Lee Se Uk, Jung Jae Yun, Ham Eun Mi, Wang Sang Won, Park Joong Wan, Hwang Soyun, Kim Do Kyun, Kwak Young Ho
Department of Emergency Medicine, Seoul Metropolitan Government-Seoul National University Boramae Medical Center, Seoul, South Korea.
Department of Emergency Medicine, Seoul National University Hospital, Seoul, South Korea.
J Vasc Access. 2020 Mar;21(2):180-185. doi: 10.1177/1129729819865709. Epub 2019 Aug 3.
Successful intravenous catheter placement plays a vital role in the pediatric emergency department. We assessed pediatric emergency department-related factors associated with difficult intravenous catheter placement.
We retrospectively reviewed the electronic medical records of patients younger than 18 years who had an intravenous catheter placement attempt during their pediatric emergency department stay. Difficult intravenous access was defined as intravenous catheter placement requiring more than one attempt. The demographic-, clinical- and procedure-related factors were collected, and a logistic regression analysis was used to evaluate the factors associated with difficult intravenous access.
In total, 925 patients were enrolled, and 77 (8.32%) cases had difficult intravenous access. The median age of the patients was 3.0 (interquartile range = 1-9) years, and 496 (53.6%) patients were male. After adjustment, we found that age (odds ratio = 0.91, 95% confidence interval = (0.85-0.98), p = 0.01); a history of prematurity (odds ratio = 2.31, 95% confidence interval (1.08-4.98), p = 0.03); the intravenous catheter insertion site (foot versus hand odds ratio = 5.65, 95% confidence interval = (2.97-10.75); p < 0.001); and the experience of the provider (<6 months versus ⩾12 months odds ratio = 4.59, 95% confidence interval = (1.92-11.01), p = 0.01) were associated with difficult intravenous access. However, the acuity of disease, crowdedness at the pediatric emergency department, sex, vein visibility, vein palpability, intravenous catheter size, patients' experience with intravenous access, and time of day were not significantly correlated with difficult intravenous access.
The success rate of intravenous catheter placement at the pediatric emergency department could be improved by experienced providers. The acuity of disease and crowdedness at the pediatric emergency department were not significantly associated factors.
在儿科急诊科，成功放置静脉导管起着至关重要的作用。我们评估了与困难静脉导管放置相关的儿科急诊科相关因素。
我们回顾性分析了18岁以下在儿科急诊科住院期间尝试放置静脉导管的患者的电子病历。困难静脉通路定义为静脉导管放置需要多次尝试。收集了人口统计学、临床和操作相关因素，并使用逻辑回归分析评估与困难静脉通路相关的因素。
共纳入925例患者，其中77例（8.32%）存在困难静脉通路。患者的中位年龄为3.0岁（四分位间距=1-9岁），496例（53.6%）患者为男性。调整后，我们发现年龄（比值比=0.91，95%置信区间=（0.85-0.98），p=0.01）；早产史（比值比=2.31，95%置信区间（1.08-4.98），p=0.03）；静脉导管插入部位（足部与手部比值比=5.65，95%置信区间=（2.97-10.75）；p<0.001）；以及医护人员的经验（<6个月与≥12个月比值比=4.59，95%置信区间=（1.92-11.01），p=0.01）与困难静脉通路相关。然而，疾病严重程度、儿科急诊科的拥挤程度、性别、静脉可见度、静脉可触知性、静脉导管尺寸、患者静脉通路经验以及一天中的时间与困难静脉通路无显著相关性。
经验丰富的医护人员可提高儿科急诊科静脉导管放置的成功率。疾病严重程度和儿科急诊科的拥挤程度不是显著相关因素。
