curriculum for nurses on MC and PICC utilization for hospitalized patients. METHODS We performed a quasi-experimental observational study. We trained nurses across all inpatient units at a large tertiary care hospital. We queried the electronic medical record to compare PICC and MC utilization for patients with DIVA during 3 periods: before USGPIV SBML training (control), during pilot testing of the intervention, and during the SBML intervention. To account for variations in insertion practices over time, we performed an interrupted time series (ITS) analysis between 2 periods, the combined control and pilot periods and the intervention period. RESULTS One hundred forty-eight nurses completed USGPIV SBML training. Midline catheters inserted monthly per 1000 patient-days for DIVA decreased significantly from 1.86 ± 0.51 (control) to 2.31 ± 0.28 (pilot) to 1.33 ± 0.51 (intervention; P = 0.001). The ITS analysis indicated a significant intervention effect (P < 0.001). Peripherally inserted central catheters inserted monthly per 1000 patient-days for DIVA also significantly decreased over the study periods; however, the ITS failed to show an intervention effect as PICC insertions were already decreasing during the control period. CONCLUSIONS A hospital-wide USGPIV SBML curriculum for inpatient nurses was associated with a significant reduction in MCs inserted for DIVA.

Aim To compare outcomes between Intraosseous (IO) and peripheral intravenous (PIV) injection during in-hospital cardiac arrest (IHCA) and examine its utility in individuals with obesity. Methods We performed a retrospective cohort analysis of adult, atraumatic IHCA at a single tertiary care center. Subjects were classified as either IO or PIV resuscitation. The primary outcome of interest was survival to hospital discharge. The secondary outcomes of interest were survival with favourable neurologic status, rates-of-ROSC (ROR) and time-to-ROSC (TTR). Subgroup analysis among patients with BMI ≥ 30 kg/m2 was performed. Results Complete data were available for 1852 subjects, 1039 of whom met eligibility criteria. A total of 832 were resuscitated via PIV route and 207 via IO route. Use of IO compared to PIV was associated with lower overall survival to hospital discharge (20.8% vs 28.4% p = 0.03), lower rates of survival with favourable neurologic status (18.4% vs 25.2% p = 0.04), lower ROR (72.2% vs 80.7%) and longer TTR (12:38 min vs 9:01 min). After multivariate adjustment there was no significant differences between IO and PIV in rates of survival to discharge (OR 0.71, 95% CI 0.47–1.06, p = 0.09) or rates of survival with favourable neurologic status (OR 0.74, 95% CI 0.49–1.13, p = 0.16). The ROR and TTR remained significantly worse in the IO group. Subgroup analysis of patients with BMI ≥ 30 kg/m2 identified no benefit or harm with use of IO compared to PIV. Conclusion Intraosseous medication delivery is associated with inferior rates-of-ROSC and longer times-to-ROSC compared to PIV, but no differences in overall survival to hospital discharge or survival with favourable neurologic status during IHCA.

BackgroundThe American Association of Medical Colleges has defined peripheral intravenous cannulation as one of the eight practical skills that a medical student should possess upon graduation. Since following a standard hygiene protocol can reduce the rate of complications such as bloodstream infections, the medical student’s compliance to hygienic standards is highly relevant.MethodsThis unicentric longitudinal cohort study included 177 medical students undergoing OSCE 1 in the winter semesters 2016/2017 and 2017/2018 as well as OSCE 2 during the winter semesters 2018/2019 and 2019/2020 at the University of Cologne. Their performance in peripheral intravenous cannulation was rated by trained student supervisors using a scaled 13-item questionnaire and compared between OSCE 1 and OSCE 2.ResultsOverall, a decline in the correct placement of peripheral intravenous catheters was observed among advanced medical students during OSCE 2 (mean total score: 6.27 ± 1.84) in comparison to their results in OSCE 1 (mean total score: 7.67 ± 1.7). During OSCE 2, the students were more negligent in regard to hygienic behavior, such as disinfection of the puncture site as well as hand disinfection before and after venipuncture. Their patients were also less likely to be informed about the procedure as compared to OSCE 1.ConclusionsAn unsatisfying performance in regard to peripheral intravenous cannulation was observed in medical students with hygiene compliance deteriorating between the third and fifth year of their study. Thus, we promote an extension of practical hygiene and stress management training in medical school to reduce complications associated with intravenous catheters, such as bloodstream infections.

