• James Cr Rippey, Peter J Carr, Marie Cooke, Niall Higgins, and Claire M Rickard.
• Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, Faculty of Medicine, Dentistry and Health Services, The University of Western Australia, Perth, Western Australia, Australia.
• Emerg Med Australas. 2016 Dec 1; 28 (6): 658-665.

ObjectiveFailed attempts at peripheral i.v. cannula (PIVC) insertion in the ED are common. The psychological, physical and economic impact of these failures is significant. We sought to explore whether clinicians of differing experience levels can predict their own likelihood (clinician 'gestalt') of first-time cannula insertion success on any given patient.MethodsData analyses from a prospective self-reported study assessing risk factors for first-time insertion success in a tertiary adult ED. We constructed and compared two simple theoretical clinical decision algorithms in an attempt to improve first-time PIVC insertion success rates.ResultsThis best algorithm identified a subgroup of 18% of the total PIVC population at higher risk of failure. This 18% comprised 57% of all PIVC failures, and implementation would result in a relative risk reduction of PIVC failure by 31%.ConclusionsWhen applied to our sample population, an algorithm relying on clinician gestalt to identify patients at high risk of PIVC failure had the greatest potential impact. These patients would be referred to expert PIVC inserters prior to, rather than after, failed attempts.© 2016 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

23 keywords...

hide…