Increasing First-Attempt Success in Difficult Venous Access Patients Using Early Identification and Ultrasound-Guided...

Evaluation of the intravenous catheterization process in our emergency department revealed that patients with difficult venous access experienced multiple failed peripheral intravenous attempts and treatment delays. This study aimed to improve flagging of patients with difficult venous access and increase first-attempt intravenous catheter insertion in adult emergency department patients.

The project used a consecutive cohort sampling approach, comparing 2 cohorts of adult patients from the emergency department. The comparator cohort (n = 2016) assessed patient venous access using standard methods, whereas the implementation cohort (n = 2005) used the adult difficult intravenous access scale. Patients flagged as high risk by the scale received ultrasound-guided cannulation from a trained nurse. Analyses compared cohorts on self-reported demographic characteristics, catheter characteristics, difficult venous access flagging, and first-attempt intravenous success.

The adult difficult intravenous access scale significantly improved the flagging of difficult venous access patients between cohorts, from 2% to 10%. Overall, first-attempt intravenous success significantly increased between cohorts from 33% to 41%. In patients with difficult venous access, 97% of the implementation cohort received catheter insertion on the first attempt.

Results showed an absolute increase of 8% in both difficult venous access flagging and first-attempt success, a relative 400% improvement in difficult venous access flagging, and a 24% increase in first-attempt intravenous success, demonstrating the effectiveness of combining the adult difficult intravenous access scale with ultrasound-guided cannulation.