BACKGROUND: Dilated veins are associated with increased success of peripheral intravenous cannulation, due to their improved visibility and palpability. We compared three strategies to achieve venodilation (tourniquet, electrical stimulation, or a combined strategy) on increase in venous size.METHODS: A total of 54 volunteers participated in this cross-over observational study with healthy adults, measuring venous cross-sectional area and diameter at six different sites of the upper extremity. Measurements were performed with ultrasound after performing any dilation strategy and compared with non-dilated venous size. An increased cross-sectional area of 25 square millimeters was denoted as clinically relevant, which was detected with paired t-test, Wilcoxon signed rank test, or ANOVA.RESULTS: The cephalic vein was the greatest at all sites (t=12.43, df=39, PCONCLUSIONS: In general, the largest sized veins are situated in the upper arm, of which the cephalic vein has the largest cross-sectional area and diameter. The combination of electrical stimulation followed by tourniquet application resulted in the greatest increase in venous size and is therefore considered as the most effective to improve peripheral intravenous cannulation success.

Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA.We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA.We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV.A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p 0.001).DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA.

Objective: Establish the feasibility of pediatric intensive care unit (PICU) nurse-directed ultrasound assessment (UA) of peripheral intravenous (PIV) catheters, compare the results of UA to traditional assessment (TA), and determine PIV survival after UA. Design: Prospective observational cohort study. Setting: PICU within a children’s hospital. Patients: PICU patients with a PIV. Interventions: None. Measurements and main results: Eight nurses performed UA on 131 PIVs in 85 patients. Median age was 3.0 years (IQR 1.0–13.8) and median weight was 15.0 kg (IQR 9.6–59.3). The most common PIV location was the arm (43%) and extravasation occurred in 15% of PIVs. Agreement between TA and UA was moderate with a Kappa of 0.47 (95% CI 0.28–0.66). Nursing confidence in the UA was significantly higher than TA (92% vs 21% very confident, p Conclusions: Nurses can perform UA of PIV status in PICU patients and express greater confidence in the findings of UA than TA. Further study is necessary to determine the impact of UA on the rate of PIV complications.

Background: Short peripheral intravenous catheters (PIVCs) fail prior to completion of therapy in up to 63% of hospitalizations. This unacceptably high rate of failure has become the norm for the most common invasive procedure in all of medicine. Securement strategies may improve PIVC survival. Methods: We conducted a prospective, single-site, parallel, two-arm randomized controlled investigation with a primary outcome of catheter failure comparing securement with standard semi-permeable dressing and clear tape (SPD) to standard semipermeable dressing and clear tape with cyanoacrylate glue (SPD + CG). Adult emergency department patients with a short PIVC and anticipated hospital duration ⩾ 48 h were enrolled and followed until IV failure or completion of therapy for up to 7 days. Secondary outcomes included complications and cost comparisons between groups. Primary outcome was assessed by intention to treat and per protocol analyses. Findings: 350 patients were enrolled between November 2019 and October 2020. PIVC survival for SPD + CG was similar to SPD group with the absolute risk difference of IV failure in the intention-to-treat (−5.8%, p = 0.065) population and improved in the per protocol (−8.1%, p = 0.04) population, respectively. Kaplan-Meier survival analysis indicated there was a significant benefit of the SPD + CG at greater than 2 days of hospitalization ( p = 0.04). Prior to 48 h, there was no survival enhancement to either group ( p = 0.98) in the intention to treat population. In a multivariable analysis with piecewise Cox regression, when the IV was functional greater than 48 h, the risk of IV failure in the SPD + CG was 43% less than the SPD group (adjusted hazard ratio [HR] 0.57, 95% confidence interval [CI] 0.34 to 0.97; p = 0.04). Cumulative cost related to IV during hospitalization was similar between groups with a lower incremental rescue cost in the SPD + CG group. Interpretation: SPD combined with cyanoacrylate glue provides similar benefit to patients compared to SPD alone and potentially improves short PIVC survival when the IV was inserted >48 h. As this strategy is cost neutral, it could be considered in admitted patients, particularly those with longer anticipated hospital durations.

