Goff David A, Larsen Pamela, Brinkley Jason, Eldridge David, Newton Dale, Hartzog Timothy, Reigart J Routt
Brody School of Medicine at East Carolina University, 3 E. 139 Brody, Department of Pediatrics, Greenville, NC 27834, USA.
Hosp Pediatr. 2013 Jul;3(3):185-91. doi: 10.1542/hpeds.2012-0089.
The goal of this study was to measure the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children; measures of resource utilization. We measured the costs and difficulty in placing peripheral intravenous (IV) catheters in hospitalized children. This common procedure has implications for the utilization of hospital resources.
This was a prospective, large-scale observational study in 2 southeastern US pediatric teaching hospitals evaluating 592 children needing peripheral IV catheters in the inpatient setting. The median age was 2.25 years with an age range of 2 days to 18 years. Costs were estimated by using directly measured staff time and national salary data. Analyses included costs according to patient characteristics (age, weight, dehydration, and difficulty of stick attempts), and nurse characteristics (experience in years and anticipated difficulty).
The median cost of the pediatric IV insertions was $41, and 60% of the placements were obtained with the first nurse. Seventy-two percent of the children had a successful IV insertion in 1 to 2 attempts and accounted for 53% of total costs. However, the 28% of children who required > or = 3 IV attempts had a cost range of $69 to more than $125, and they consumed 43% of the total IV costs. This subset was often < 2 years old or dehydrated (P = .0002).
The insertion of peripheral IV catheters in an inpatient setting can be time intensive and requires significant skill. Our study suggests that resource utilization may improve when nurses and personnel proficient in starting peripheral IV catheters are used when the initial nurse has failed to obtain IV access. This systems improvement should result in shortened time to administration of parenteral therapies, positively improving outcomes and lessening length of stay, as well as improving patient/family satisfaction due to reduced perceptions of pain.
本研究的目的是衡量为住院儿童放置外周静脉（IV）导管的成本和难度；资源利用的衡量指标。我们测量了为住院儿童放置外周静脉（IV）导管的成本和难度。这一常见操作对医院资源的利用有影响。
这是一项在美国东南部两家儿科教学医院进行的前瞻性大规模观察性研究，评估了592名住院时需要外周IV导管的儿童。中位年龄为2.25岁，年龄范围为2天至18岁。成本通过直接测量的工作人员时间和国家薪资数据进行估算。分析包括根据患者特征（年龄、体重、脱水情况和穿刺尝试难度）以及护士特征（工作年限和预期难度）计算的成本。
儿科IV置入的中位成本为41美元，60%的置管是由第一名护士完成的。72%的儿童在1至2次尝试中成功置入IV，占总成本的53%。然而，28%需要≥3次IV尝试的儿童成本范围为69美元至超过125美元，他们消耗了IV总成本的43%。这一子集儿童通常年龄＜2岁或脱水（P = 0.0002）。
在住院环境中放置外周IV导管可能耗时且需要高超技能。我们的研究表明，当初始护士未能成功建立IV通路时，使用熟练于启动外周IV导管的护士和人员，资源利用可能会得到改善。这种系统改进应能缩短肠外治疗的给药时间，积极改善治疗结果并缩短住院时间，同时由于减少了对疼痛的感知，提高患者/家属满意度。
