De-Cannulate – a review of Peripheral Intravenous Cannulas in an Emergency Department

Miss Clare Thomas1, Ms Cara-Joyce Cabilan1, Dr Amy NB Johnston1,2, Professor Samantha Keogh3

1Department of Emergency Medicine, Princess Alexandra Hospital, Brisbane, Australia, 2School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, Australia, 3School of Nursing, Queensland University of Technology, Brisbane, Australia

Background: Peripheral intravenous cannula (PIVC) insertion is a common procedure in the emergency department (ED). Though an invaluable clinical tool, PIVCs are not innocuous.  They are associated with patient discomfort, pain, increased risk of bacteraemia, and increased costs. Therefore, unused PIVCs are all pain with no gain.

Objectives: To determine the proportion of unused PIVCs and assess documentation compliance in a level 1 trauma ED.

Methods: This was an observational study that involved 4 hourly direct patient assessment and concomitant review of their electronic medical records (EMR) over two time blocks. Data collected included patient sex, triage category, disposition, PIVC characteristics, proceduralist, PIVC use, and documentation adherence. Data were de-identified analysed using descriptive and inferential statistics. Ethical approval was obtained.

Results: Over 70% of patients had a PIVC inserted in the ED. One in three PIVC remained unused in the ED. Patients with a triage category of 3-5 were more likely to have an unused PIVC (43%).  Over 30% of PIVCs were undocumented.  Of those that were documented, 62% did not contain proceduralist information.

Conclusion: Our findings are commensurate with earlier studies. Despite increasing awareness of the risk associated with PIVCs, there has been little change in the rate of unused PIVCs.   An understanding of the factors that influence clinicians’ decisions to insert PIVCs in ED is needed to develop effective interventions to address this issue. Despite the introduction of EMR, documentation of PIVCs continues to be poor, albeit better than in previous studies.  This is worthy of further exploration because EMR may both assist and hinder the compliance of documentation standards.


Biography:

Clare Thomas is an experienced emergency nurse currently undertaking her Masters of Nursing (emergency) at Queensland University of Technology.  She currently works as a Clinical Nurse at the Princess Alexandra Hospital in Brisbane, where she started as a graduate ten years ago.   She has tried her hand in clinical facilitation, quality improvement, Associate Nurse Manager and Acting Clinical Nurse Consulting roles, which have built her passion for continuous improvement.  She loves her ED and all the people that make it great.  This is her first research project which she hopes to build into an intervention that becomes a strongly embedded and sustainable culture change that improves our patients’ experiences and outcomes in ED.

Dr Amy Johnston currently holds a conjoint position between Metro South Hospital and Health Service, Department of Emergency Medicine (based at Princess Alexandra Hospital) and the School of Nursing, Midwifery and Social Work, University of Queensland. For the past 5 years she has worked across the academic and ED healthcare environments to conduct her own research as well as supporting clinicians, particularly nurses, to develop the skills and confidence they need to participate in and conduct research projects relevant to their clinical work. She has a heartfelt and passionate commitment to evidence-based practice in emergency departments and to helping clinicians describe and evaluate the amazing innovations they implement. Her wide experience has helped her develop a broading national and international profile. She has co-authored in excess of 80 publications and supported 3 PhD candidates to completion with another 7 currently working towards their PhD qualifications. Her H-index is 17 (Scopus), google scholar is 21, with i10 index of 27.