Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study

Area of Science:

• Emergency Medicine
• Clinical Decision-Making
• Patient Safety

Background:

• High rates of unused peripheral intravenous catheters (PIVCs) are a concern in healthcare settings.
• Understanding the factors influencing PIVC insertion decisions in emergency care is crucial for optimizing resource use and patient outcomes.

Purpose of the Study:

• To explore the factors influencing the decision-making process of doctors, nurses, and paramedics regarding PIVC insertion in the emergency setting.
• To identify potential strategies for reducing unnecessary PIVC cannulations.

Main Methods:

• Qualitative descriptive study utilizing in-depth semistructured interviews.
• Thematic analysis was employed to analyze data from 15 emergency clinicians (doctors, nurses, paramedics).

Main Results:

• Four key themes emerged: clinician knowledge and experience, the multifactorial nature of decisions, convenience, and anticipated patient clinical course.
• Clinicians' decisions to insert PIVCs are often complex, influenced by personal experience and patient factors, and can become routine with little conscious thought.

Conclusions:

• The decision to insert a PIVC is more complex than often realized, involving numerous influencing factors.
• Increased awareness of clinician experience, cognitive biases, and patient-centered factors is needed to support appropriate risk assessment and reduce unnecessary PIVC insertions.