Highlights Abstract Background: Evidence to support an optimum continuous to-keep-vein-open (TKVO) infusion rate for peripheral intravenous catheters (PIVCs) is lacking. The aim of this study was to simulate typical TKVO rates, in combination with flushing, to better understand TKVO in relation to PIVC patency. Methods: We simulated saline infusion through a 20-gauge PIVC in 2 forearm veins (3.3 and 2.2 mm) using computational fluid dynamics under various venous flow rates (velocities 3.7–22.1 cm/s), with a saline flush rate of 1 mL/s and TKVO infusion rates of 10, 20, and 40 mL/h. We determined TKVO efficacy using the stream of saline clearing the stasis region at the device tip and the shear stress acting on the vein. Results: At 10 mL/h TKVO rate, blood stasis occurs around the PIVC tip as saline is pulled into the faster-moving venous blood flow, creating the blood recirculation (stasis) zone at the device tip. When TKVO increases >20 mL/h, this stasis diminishes, and the likelihood of patency increases. Shear stress on the vein is negligible during TKVO but increases 10- to 19-fold when flushing the small and large veins investigated here. Conclusions: Low TKVO rates (10 mL/h) may not clear the PIVC tip and keep the device patent. Based on our simulations, we propose a TKVO rate of at least 20 mL/h could be used in practice; however, 30–40 mL/h appears most effective across different venous flow rates and peripheral vein sizes. However, this additional fluid load must be carefully considered based on the needs of each patient.

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Objective: Thrombophlebitis associated with peripheral intravenous catheters (PIVCs) is a poorly described complication in the literature. Given limited accuracy of current assessment tools and poor documentation in the medical record, the true incidence and relevance of this complication is misrepresented. We aimed to identify risk factors in the development of thrombophlebitis using an objective methodology coupling serial diagnostic ultrasound and clinical assessment. Methods: We conducted a single-site, prospective observational cohort study. Adult patients presenting to the emergency department that underwent traditionally placed PIVC insertion and were being hospitalized with an anticipated length of stay greater than two days were eligible participants. Using serial, daily ultrasound evaluations and clinical assessments via the phlebitis scale, we identified patients with asymptomatic and symptomatic thrombosis. The primary goal was to identify demographic, clinical, and IV related risk factors associated with thrombophlebitis. Univariate and multivariate analyses were employed to identify risk factors for thrombophlebitis. Results: 62 PIVCs were included between July and August 2020. 54 (87.10%) developed catheter-related thrombosis with 22 (40.74%) of the thrombosed catheters were characterized as symptomatic. Multivariate cox regression demonstrated that catheter diameter relative to vein diameter greater than one-third [AHR 5.41 (1.91, 15.4) P = 0.0015] and angle of distal tip of catheter against vein wall ≥ 5 degrees [AHR 4.39 (1.39, 13.8) P = 0.0116] were associated with increased likelihood of thrombophlebitis. Conclusions: Our study found that the increased proportion of catheter relative to vein size and steeper catheter tip angle increased the risk of thrombophlebitis. Catheter size relative to vein size is a modifiable factor that should be considered when inserting PIVCs. Additional larger prospective investigations using objective methodologies are needed to further characterize complications in PIVCs. Funding Statement: There is no funding source for this study. Declaration of Interests: All authors (AB, SJ, PK, NM) have nothing to disclose. There are no relevant conflict of interest disclosures relevant to the research, authorship, and/or publication of this article. Ethics Approval Statement: The Institutional Review Board (IRB) at our institution approved this study.

Background. Emergency physicians often have difficulty providing vascular access to patients in critical condition. In these conditions, intraosseous access has an advantage over traditional peripheral vein catheterization. Currently, intraosseous access is not widely used at the stage of emergency medical care.Aim. Analysis and generalization of current information on the use of the method of intraosseous access to emergency medicine.Materials and methods. We have found publications in Russian and international search engines (PubMed, eLIBRARY, etc.) over the past 20 years. Publications reflected current issues of intraosseous access application. 74 articles were found and 30 were selected for review.Results. Intraosseous access showed good results in patients with weakly expressed venous network at the stage of emergency medical care. The method has a simple technique of manipulation, does not have a large number of complications and contraindications. Doctors who have received training often use intraosseous access, taking into account the indications for use.Conclusion. Intraosseous access has an advantage over peripheral intravenous access in patients in critical condition at the stages of emergency care.

