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A clinical pathway for the management of difficult venous access

BACKGROUND: Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by i...

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Autores principales: Sou, Vanno, McManus, Craig, Mifflin, Nicholas, Frost, Steven A., Ale, Julie, Alexandrou, Evan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693534/
https://www.ncbi.nlm.nih.gov/pubmed/29176933
http://dx.doi.org/10.1186/s12912-017-0261-z
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author Sou, Vanno
McManus, Craig
Mifflin, Nicholas
Frost, Steven A.
Ale, Julie
Alexandrou, Evan
author_facet Sou, Vanno
McManus, Craig
Mifflin, Nicholas
Frost, Steven A.
Ale, Julie
Alexandrou, Evan
author_sort Sou, Vanno
collection PubMed
description BACKGROUND: Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by increasing first attempt success with ultrasound guidance. The emphasis was to provide a solution for hospitalised patients after business hours by training the after-hours clinical support team in ultrasound guided cannulation. METHODS: Inception cohort study of patients referred to the after-hours clinical support team including outcomes such as number of attempts at cannulation before and after referral, insertion site, type of device inserted and recorded pain score for attempts prior to referral and for attempts by the after-hours clinical support team. RESULTS: Between January and December 2016, 379 patients were referred to the after-hours clinical support team for placement of a peripheral intravenous catheter under ultrasound guidance. The median number of unsuccessful attempts before referral was 2 (IQR 2, 4), this ranged between 1 attempt to 10 attempts compared to only 1 attempt (IQR 1, 1, p < 0.001) with no more than 2 attempts in total by the after-hours clinical support team. The first time success rate by the after-hours clinical support team was 93% (n = 348). The median pain score for attempts with ultrasound use was 2/10 (IQR 1–3) compared to 7/10 (IQR 5–9) for previous attempts without ultrasound (p < 0.001). CONCLUSION: The use of ultrasound guidance for peripheral intravenous catheter insertion by the after-hours clinical support team for patients with difficult venous access has been successful at our institution with 9 out of every 10 catheters inserted at first attempt with significantly lower recorded pain scores.
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spelling pubmed-56935342017-11-24 A clinical pathway for the management of difficult venous access Sou, Vanno McManus, Craig Mifflin, Nicholas Frost, Steven A. Ale, Julie Alexandrou, Evan BMC Nurs Research Article BACKGROUND: Many patients are admitted to hospital with non-visible or palpable veins, often resulting in multiple painful attempts at cannulation, anxiety and catheter failure. We developed a difficult intravenous pathway at our institution to reduce the burden of difficult access for patients by increasing first attempt success with ultrasound guidance. The emphasis was to provide a solution for hospitalised patients after business hours by training the after-hours clinical support team in ultrasound guided cannulation. METHODS: Inception cohort study of patients referred to the after-hours clinical support team including outcomes such as number of attempts at cannulation before and after referral, insertion site, type of device inserted and recorded pain score for attempts prior to referral and for attempts by the after-hours clinical support team. RESULTS: Between January and December 2016, 379 patients were referred to the after-hours clinical support team for placement of a peripheral intravenous catheter under ultrasound guidance. The median number of unsuccessful attempts before referral was 2 (IQR 2, 4), this ranged between 1 attempt to 10 attempts compared to only 1 attempt (IQR 1, 1, p < 0.001) with no more than 2 attempts in total by the after-hours clinical support team. The first time success rate by the after-hours clinical support team was 93% (n = 348). The median pain score for attempts with ultrasound use was 2/10 (IQR 1–3) compared to 7/10 (IQR 5–9) for previous attempts without ultrasound (p < 0.001). CONCLUSION: The use of ultrasound guidance for peripheral intravenous catheter insertion by the after-hours clinical support team for patients with difficult venous access has been successful at our institution with 9 out of every 10 catheters inserted at first attempt with significantly lower recorded pain scores. BioMed Central 2017-11-17 /pmc/articles/PMC5693534/ /pubmed/29176933 http://dx.doi.org/10.1186/s12912-017-0261-z Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Sou, Vanno
McManus, Craig
Mifflin, Nicholas
Frost, Steven A.
Ale, Julie
Alexandrou, Evan
A clinical pathway for the management of difficult venous access
title A clinical pathway for the management of difficult venous access
title_full A clinical pathway for the management of difficult venous access
title_fullStr A clinical pathway for the management of difficult venous access
title_full_unstemmed A clinical pathway for the management of difficult venous access
title_short A clinical pathway for the management of difficult venous access
title_sort clinical pathway for the management of difficult venous access
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5693534/
https://www.ncbi.nlm.nih.gov/pubmed/29176933
http://dx.doi.org/10.1186/s12912-017-0261-z
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