Derivation of a clinical decision-making aid to improve the insertion of clinically indicated peripheral intravenous catheters and promote vessel health preservation. An observational study

• Published in: PloS one 2019-03, Vol.14 (3), p.e0213923-e0213923
• Main Authors: Carr, Peter J, Rippey, James C R, Cooke, Marie L, Higgins, Niall S, Trevenen, Michelle L, Foale, Aileen, Keijzers, Gerben, Rickard, Claire M
• Format: Article
• Language: English
• Subjects: Analysis; Biology and Life Sciences; CAT scans; Catheterization, Peripheral - methods; Catheters; Clinical decision making; Clinical Decision-Making - methods; Cohort Studies; Computational fluid dynamics; Computed tomography; Confidence intervals; Data processing; Decision making; Decision Support Techniques; Device Removal - methods; Dilution; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Engineering and Technology; Female; Fluids; Health aspects; Health care; Hospital admission and discharge; Hospitalization; Hospitals; Humans; Indication; Insertion; Intravenous administration; Male; Medical instruments; Medical records; Medical research; Medicine; Medicine and Health Sciences; Middle Aged; Midwifery; Nosocomial infections; Nursing schools; Observational studies; Patients; People and Places; Preservation; Preservation, Biological - methods; Regression analysis; Research and Analysis Methods; Respiratory system agents; Secondary analysis; Social Sciences; Statistical analysis; Tomography; Vascular Access Devices
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0213923

It is well established that the idle peripheral intravenous catheter (PIVC) provides no therapeutic value and is a clinical, economic and above all, patient concern. This study aimed to develop a decision aid to assist with clinical decision making to promote clinically indicated peripheral intravenous catheter (CIPIVC) insertion in the emergency department (ED) setting. Providing evidence for a uniform process could assist clinicians in a decision-making process for PIVC insertion. This could enable patients receive appropriate vascular access healthcare. We performed a secondary analysis of data from a multicentre cohort of emergency department clinicians who performed PIVC insertion. We defined CIPIVC a priori as one used for a specific clinical treatment and or procedure such as prescribed intravenous (IV) fluids; prescribed IV medication; or IV contrast (for computerized tomography scans). We sought to refute or validate an assumption if the clinician performing or requesting the insertion decided the patient was >80% likely to need a PIVC. Using logistic regression, we derived a decision aid for CIPIVCs. In 817 patients undergoing PIVC insertion, we observed 68% of these to be CIPIVCs. Admitted patients were significantly more likely to have a CIPIVC, Odds Ratio (OR) = 3.05, 95% confidence interval (CI) = 2.17-4.30, p =