Failed attempts and improvement strategies in peripheral intravenous catheterization.

BACKGROUND

Access to peripheral veins is necessary for sample collection, transfusion and infusion of fluids or medications. The peripheral intravenous catheterization (PIVC) procedure is the introduction of a short catheter into a peripheral vein and can be problematic, leading to multiple failed attempts.

PURPOSE

To analyze scientific literature regarding difficulties in establishing peripheral intravenous access and improvement strategies.

METHOD

A literature search was undertaken and secondary references were retrieved from the papers obtained from the initial search. A total of 128 papers published from 1975 to 2011 were reviewed.

RESULTS

The first attempt of PIVC fails in 12-26% of adults and 24-54% of children. Factors associated with the currently utilized PIVC success include: (1) patient's characteristics such as age, gender, race, weight/BMI, co-existing medical conditions and skin/vein characteristics, (2) procedure related factors such as the insertion site and catheter caliber, and (3) the operator's expertise. Strategies to improve PIVC success include: (1) bedside techniques such as venodilation, vascular visualization and vein entry indication, (2) pain management and (3) engagement of expert health care providers.

CONCLUSION

Bedside techniques have shown more improvement in PIVC success rates as opposed to pain management. Expert health care providers have shown higher performance levels with regard to the difficult cases of PIVC.