Difficult intravenous access in the emergency department: Performance and impact of ultrasound-guided IV insertion performed by nurses
Autor: | Victor Gappmaier, Paul Trinquero, Arthur G. Moore, J. Sell, Evan Davis, Ashley E. Amick, Katharine Colton, Joe Feinglass, Andrew Cunningham, William Ford, Jeffrey H. Barsuk, S. Feinsmith, Valerie McDonald |
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Rok vydání: | 2021 |
Předmět: |
Adult
Male medicine.medical_specialty Time Factors Adolescent Peripheral intravenous Nurses Severity of Illness Index Time-to-Treatment Young Adult 03 medical and health sciences 0302 clinical medicine Phlebotomy Physicians Catheterization Peripheral Humans Medicine In patient Ultrasonography Interventional Aged Retrospective Studies Ultrasonography Analgesics business.industry Electronic medical record 030208 emergency & critical care medicine General Medicine Emergency department Length of Stay Middle Aged Ultrasound guided Diva Catheter Emergency medicine Emergency Medicine Female Emergency Service Hospital business Venous cannulation |
Zdroj: | The American Journal of Emergency Medicine. 46:539-544 |
ISSN: | 0735-6757 |
Popis: | Difficult intravenous access (DIVA) is a common problem in Emergency Departments (EDs), yet the prevalence and clinical impact of this condition is poorly understood. Ultrasound-guided peripheral intravenous catheter (USGPIV) insertion is a successful modality for obtaining intravenous (IV) access in patients with DIVA.We aimed to describe the prevalence of DIVA, explore how DIVA affects delivery of care, and determine if nurse insertion of USGPIV improves care delays among patients with DIVA.We retrospectively queried the electronic medical record for all ED patients who had a peripheral IV (PIV) inserted at a tertiary academic medical center from 2015 to 2017. We categorized patients as having DIVA if they required ≥3 PIV attempts or an USGPIV. We compared metrics for care delivery including time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED length of stay (LOS) between patients with and without DIVA. We also compared these metrics in patients with DIVA with a physician-inserted USGPIV versus those with a nurse-inserted USGPIV.A total of 147,260 patients were evaluated during the study period. Of these, 13,192 (8.9%) met criteria for DIVA. Patients with DIVA encountered statistically significant delays in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients without DIVA (all p 0.001). Patients with nurse-inserted USGPIVs also had statistically significant improvements in time-to-IV-access, time-to-laboratory-results, time-to-IV-analgesia, and ED LOS compared to patients with physician-inserted USGPIVs (all p 0.001).DIVA affects many ED patients and leads to delays in PIV access-related care. Nurse insertion of USGPIVs improves care in patients with DIVA. |
Databáze: | OpenAIRE |
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