Reality and challenges of peripheral vascular access: a mixed-methods study

While up to 60% of patients experience difficult intravenous access during peripheral venous catheter insertion, existing tools to prevent this phenomenon remain partial with limited integration of healthcare professionals' practical experience.

To inform development of an algorithm (composed of a scale and a decision-making tree) tailored to puncture conditions for preventing failures and guiding responses when failures occur by identifying real needs and requirements of health professionals with respect to organization of peripheral venous catheter care.

Observational study with a parallel mixed methods approach.

Two hospitals from northeastern France.

A total of 298 adult patients (quantitative data) and 17 healthcare professionals (qualitative data).

Recruitment took place in an operating theatre and an emergency department in France. The study used a detailed description of existing peripheral venous catheter placement practices (auto-questionnaires) and individual semi-structured elicitations interviews with health professionals.

A total of 18% of patients had unsuccessful puncture on the first attempt. In cases of difficulties, health professionals mainly called other professionals for assistance. However, in a third of cases, they did not implement any strategy. During interviews, health professionals outlined variations in performance linked to patients' characteristics and intraindividual factors (e.g., stress, fatigue, and emotional state). They emphasized the lack of specific placement protocols and called for them to be implemented. Factors related to health care setting emerged, such as i) working conditions (which do not always enable handover), ii) workspace layout, iii) difficulties in anticipating the workload, and iv) a lack of knowledge regarding nurses' access to alternative techniques (e.g., transillumination and ultrasound).

By identifying critical gaps in current catheter placement practices including the absence of standardized placement protocol and influence of contextual and emotional factors, this work will inform the development of a catheter placement algorithm.

clinicaltrials.gov NCT05935228, registered 07/07/2023, first recruitment 05/12/2023.