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

Area of Science:

• Medical Devices
• Nursing Practice
• Patient Safety

Background:

• Up to 60% of patients experience difficult peripheral venous catheter insertion.
• Existing tools for difficult intravenous access are insufficient and lack integration of healthcare professional experience.

Purpose of the Study:

• To develop an algorithm, including a scale and decision-making tree, for preventing and managing peripheral venous catheterization failures.
• To identify the real needs and requirements of healthcare professionals in peripheral venous catheter care organization.

Main Methods:

• An observational study employing a parallel mixed-methods approach.
• Quantitative data from 298 adult patients and qualitative data from 17 healthcare professionals.
• Data collection involved auto-questionnaires on current practices and semi-structured interviews with healthcare professionals in operating theatre and emergency departments.

Main Results:

• 18% of patients experienced an unsuccessful first attempt at peripheral venous catheter insertion.
• Healthcare professionals often sought assistance or implemented no strategy for difficult insertions.
• Identified influencing factors included patient characteristics, intra-individual factors (stress, fatigue), lack of protocols, working conditions, and limited knowledge of alternative techniques.

Conclusions:

• Critical gaps exist in current peripheral venous catheter placement practices, notably the absence of a standardized protocol.
• Contextual and emotional factors significantly influence catheter placement success.
• The findings will inform the development of a catheter placement algorithm to improve care.