Background: Peripheral venous catheters are the most frequently used invasive medical device for care of 80% of hospitalised patients. Previous prevalence studies of peripheral venous catheter practice have identified areas for clinical practice improvement with studies addressing insertion in the emergency department, as well as insertion and care in general and oncology hospital wards. However, perioperative insertion and care have not been examined.
Objectives: To compare the clinical practice of insertion and management of perioperative patients’ peripheral venous catheters with guideline recommendations.
Methods: A prospective audit of 102 perioperative patients’ peripheral venous catheters was performed in a 929 bed, tertiary and quaternary referral teaching hospital in Brisbane, Australia. Baseline data were collected after device insertion in the operating theatre, and postoperative data were recorded on one occasion on the following calendar day. Descriptive analyses of data were performed.
Results: The majority of patients (83%) had 18 or 20 gauge peripheral venous catheters inserted by skilled practitioners. Postoperatively, there were 26 (24.5%) unused catheters without ordered medical treatment. Phlebitis was reported in 3 (2.9%) patients and 7 (6.9%) patients had insecure dressings. No insertion site complications were reported for 63 (61.8%) patients. Specific site assessment was not recorded for 69 (67.6%) of cases. The overall complication rate was 10%.
Conclusion: Multiple problems were identified including failure to remove catheters without a known purpose, phlebitis, insecure dressings, non-compliant flushing practice and incomplete documentation. Future perioperative education should focus on these areas to improve device management and patient care.

Key Words: intravenous catheters; dressings; securement; perioperative; quality improvement
A way to go to meet guidelines for prevention of intravenous catheter infection and complications: Audit of perioperative peripheral venous catheter care.

Background: We sought to identify the reasons for peripheral intravenous cannulae insertion in the emergency department (ED), and the first-time insertion success rate, along with patient and clinician factors influencing this phenomenon.
Methods: A prospective cohort study of patients requiring peripheral cannulae insertion in a tertiary ED. Clinical and clinician data were obtained.
Results: A total 734 peripheral intravenous cannula (PIVC) insertions were included in the study where 460 insertions were analysed. The first-time insertion success incidence was 86%. The antecubital fossa (ACF) site accounted for over 50% of insertions. Multivariate logistic regression modelling to predict first-time insertion success for patient factors found: age <40 versus 80+ years, emaciated versus normal patient size, having a visible or palpable vein/s, and ACF versus forearm insertion site to be statistically significant. Statistically significant clinician factors predicting success were: higher number of prior cannulation procedures performed, and increased clinician perception of the likelihood of a successful insertion. When patient and clinician factors were combined in a logistic regression model, emaciated versus normal, visible vein/s, ACF versus forearm site, higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success.
Conclusions: Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success. Some patient factors predict cannulation success: normal body weight, visible vein/s and cubital fossa placement; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative.
Keywords: Peripheral intravenous cannula, Emergency department, Insertion success, Insertion failure

Introduction: Neonates admitted to a neonatal intensive care unit (NICU) rely highly on intravenous (IV) therapy, for which the peripheral intravenous cannula (PIVC) is the preferred device to allow such therapies to proceed. Placement of a PIVC is a painful procedure and repeated attempts for successful insertion should therefore be limited. We aimed to quantify the incidence, complications, and factors associated with these complications.
Methods: We conducted a prospective observational study to examine PIVC-related complications in level III NICUs of two university medical centers (UMC) in The Netherlands. We performed descriptive analyses and binary logistic regression analysis to identify factors associated with PIVC complications.
Results: A total of 518 catheters were inserted in 235 infants. The first-time success rate was 45%. The predominant reason for non-elective removal due to complications was infiltration (N = 193; 67%). No significant association was found between discipline of the inserter, vein visualization device and location of the PIVC and whether or not a catheter needed to be removed due to a complication.
Conclusions: In this study the majority of PIVCs were removed after the occurrence of a complication. The most common complication was infiltration. Strategies to identify and prevent infiltration in an NICU population are required. Future interventional studies should attempt to improve first-time insertion success and reduce PIVC failure from infiltration in the neonate. Based on the results of the present study, neonatologists and physician assistants are the preferential PIVC inserters. Advanced training of all members of vascular access specialist teams and ongoing monitoring of PIVC-related complications are recommended.
Keywords: Peripheral complications, Neonates, Insertion.