Peripheral Intravenous Cannula Insertion and Use in the Emergency Department: An Intervention Study

Despite the growing frequency of intravenous (IV) injections, establishing peripheral IV access is challenging, particularly in patients with small or collapsed veins. Therefore, patients often endure failed attempts and eventually become venous depleted. Furthermore, maintaining patients' vascular access throughout treatment is difficult because a number of complications including phlebitis, infiltration, extravasation, and infections can occur. The aim of this article is to review the use of the IV route for administering therapy, identify and analyze key risks and complications associated with achieving and maintaining peripheral IV access, examine measures to reduce these risks, and discuss implications for nurses in clinical practice.

Our study aims to determine the incidence of unused peripheral intravenous cannulas inserted in the emergency department (ED).

Better understand the incidence, risk factors, and outcomes of peripheral venous catheter (PVC)-related Staphylococcus aureus bacteremia. Retrospective study of PVC-related S. aureus bacteremias in adult patients from July 2005 through March 2008. A point-prevalence survey was performed January 9, 2008, on adult inpatients to determine PVC utilization; patients with a PVC served as a cohort to assess risk factors for PVC-related S. aureus bacteremia. Tertiary care teaching hospital. Twenty-four (18 definite and 6 probable) PVC-related S. aureus bacteremias were identified (estimated incidence density, 0.07 per 1,000 catheter-days), with a median duration of catheterization of 3 days (interquartile range, 2-6). Patients with PVC-related S. aureus bacteremia were significantly more likely to have a PVC in the antecubital fossa (odds ratio [OR], 6.5), a PVC placed in the emergency department (OR, 6.0), or a PVC placed at an outside hospital (P = .005), with a longer duration of catheterization (P < .001). These PVCs were significantly less likely to have been inserted in the hand (OR, 0.23) or placed on an inpatient medical unit (OR, 0.17). Mean duration of antibiotic treatment was 19 days (95% confidence interval, 15-23 days); 42% (10/24) of cases encountered complications. We estimate that there may be as many as 10,028 PVC-related S. aureus bacteremias yearly in US adult hospitalized inpatients. PVC-related S. aureus bacteremia is an underrecognized complication. PVCs inserted in the emergency department or at outside institutions, PVCs placed in the antecubital fossa, and those with prolonged dwell times are associated with such infections.