Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.
Department of Science and Technology in Anesthesia Nursing Practice, Fontys University of Applied Sciences, Eindhoven, The Netherlands.
PLoS One. 2021 May 24;16(5):e0252166. doi: 10.1371/journal.pone.0252166. eCollection 2021.
Intravenous cannulation is usually the first procedure performed in modern healthcare, although establishing peripheral intravenous access is challenging in some patients. The impact of the ratio between venous diameter and the size of the inserted catheter (catheter to vein ratio, CVR) on the first attempt success rate can be of added value in clinical. This study tries to give insight into the consideration that must be made when selecting the target vein and the type of catheter, and proved the null hypothesis that an optimal CVR would not be associated with increased first attempt cannulation success.
This was a post-hoc analyses on adult patients admitted for peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines, by applying the traditional landmark approach. The CVR was calculated afterwards for each individual patient by dividing the external diameter of the inserted catheter by the diameter of the target vein, which was multiplied by 100%.
In total, 610 patients were included. The median CVR was 0.39 (0.15) in patients with a successful first attempt, whereas patients with an unsuccessful first attempt had a median CVR of 0.55 (0.20) (P<0.001). The optimal cut-off point of the CVR was 0.41. First attempt cannulation was successful in 92% of patients with a CVR<0.41, whereas as those with a CVR>0.41 had a first attempt success rate of 65% (P<0.001).
This first introduction of the CVR in relation to cannulation success should be further investigated. Although, measuring the venous diameter or detection of a vein with a specific diameter prior to cannulation may increase first attempt cannulation success.
静脉穿刺通常是现代医疗保健中进行的第一步，但在某些患者中建立外周静脉通路具有挑战性。静脉直径与插入导管大小之间的比值（导管与静脉比，CVR）对首次尝试成功率的影响在临床中可能具有附加价值。本研究试图深入了解在选择目标静脉和导管类型时必须考虑的因素，并证明了无效假设，即最佳 CVR 不会与增加首次尝试置管成功率相关。
这是一项对成人患者进行外周静脉穿刺的回顾性分析。静脉穿刺按照实践指南进行，采用传统的地标方法。然后，为每位患者计算 CVR，即将插入导管的外径除以目标静脉的直径，再乘以 100%。
共纳入 610 例患者。首次尝试成功的患者的 CVR 中位数为 0.39（0.15），而首次尝试不成功的患者的 CVR 中位数为 0.55（0.20）（P<0.001）。CVR 的最佳截断值为 0.41。CVR<0.41 的患者首次尝试置管成功率为 92%，而 CVR>0.41 的患者首次尝试置管成功率为 65%（P<0.001）。
首次介绍 CVR 与置管成功率的关系，应进一步研究。尽管在置管前测量静脉直径或检测特定直径的静脉可能会增加首次尝试置管成功率。
