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The parent, child and young person experience of difficult venous access and recommendations for clinical practice: A
Rebecca Sharp1,2, Michele Muncaster3,4, Catherine L Baring1,3,4
1Clinical & Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
Insights
Repeated attempts to insert peripheral intravenous catheters cause significant distress for children, impacting treatment and leading to avoidance. Improving clinical practice requires better communication and timely referral to specialists for difficult venous access cases.
Area of Science:
- Pediatric healthcare
- Clinical practice improvement
- Patient experience
Background:
- Peripheral intravenous catheter insertion is a common procedure in hospitalized children.
- Multiple insertion attempts are frequent and cause pain and distress.
- Limited research exists on the child/young person and parent experience of difficult venous access.
Purpose of the Study:
- To explore the experiences of parents and children/young people regarding difficult venous access.
- To identify parent and child/young person preferences for improving clinical practice.
Main Methods:
- Qualitative descriptive study design.
- Purposive sampling of children/young people with difficult venous access and their parents.
- Semi-structured interviews and thematic analysis of transcripts.
Main Results:
- Three main themes emerged: distress, navigating the healthcare system, and the impact of difficult venous access on treatment and life.
- A fourth theme identified recommendations for good clinical practice.
- Participants included seven parents and five children/young people.
Conclusions:
- Multiple peripheral intravenous catheter insertion attempts cause significant distress and treatment avoidance in children.
- Effective communication, patient choice, and avoiding frightening language are crucial for minimizing distress.
- Referral to specialists for children with a history of difficult venous access is recommended, requiring cultural change to recognize the psychological impact.
Aims And Objectives:
Explore the parent and child/young person experience of difficult venous access and identify ideas and preferences for changes to clinical practice.
Background:
Peripheral intravenous catheter insertion is one of the most common invasive procedures in hospitalised paediatric patients. Multiple insertion attempts in paediatric patients are common and associated with pain and distress. Little research has explored the parent and child/young person experience of difficult venous access nor sought to identify their suggestions to improve clinical practice.
Design:
Qualitative description.
Methods:
A purposive sampling approach was used to identify children and young people with experience of difficult venous access and their parents. Semi-structured interviews were conducted, with sample size based on data saturation. Transcripts were analysed using thematic analysis.
Results:
There were 12 participants, seven parents and five children/young people (five parent/child dyads and two individual parents). Analysis of the data revealed three main themes: (1) Distress-before, during and after (2) Families navigating the system: the challenging journey from general clinician to specialist and (3) Difficult venous access impacts both treatment and life outside the hospital A pre-determined theme, (4) Recommendations for good clinical practice is also described.
Conclusions:
Multiple attempts to insert a peripheral intravenous catheter are a source of substantial distress for children/young people, leading to treatment avoidance. Effective interpersonal skills, providing choice and avoiding frightening language are important to minimise distress. Clinicians without specialist training should assess each child's venous access experience and consider immediate referral to a specialist if they have a history of difficult venous access. Cultural change is required so clinicians and healthcare services recognise that repeated cannulation may be a source of psychological distress for children/young people.
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