Introduction: Many patients are discharged from hospital with a peripherally inserted central catheter in place. Monitoring the peripherally inserted central catheter insertion site for clinical and research purposes is important for identifying complications, but the extent to which patients can reliably report the condition of their catheter insertion site is uncertain. The aim of this study was to assess the inter-observer agreement between nurses and patients when assessing a peripherally inserted central catheter site.
Methods: The study was based on inpatients who were enrolled in a single-centre, randomised controlled trial comparing four different dressing and securement devices for peripherally inserted central catheter sites. A seven-item peripherally inserted central catheter site assessment tool, containing questions about the condition of the dressing and the insertion site, was developed. Assessment was conducted once by the research nurse and, within a few minutes, independently by the patient. Proportions of agreement and Cohen’s kappa were calculated.
Results: In total, 73 patients agreed to participate. Overall, percentage agreement ranged from 83% to 100% (kappa = .65–.82). For important clinical signs (redness, swelling, ooze, pus and tracking), there were high levels of percentage agreement (99%–100%).
Conclusion: The high level of agreement between nurse–patient pairs make the instrument useful for assessing peripherally inserted central catheter–associated signs of localised infection, allergic or irritant dermatitis or dressing dislodgement in a community setting.

Keywords: Observer variation, central venous catheters, inter-observer agreement, patient-reported outcomes.

Date received: 25 July 2017; accepted: 17 December 2017.

Background: Approximately 1.2 billion peripheral intravenous catheters are inserted across the world annually. It is known that intravenous cannulation may be a painful procedure, which affects cognitive abilities by increasing anxiety and discomfort.
Aim: We hypothesised that inserting a smaller sized peripheral intravenous catheter has a lower level of pain sensation compared to a larger sized catheter.
Methods: This observational, cross-sectional study was conducted between May and October 2016, in which surgical patients, aged 18 years or older, were eligible to participate. Experienced anaesthesiologists and nurse anaesthetists routinely obtained peripheral intravenous access according to the standards of care. The primary outcome was pain (verbal numeric rating scale, 0–10) upon intravenous cannulation.
Results: A total of 1063 patients were included and they were divided into four groups: group 1, 22 gauge (N = 29); group 2, 20 gauge (N = 447); group 3, 18 gauge (N = 531); and group 4, sized over 18 gauge (N = 56). Inserting an 18-gauge peripheral intravenous catheter resulted in the lowest pain score (3.2 ± 2.0). As a result of the multivariate linear analysis, five factors were significantly associated with pain upon inserting a peripheral intravenous catheter (sex, American Society of Anesthesiology classification, a patient's risk profile on the A-DIVA scale, site of cannulation on the extremity, and whether or not the attempt was successful); however, the size of the inserted peripheral intravenous catheter had no significant relation to the primary outcome.
Conclusion: Inserting a smaller sized peripheral intravenous catheter did not result in a lower pain sensation. Moreover, to prevent pain upon inserting a peripheral intravenous catheter, an unsuccessful attempt must be avoided.

Keywords: Catheterisation, peripheral, pain, vascular access devices.

Date received: 6 January 2017; accepted: 6 November 2017.