Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department-Convenience or necessity?

Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVC...

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Published in:	PloS one Vol. 19; no. 6; p. e0305276
Main Authors:	Willis, Michael, Colonetti, Efrem, Bakir, Ali, Alame, Yousef Jamal, Annetts, Megan, Aygin, Deren T, Daou, Amina, Farooq, Sultan, Fine, Nicholas A, Firat, Gozde, Goozee, Benjamin, Gupta, Anuj Neelesh, Hubbett, Charlotte, Loi, Nicole Shun Yee, Maciejec-Biskup, Laura, Muthukumar, Merline Gabriela, Pott, Jason, Bloom, Benjamin M, Muiesan, Maria Lorenza, Harris, Tim
Format:	Journal Article
Language:	English
Published:	United States Public Library of Science 14-06-2024 Public Library of Science (PLoS)
Subjects:	Administration, Intravenous Adult Aged Aged, 80 and over Audit departments Biology and Life Sciences Cannula Cannulae Catheterization, Peripheral Catheters Data collection Decision making Emergency medical care Emergency medical services Emergency service Emergency Service, Hospital - statistics & numerical data Female Fluid Therapy - methods Fluid Therapy - statistics & numerical data Fluids Hospitals Humans Hydration Insertion Intravenous administration Male Medical care Medicine and Health Sciences Middle Aged Observational studies Patients Phlebotomy Prospective Studies Research and Analysis Methods Teaching hospitals Trauma United Kingdom Utilization United Kingdom United Kingdom > UK Italy
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Summary:	Peripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary. The objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose. A total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink. More than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 ObjectType-Undefined-3 Competing Interests: The authors have declared that no competing interests exist.
ISSN:	1932-6203 1932-6203
DOI:	10.1371/journal.pone.0305276