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Published on: November 9, 2016
Difficult intravenous access in a paediatric intensive care unit
M de la Vieja-Soriano1, M Blanco-Daza1, S Macip-Belmonte1
1Servicio de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain.
Insights
Difficult venous access (DVA) in pediatric intensive care units (PICU) leads to low first-attempt success rates for peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) placement, increasing complications and resource use.
Area of Science:
- Pediatric Intensive Care
- Vascular Access Procedures
- Nursing Research
Background:
- Multiple attempts at peripheral cannulation in pediatric intensive care units (PICU) can significantly impact patients, families, and healthcare professionals.
- Understanding the prevalence and challenges of peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation is crucial.
Purpose of the Study:
- To describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children within a PICU.
- To determine the first-attempt success rate for cannulation.
- To quantify patients with difficult venous access (DVA) and explore associated factors.
Main Methods:
- A cross-sectional descriptive study was conducted.
- Consecutive sampling recruited 163 pediatric patients (0-18 years) requiring peripheral venous cannulation.
- An ad hoc questionnaire assessed DVA and related variables.
Main Results:
- 38.7% of cannulations were successful on the first attempt, and 36.8% of patients had DVA.
- Patients with DVA experienced higher complication rates (85%) and required more nursing time and personnel.
- DVA was significantly associated with younger age, lower weight, poor perfusion, non-palpable veins, and a history of difficult access.
Conclusions:
- A low first-attempt success rate and a high proportion of DVA were observed in the PICU.
- DVA is linked to increased complications, longer procedure times, and greater nursing resource utilization.
- Factors such as age, weight, perfusion, vein characteristics, and prior access history predict DVA.
Introduction:
Multiple attempts during peripheral cannulation can have major consequences for patients, relatives, and healthcare professionals, therefore we set out to determine the extent of this problem in a paediatric intensive care unit (PICU).
Objectives:
The main aim was to describe peripheral venous catheter (PVC) and peripherally inserted central catheter (PICC) cannulation in children in the PICU. Secondary objectives were to determine the success rate of the first cannulation attempt, to quantify patients with difficult venous access (DVA), and to explore the association between DVA and sociodemographic, technique and nursing-related characteristics.
Method:
A cross-sectional descriptive study. Consecutive sampling was used to recruit patients aged 0-18 years admitted to the PICU who required peripheral venous cannulation. An ad hoc questionnaire was used for this purpose, including the presence of DVA as an independent variable.
Results:
A total of 163 venous cannulations were reported. A total of 55.8% (91) were performed in patients under 1 year of age. Of these, 38.7% (63) were successful on the first attempt and 36.8% (60) had DVA. When there was DVA, 85% (51) of patients had complications, median time to cannulation by short CVP was 30 minutes [15-53] and 2 or more nurses were required on 80% (48) of occasions.
Conclusions:
We found a low success rate at first attempt and a high proportion of DVA. More nurses and time were employed during cannulation and complications increased if the patient had DVA. A statistically significant association was found between DVA and age, weight, poor perfusion, veins that were neither visible nor palpable, DIVA score ≥ 4, history of difficult intravenous access, complications, number of nurses and time spent.
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