制定一项临床预测规则以提高急诊科外周静脉置管首次尝试成功率并降低置管后失败率：急诊室血管通路决策（VADER）研究方案
Development of a clinical prediction rule to improve peripheral intravenous cannulae first attempt success in the emergency department and reduce post insertion failure rates: the Vascular Access Decisions in the Emergency Room (VADER) study protocol.
作者信息
Carr Peter J, Rippey James C R, Cooke Marie L, Bharat Chrianna, Murray Kevin, Higgins Niall S, Foale Aileen, Rickard Claire M
机构信息
Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia Alliance for Vascular Access Teaching & Research (AVATAR) Group, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.
Department of Emergency Medicine, Faculty of Medicine, Dentistry and Health Services, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Nedlands, Perth, Western Australia, Australia Sir Charles Gairdner Hospital, QEII Medical Centre, Nedlands, Perth, Western Australia, Australia.
出版信息
BMJ Open. 2016 Feb 11;6(2):e009196. doi: 10.1136/bmjopen-2015-009196.
INTRODUCTION
Peripheral intravenous cannula (PIVC) insertion is one of the most common clinical interventions performed in emergency care worldwide. However, factors associated with successful PIVC placement and maintenance are not well understood. This study seeks to determine the predictors of first time PIVC insertion success in emergency department (ED) and identify the rationale for removal of the ED inserted PIVC in patients admitted to the hospital ward. Reducing failed insertion attempts and improving peripheral intravenous cannulation practice could lead to better staff and patient experiences, as well as improving hospital efficiency.
METHODS AND ANALYSIS
We propose an observational cohort study of PIVC insertions in a patient population presenting to ED, with follow-up observation of the PIVC in subsequent admissions to the hospital ward. We will collect specific PIVC observational data such as; clinician factors, patient factors, device information and clinical practice variables. Trained researchers will gather ED PIVC insertion data to identify predictors of insertion success. In those admitted from the ED, we will determine the dwell time of the ED-inserted PIVC. Multivariate regression analyses will be used to identify factors associated with insertions success and PIVC failure and standard statistical validation techniques will be used to create and assess the effectiveness of a clinical predication rule.
ETHICS AND DISSEMINATION
The findings of our study will provide new evidence to improve insertion success rates in the ED setting and identify strategies to reduce premature device failure for patients admitted to hospital wards. Results will unravel a complexity of factors that contribute to unsuccessful PIVC attempts such as patient and clinician factors along with the products, technologies and infusates used.
TRIAL REGISTRATION NUMBER
ACTRN12615000588594; Pre-results.
引言
外周静脉留置针（PIVC）穿刺是全球急诊护理中最常见的临床操作之一。然而，与PIVC成功置入和维护相关的因素尚未得到充分了解。本研究旨在确定急诊科（ED）首次PIVC穿刺成功的预测因素，并确定医院病房收治患者中拔除ED置入的PIVC的原因。减少穿刺失败尝试并改善外周静脉置管操作可带来更好的医护人员和患者体验，同时提高医院效率。
方法与分析
我们提议对到ED就诊的患者群体进行PIVC穿刺的观察性队列研究，并对随后收治到医院病房的患者的PIVC进行随访观察。我们将收集特定的PIVC观察数据，如临床医生因素、患者因素、设备信息和临床实践变量。经过培训的研究人员将收集ED的PIVC穿刺数据，以确定穿刺成功的预测因素。对于从ED收治的患者，我们将确定ED置入的PIVC的留置时间。将使用多变量回归分析来确定与穿刺成功和PIVC失败相关的因素，并使用标准统计验证技术来创建和评估临床预测规则的有效性。
伦理与传播
我们研究的结果将为提高ED环境中的穿刺成功率提供新证据，并确定降低医院病房收治患者的PIVC过早失败的策略。结果将揭示导致PIVC穿刺失败的复杂因素，如患者和临床医生因素以及所使用的产品、技术和输注液。
试验注册号
ACTRN12615000588594；预结果。
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