Factors affecting the first-attempt success rate of intravenous cannulation in older people.

ABSTRACT

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.