Tools, Clinical Prediction Rules, and Algorithms for the Insertion of Peripheral Intravenous Catheters in Adult Hospitalized Patients: A Systematic Scoping Review of Literature
BACKGROUND: First-time peripheral intravenous catheter (PIVC) insertion success is dependent on patient, clinician, and product factors. Failed PIVC insertion are an under-recognized clinical phenomenon.
OBJECTIVE: To provide a scoping review of decision aids for PIVC insertion including tools, clinical prediction rules, and algorithms (TRAs) and their findings on factors associated with insertion success.
METHODS: In June 2016, a systematic literature search was performed using the medical subject heading of peripheral catheterization and tool* or rule* or algorithm*. Data extraction included clinician, patient, and/or product variables associated with PIVC insertion success. Information about TRA reliability, validity, responsiveness, and utility was also extracted.
RESULTS: We screened 36 studies, and included 13 for review. Seven papers reported insertion success ranging from 61%-90% (4030 insertion attempts), 6 on validity, and 5 on reliability, with none reporting on responsiveness and utility. Failed insertions were associated with obesity (odds ratio [OR], 0.71-1.7; 2 studies) and smaller gauge PIVCs (OR, 6.4; 95% Confidence Interval [CI}, 3.4-11.9). Successful inser tions were associated with visible veins (OR, 0.87-3.63; 3 studies) or palpable veins (OR, 0.79-5.05; 3 studies) and inserters with greater procedural volume (OR, 4.4; 95% CI, 1.6-12.1) or who predicted that insertion would be successful (OR, 1.06; 95% CI, 1.04-1.07). Definitions of insertion difficulty are heterogeneous such as time to insert to a number of failed attempts.
CONCLUSION: Few well-validated reliable TRAs exist for PIVC insertion. Patients would benefit from a validated, clinically pragmatic TRA that matches insertion difficulty with clinician competency.
© 2017 Society of Hospital Medicine
CONCLUSION
This review identifies a clinically significant gap in vascular access science. The findings of this review support recent work on vessel health and preservation47-49 and appropriate device insertion.50 It also points to the need for further research on the development and testing of an appropriate clinical TRA to improve vascular access outcomes in clinical practice.
Acknowledgments
The authors thank Ms. Kylie Black and Mr. Simon Lewis, who are medical research librarians at The University of Western Australia.
Disclosure
Mr. Carr has received “speakers bureau” payment form CareFusion in 2013 and Becton Dickinson (BD) in 2014 for lectures on the subject of vascular access. He received a grant from CareFusion (facilitated by his institution at the time) to attend a scientific meeting on vascular access in the USA in 2012. Griffith University has received unrestricted investigator initiated research or educational grants on Marie Cooke’s behalf from product manufacturers: Baxter; Becton, Dickinson and Company; Centurion Medical Products and Entrotech Lifesciences. Griffith University has received unrestricted investigator initiated research or educational grants on Claire M. Rickard’s behalf from product manufacturers: 3M; Adhezion Biomedical, AngioDynamics; Bard, Baxter; B.Braun; Becton, Dickinson and Company; Centurion Medical Products; Cook Medical; Entrotech, Flomedical; ICU Medical; Medtronic; Smiths Medical, Teleflex. Griffith University has received consultancy payments on Claire M. Rickard’s behalf from product manufacturers: 3M, Bard; BBraun, BD, ResQDevices, Smiths Medical. Dr. Higgins and Dr. Rippey have nothing to disclose. All of the aforementioned have not biased or influenced this review.
All authors have made substantial contributions with this review. Each author has contributed to drafting and editing the manuscript and approves the final version for publishing.
