Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, PA 15261, USA.
Prehosp Emerg Care. 2013 Jan-Mar;17(1):46-50. doi: 10.3109/10903127.2012.710717. Epub 2012 Aug 22.
Intravenous (IV) line placement is an important prehospital advanced life support skill, but IV success rates are variable among providers. Little is known about what factors are associated with successful IV placement, limiting the ability to develop benchmarks for skill maintenance, such as requiring a specific number of IV placements per year.
We aimed to identify whether first-pass IV success was associated with the number of attempted or successful previous IV attempts. We hypothesized that IV success is associated with the number of successful IV placements in the preceding year.
We retrospectively studied 800 consecutive charts with an IV attempt from 11 suburban and rural emergency medical services (EMS) agencies over a one-month period. Cases involving pediatric patients (age <18 years) and those with incomplete data were excluded. Success of the first IV attempt was identified. Potential predictor variables were collected and analyzed by univariate logistic regression, including patient age, systolic blood pressure, history of IV drug abuse or renal disease, traumatic event, catheter size, and location of IV attempt, as well as the individual provider's numbers of total and successful IV attempts in the preceding year. Variables significantly associated with IV success at the p < 0.10 level were included in a multivariate regression model using a p-value of 0.05.
Of 602 cases meeting the study criteria, 469 (77.9%) had a successful first-pass IV placement. Significantly associated with IV success in the univariate regression were patient age (p = 0.054), trauma (p = 0.074), IV catheter size (p < 0.001), IV location (p = 0.056), and the number of previous successful IV attempts (p = 0.039), whereas the number of total previous IV attempts was not significantly associated (p = 0.871). In the multivariate logistic regression model, only IV catheter size had a significant association (p < 0.001), with a larger-bore IV catheter size associated with higher success.
In this retrospective study, larger IV catheter size, but not the prehospital providers' previous year's experience, was associated with successful IV placement in adult patients. These data fail to support requirements for a minimum number of yearly IV placements by full-time paramedics to improve success rates.
静脉（IV）置管是一项重要的院前高级生命支持技能，但提供者之间 IV 置管成功率存在差异。对于哪些因素与 IV 置管成功相关知之甚少，这限制了制定技能维护基准的能力，例如要求每年进行特定数量的 IV 置管。
我们旨在确定首次尝试 IV 置管是否与尝试次数或之前尝试的成功次数有关。我们假设 IV 成功率与前一年的成功 IV 置管次数相关。
我们回顾性研究了来自 11 个郊区和农村紧急医疗服务（EMS）机构在一个月内的 800 例连续 IV 尝试图表。排除了儿科患者（年龄 <18 岁）和数据不完整的病例。确定了首次 IV 尝试的成功率。收集了潜在的预测变量，并通过单变量逻辑回归进行分析，包括患者年龄、收缩压、静脉内药物滥用或肾脏疾病史、创伤事件、导管大小以及 IV 尝试的位置，以及个体提供者在前一年的总 IV 尝试次数和成功次数。在 p < 0.10 水平与 IV 成功显著相关的变量被纳入多元回归模型，p 值为 0.05。
在符合研究标准的 602 例病例中，469 例（77.9%）首次尝试 IV 置管成功。单变量回归分析中与 IV 成功显著相关的变量包括患者年龄（p = 0.054）、创伤（p = 0.074）、IV 导管大小（p < 0.001）、IV 位置（p = 0.056）和之前成功的 IV 尝试次数（p = 0.039），而总 IV 尝试次数与 IV 成功率无显著关联（p = 0.871）。多元逻辑回归模型中，只有 IV 导管大小具有显著相关性（p < 0.001），较大口径的 IV 导管与更高的成功率相关。
在这项回顾性研究中，较大的 IV 导管大小，但不是院前提供者前一年的经验，与成年患者 IV 置管的成功相关。这些数据不支持要求全职护理人员每年进行一定数量的 IV 置管以提高成功率的要求。