Peripheral intravenous cannulation (PIVC) in children is one of the most common procedures in acute care paediatrics. This can be difficult for experienced clinicians and daunting for those with limited paediatric experience. We aimed to evaluate the level of confidence of non-consultant hospital doctors (NCHDs) in PIVC and identify factors that impact on their level of confidence. This was a cross-sectional nationwide survey of NCHDs on the level of confidence in paediatric PIVC. Self-reported questionnaires explored clinical experience with PIVC, level of confidence, and potential factors impacting on confidence. Primary outcome was the level of confidence in PIVC. A survey response rate of 45% (202/450) was received from 12 Irish hospitals. Despite 89% (180/202) of NCHDs self-reporting average or above average success rates and 76% (155/202) having inserted ≥10 cannula within the preceding 3 months, self-reported confidence was low across the entire cohort. Only 48% (97/202) of NCHDs reported confidence scores >3 on 5-point scale and 37% (75/202) reported significant anxiety proceeding with PIVC. Level of confidence was increased with previous paediatric experience (p = 0.00004) and seniority of the doctor (p < 0.00001), whilst previous unsuccessful attempts by colleagues were strongly associated with decreased confidence (p = 0.009). Our study described the levels of confidence of NCHDs in PIVC. Although the experienced paediatric NCHDs are confident in PIVC, there still exists some degree of anxiety. These have implications for workforce educational planning and training to improve level of confidence which may lead to better patient care.

Background The use of enhancing agents in echocardiography has been shown to facilitate improved study quality. Despite the known benefits, its use remains limited by institutional policies. Methods We aimed to retrospectively evaluate if allowing sonographers to place a peripheral intravenous catheter and administer enhancing agent led to a decrease in time to complete outpatient transthoracic echocardiograms in comparison to using nursing personnel. Three separate protocols were employed. The ‘nurse driven protocol’ utilized nurses to place a peripheral intravenous catheter and inject enhancing agent. In a ‘mixed protocol,’ a nurse placed a peripheral intravenous catheter and the sonographer gave the enhancing agent. The ‘sonographer driven protocol’ involved the sonographer placing the peripheral intravenous catheter and delivering enhancing agent. Results A total of 232 echocardiograms were included for analysis. Patient characteristics across the three protocols were not statistically significant. The ‘mixed protocol’ had an average study time that was significantly less than the ‘nurse driven protocol’ (49.4 min ± 11.4 vs 54.6 min ± 12.9; p = 0.024). The ‘sonographer driven protocol’ also showed a significant reduction in study time (50.3 min ± 12.6) when compared to the ‘nurse driven protocol’ (p = 0.017). The additional task for the sonographer to place the peripheral intravenous catheter did not significantly increase the time to complete the study. Conclusion Allowing sonographers to administer enhancing agent reduced individual echocardiogram study times by approximately 5 min, supporting that a ‘sonographer driven protocol’ is more efficient with potential downstream economic benefits.

Background Failed peripheral intravenous catheterizations result in multiple painful skin punctures, diagnostic and treatment delays, and increased morbidity and mortality. Incorporating gaze behavior training may increase success rates. Method Using eye tracking glasses with simulated catheterizations, we compared novice (n = 12) and expert nurses’ (n = 10) insertion attempt success rates and eye movements. Results Experts took significantly less time to complete catheterization and had fewer visits and fixations on the area of interest than novices. Conclusions Training gaze behaviors during simulated peripheral intravenous catheterizations may increase novice nurses’ success rates.

BACKGROUND: Peripheral intravenous catheter (PIVC) is one of the medical devices commonly inserted in hospitalized patients, both adults and pediatrics. PIVC has crucial functions for delivering drugs, fluids, blood transfusions, and diagnostic tests for patients. Thus, nursing students must be confident in terms of insertion and management of this device. However, studies assessing nursing students’ confidence and its determinants are still limited. AIM: This study aims to examine the internship nursing student’s confidence in PIVC insertion and management in adult patients and its contributing factors. METHODS: A cross-sectional study was conducted to measure internship nursing students’ confidence in PIVC cannulation and management in adult patients as well as its contributing factors. Purposive samples of 100 nursing students in Yogyakarta were recruited, and a 5-point Likert scale questionnaire consisting of 19 questions was used. Kruskal–Wallis test was utilized to investigate the association of the internship nursing student confidence on PIVC insertion and maintenance with the factors. A general linear regression analysis was performed to obtain adjusted estimates of the potential factors with students’ confidence. RESULTS: Results indicated that the internship nursing student’s confidence score ranged from 57 to 95, with a mean value of 75 (±8.1). Among determinants of the student’s confidence investigated in this study, t-test analysis showed that the students’ confidence was associated with their participation in expert lecture, bedside teaching, and direct observation of procedural skill assessment of PIVC insertion and care (p < 0.05). The general linear analysis showed that only bedside teaching and interaction of bedside teaching and direct observation procedural skill assessment were significant predictors of the internship nursing student’s confidence on PIVC insertion and care (β = 10.99, 95% confidence interval [CI] 2.00–20.00 and β = 13.15, 95% CI 1.20–25.15, p < 0.05, respectively). CONCLUSION: This result indicated that nursing students need direct simulation and assessment of PIVC insertion and care to the patients to improve their confidence in PIVC insertion and management in adult patients.

