Kishihara Yuki, Yasuda Hideto, Kashiura Masahiro, Oishi Takatoshi, Shinzato Yutaro, Moriya Takashi
Jichi Ika University Saitama Medical Center, Saitama-shi, Saitama Japan.
J Crit Care Med (Targu Mures). 2024 Jul 31;10(3):213-221. doi: 10.2478/jccm-2024-0025. eCollection 2024 Jul.
Peripheral intravascular catheter (PIVC) insertion is frequently performed in the emergency room (ER) and many failures of initial PIVC insertion occur. To reduce the failures, new needles were developed. This study aimed to investigate whether the use of the newly developed needle reduced the failure of initial PIVC insertion in the ER compared with the use of the existing needle.
This single-centre, prospective observational study was conducted in Japan between April 1, 2022, and February 2, 2023. We included consecutive patients who visited our hospital by ambulance as a secondary emergency on a weekday during the day shift (from 8:00 AM to 5:00 PM). The practitioners for PIVC insertion and assessors were independent. The primary and secondary outcomes were the failure of initial PIVC insertion and number of procedures, respectively. We defined the difficulty of titrating, leakage, and hematoma within 30 s after insertion as failures. To evaluate the association between the outcomes and the use of newly developed needles, we performed multivariate logistic regression and multiple regression analyses by adjusting for covariates.
In total, 522 patients without missing data were analysed, and 81 (15.5%) patients showed failure of initial PIVC insertion. The median number of procedures (interquartile range) was 1 (1-1). Multivariate logistic regression analysis revealed no significant association between the use of newly developed PIVCs and the failure of initial PIVC insertion (odds ratio, 0.79; 95% confidence interval, [0.48-1.31]; p = 0.36). Moreover, multiple regression analysis revealed no significant association between the use of newly developed PIVCs and the number of procedures (regression coefficient, -0.0042; 95% confidence interval, [-0.065-0.056]; p = 0.89).
Our study did not show a difference between the two types of needles with respect to the failure of initial PIVC insertion and the number of procedures.
外周血管内导管（PIVC）插入术常在急诊室（ER）进行，且首次PIVC插入术常出现失败情况。为减少失败率，研发了新型针头。本研究旨在调查与使用现有针头相比，使用新研发的针头是否能降低急诊室首次PIVC插入术的失败率。
本单中心前瞻性观察性研究于2022年4月1日至2023年2月2日在日本进行。我们纳入了在工作日白班（上午8:00至下午5:00）通过救护车作为二级急诊来我院就诊的连续患者。PIVC插入术的操作者和评估者相互独立。主要和次要结局分别为首次PIVC插入术的失败率和操作次数。我们将插入后30秒内滴定困难、渗漏和血肿定义为失败。为评估结局与使用新研发针头之间的关联，我们通过调整协变量进行多因素逻辑回归和多元回归分析。
总共分析了522例无缺失数据的患者，其中81例（15.5%）患者首次PIVC插入术失败。操作次数的中位数（四分位间距）为1（1 - 1）。多因素逻辑回归分析显示，使用新研发的PIVC与首次PIVC插入术失败之间无显著关联（优势比，0.79；95%置信区间，[0.48 - 1.31]；p = 0.36）。此外，多元回归分析显示，使用新研发的PIVC与操作次数之间无显著关联（回归系数， - 0.0042；95%置信区间，[-0.065 - 0.056]；p = 0.89）。
我们的研究未显示两种类型的针头在首次PIVC插入术失败率和操作次数方面存在差异。
