Factors Associated with Successful Intravenous Access in the Prehospital Setting

The most common invasive procedure performed in the prehospital setting by emergency medical services (EMS) clinicians is intravenous (IV) cannula insertion. We aimed to characterize first attempt and overall success in a nationwide cohort, investigate factors associated with first attempt IV access success, and determine the prehospital utilization rate of successful IV access.

We conducted a retrospective analysis using the 2023 ESO Data Collaborative research dataset. We included all patients with at least one attempt at peripheral IV access following a 9-1-1 call, and defined success using EMS clinician documentation. We used logistic regression modeling with clustered standard errors at the EMS agency level to estimate the association between sex, race, EMS clinician primary impression, insertion site, attempt interval (on scene vs. during transport) and first attempt success. Among patients with successful IV access, we defined 'prehospital utilization' as any IV medication, blood products, or >250 mL of crystalloid fluid.

We analyzed 3,006,069 IV access attempts. First attempt insertion success was achieved for 2,298,826 (76.5%) patients, and 2,553,731 patients (84.3%) had at least one successful IV attempt. Our cohort was a median 64 (45, 77) years of age, 51.3% female, and 66.0% White, non-Hispanic. The most common first attempt insertion site was the antecubital fossa (n = 1,866,607; 62.1%) and the most commonly utilized cannula size was 20 G (1,760,684; 58.6%). First attempt success was associated with sex, race, EMS clinician primary impression, cannula size, and insertion site. Among patients who had any successful IV access established, 1,129,819 (44.6%) received an intravenous medication, blood products, or >250 mL of crystalloid fluid in the prehospital setting.

In this retrospective, nationwide cohort, approximately three of every four first-attempt IV access attempts were successful. First attempt success was associated with patient and encounter characteristics. Less than 50% of the patients with successful IV access received any IV therapy.