Choden Jigme, Carr Peter J, Brock Aleisha R, Esterman Adrian
1 Quality Assurance and Standardization Division, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan.
2 School of Nursing and Midwifery and AVATAR Group, Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia.
J Vasc Access. 2019 Mar;20(2):184-189. doi: 10.1177/1129729818792826. Epub 2018 Aug 15.
: Peripheral intravenous catheter insertion is a clinical procedure commonly performed by nurses for pediatric patients in Bhutan. This study describes peripheral intravenous catheter first attempt success and factors associated with such insertions.
: A cross-sectional survey was conducted from October 2016 to March 2017, comprised of a national sample of the Bhutan pediatric patient population (0-12 years). We collected data on peripheral intravenous catheter first time insertion success rate of admitted pediatric patients, to identify predictors of a successful first time attempt. Clustered log binomial generalized linear models were used to obtain the prevalence of first time attempt success and predictors of success.
: The prevalence rate of successful first time attempt adjusted for clustering was 64% (95% confidence interval: 51%-80%). Predictors of a successful first time attempt were older patient age, lighter skin color, the vein being visible with a tourniquet, and the left hand being used for insertion. A transilluminator was used in 52 patients, and the peripheral intravenous catheter was eventually successfully placed in 82% of the patients.
: Our first time successful cannulation rate is substantially lower than that found in similar studies in other countries. Considering the impact a peripheral intravenous catheter has on patients' clinical outcomes and cost implications, reducing the number of failed attempts should be of high importance. Better education and simulation, combined with the adoption of vessel locating technology, are required to improve insertion practice in Bhutan. This could lead to greater efficiency of the health facilities in Bhutan.
在不丹，外周静脉导管插入术是护士为儿科患者普遍实施的一项临床操作。本研究描述了外周静脉导管首次插入的成功率以及与此类插入相关的因素。
于2016年10月至2017年3月进行了一项横断面调查，样本来自不丹全国范围内的儿科患者群体（0至12岁）。我们收集了入院儿科患者外周静脉导管首次插入成功率的数据，以确定首次尝试成功的预测因素。采用聚类对数二项式广义线性模型来获得首次尝试成功的患病率及成功的预测因素。
经聚类调整后的首次尝试成功患病率为64%（95%置信区间：51% - 80%）。首次尝试成功的预测因素包括患者年龄较大、肤色较浅、使用止血带时静脉可见以及使用左手进行插入。52例患者使用了透照器，最终82%的患者外周静脉导管成功置入。
我们的首次成功插管率显著低于其他国家类似研究中的结果。考虑到外周静脉导管对患者临床结局的影响及成本因素，减少失败尝试的次数应具有高度重要性。不丹需要更好的教育和模拟，并结合采用血管定位技术来改善插入操作。这可能会提高不丹医疗机构的效率。