Objective: The primary purpose of this study was to explore the safety of peripheral intravenous catheter (PIVC) replacement every 96 h compared to that of clinically indicated catheter removal. Methods: A prospective, single-blind, randomized controlled trial was conducted. A random number table method was used. Six hundred patients treated with PIVC intravenous infusion in 10 nursing units of a hospital from September to October 2019 were selected. Sixty were collected from each nursing unit, including 30 in the clinically indicated replacement group and 30 in the routine replacement group. The incidence of phlebitis, catheter-related infection (CRI), occlusion, infiltration, and any form of infusion therapy failure were compared between the two groups. SPSS 23.0 software was used. Results: The dwelling times of PIVC in the clinically indicated replacement group and routine replacement group were significantly different (hours) (83.62 ± 50.08, 69.75 ± 25.54, t = 3.021, p = 0.003). The incidence of any form of infusion therapy failure (RR = 4.448, 95% CI: 3.158–6.265, p Conclusion: Replacement of PIVC every 96 h is safer than clinically indicated.

Objective: To determine the effect of splint on the dwell time of peripheral intravenous cannula in neonates. Setting: Level II Neonatal Intensive Care Unit (NICU). Patients: Consecutive babies with presumed need of peripheral intravenous access of at least 24 h. Methods: Enrolled subjects were randomized to “splint” or “splint-less” group. Insertion site was cleaned with Isopropyl alcohol and 2% Chlorhexidine and peripheral intravenous catheter was inserted under strict asepsis. Insertion sites was examined regularly for occurrence of complication which necessitated removal of the catheter. Results: Out of 159 neonates, 80 were allotted to splint group and the rest to splint-less group. Mean dwell time of intravenous line in splint group was 27.68 ± 13.03 h which was significantly less than in splint-less group (32.87 ± 15.79 h, mean difference: 5.11 h, p value: 0.03). Subgroup analysis in preterms showed mean dwell time of 28.54 ± 14.86 h in splint group which was less than that of splint-less group (35.10 ± 16.24 h) ( p value: 0.03). No such difference was noted in the term neonates. Subgroup analysis for catheters put across joints does not show difference in mean dwell times between splint and splint-less groups. Multivariate regression analysis did not identify any variable which independently affected the outcome. Conclusion: Use of splint does not prolong the dwell time of the catheter and is probably harmful in some neonates.

Peripheral intravenous cannulation (PIVC) is one of the most commonly performed invasive procedures in healthcare and can be a stressful experience for patients. Co-creating a patient journey map of intravenous therapy (IVT) together with patients highlighted the need to better understand patient experiences of IVT and informed the development of a patient-reported experience measure of intravenous therapy (IVT). The British Columbia (BC) Lower Mainland IVT Working Group, the BC Office of Patient-Centred Measurement and the provincial supplier of IVT products, hypothesized patient feedback about their IVT experiences would garner new insights to improve both patient experiences and outcomes related to IVT. Leveraging BC's province-wide, coordinated, scientifically rigorous patient-centred measurement program (BCPCM), a module of eight questions were developed, tested and fielded with the 2018 BC Emergency Department patient survey (n=14 076). Weekly monitoring of patient responses, through the BCPCM's web-based Dynamic Analysis and Reporting Tool (the DART), showed key themes and opportunities for improvement, leading to a test of change that introduced a patient information card (Why do I need an IV, What will happen when I get an IV, Tell a nurse if the following happens). This paper outlines the development of the IVT patient experience survey, and presents initial findings and the next steps to take action on the results. Additional data collection is now underway to solicit patient feedback of IVT across BC in outpatient cancer care and acute care hospital settings.

Peripheral intravenous placement can be difficult in children. Vein finder devices are vascular access devices that delineate veins lying in the subcutaneous tissues to identify potential venipuncture sites. In this narrative review, we highlight the currently available literature on this device to analyse the hope that this device has to offer vs. the unnecessary hype. The search of the databases (Cochrane Library, Google Scholar, and PubMed) was limited to studies on the paediatric population and in English language between 2011 and 2019. Twenty-three relevant articles were found. Most of the articles did not demonstrate a major impact of these modalities in the general paediatric population. However, they may be beneficial in children with difficult intravenous access. Appro­priate simulator mannequins should be utilised to train healthcare providers in using these vein finder devices.