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A Novel Approach for the Administration of Medications and Fluids in Emergency Scenarios and Settings
Published on: November 9, 2016
Factors associated with difficult intravenous access in the paediatric emergency department: A prospective cohort
Lucy Dunstan1, Amy L Sweeny1,2,3, Clayton Lam1,2
1Department of Emergency Medicine, Gold Coast University Hospital, Gold Coast, Queensland, Australia.
Insights
Difficult intravenous access (DIVA) in children is common. Factors like younger age, limited veins, less experienced staff, and a noisy environment contribute to failed peripheral intravenous catheter (PIVC) insertions.
Area of Science:
- Pediatric Emergency Medicine
- Vascular Access Procedures
- Clinical Observation Studies
Background:
- Peripheral intravenous catheter (PIVC) insertion is the most frequent invasive procedure in pediatric emergency departments (EDs).
- Difficult intravenous access (DIVA) presents a significant challenge in pediatric care, impacting patient comfort and treatment efficiency.
Purpose of the Study:
- To identify patient, proceduralist, and situational factors associated with difficult intravenous access (DIVA) in children presenting to a pediatric ED.
- To inform strategies for improving first-attempt PIVC success rates in pediatric patients.
Main Methods:
- Prospective observational cohort study over 28 days in a single pediatric ED.
- Data collection on patient demographics, proceduralist experience, and situational elements during PIVC attempts in children under 16.
- Univariate logistic regression analysis to determine factors correlated with DIVA, defined as requiring more than one PIVC insertion attempt.
Main Results:
- 39% of 134 children experienced DIVA (requiring multiple attempts).
- Patient factors linked to DIVA: age ≤3 years, limited vein options.
- Proceduralist factors: low perceived success rate, use of larger gauge PIVCs, less experience.
- Situational factors: combative child, high pain scores, loud ambient noise.
Conclusions:
- Multiple patient, proceduralist, and situational factors significantly influence DIVA in pediatric EDs.
- Future research should focus on developing interventions to mitigate DIVA, aiming to reduce patient distress and enhance procedural success.
Objectives:
Although it is the most performed invasive procedure, peripheral intravenous catheter (PIVC) insertion in children can be difficult. The primary objective of the study was to identify the factors associated with difficult intravenous access (DIVA) in the paediatric ED, including patient, proceduralist and situational factors.
Methods:
This was a single-centre prospective observational cohort study conducted over 28 consecutive days. Research assistants observed PIVC insertion attempts for children under 16 years of age and recorded data for variables relating to the patient, proceduralist and event. Univariate logistic regression modelling was performed to identify factors associated with DIVA, defined as unsuccessful PIVC insertion on the first attempt.
Results:
A total of 134 participants were recruited; 66 were male (49%) with a median age of 5.7 years. Fifty-two (39%) were classified as having DIVA. There was a total of 207 PIVC insertion attempts with two or more attempts needed for 48 children (36%). Patient factors associated with DIVA included age of 3 years or less and limited vein options. Proceduralist factors included gestalt of 50% or less chance of success, use of a larger gauge (smaller bore) PIVC and less PIVC insertion experience. Situational factors included a combative child, higher pain score and loud ambient noise.
Conclusions:
The present study identified multiple patient, proceduralist and situational factors that were associated with DIVA in the paediatric ED. Future studies should explore the development and implementation of a package to address DIVA in children, with the patient-centred goals of reducing pain and improving success.
