PLoS ONE (Jan 2024)

Prospective observational study of peripheral intravenous cannula utilisation and frequency of intravenous fluid delivery in the emergency department-Convenience or necessity?

  • Michael Willis,
  • Efrem Colonetti,
  • Ali Bakir,
  • Yousef Jamal Alame,
  • Megan Annetts,
  • Deren T Aygin,
  • Amina Daou,
  • Sultan Farooq,
  • Nicholas A Fine,
  • Gozde Firat,
  • Benjamin Goozee,
  • Anuj Neelesh Gupta,
  • Charlotte Hubbett,
  • Nicole Shun Yee Loi,
  • Laura Maciejec-Biskup,
  • Merline Gabriela Muthukumar,
  • Jason Pott,
  • Benjamin M Bloom,
  • Maria Lorenza Muiesan,
  • Tim Harris

DOI
https://doi.org/10.1371/journal.pone.0305276
Journal volume & issue
Vol. 19, no. 6
p. e0305276

Abstract

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BackgroundPeripheral Intravenous Cannulas (PIVCs) are frequently utilised in the Emergency Department (ED) for delivery of medication and phlebotomy. They are associated with complications and have an associated cost to departmental resources. A growing body of international research suggests many of the PIVCs inserted in the ED are unnecessary.MethodsThe objective of this study was to determine the rates of PIVC insertion and use. This was a prospective observational study conducted in one UK ED and one Italian ED. Adult ED patients with non-immediate triage categories were included over a period of three weeks in the UK ED in August 2016 and two weeks in the Italian ED in March and August 2017. Episodes of PIVC insertion and data on PIVC utilisation in adults were recorded. PIVC use was classified as necessary, unnecessary or unused. The proportion of unnecessary and unused PIVCs was calculated. PIVCs were defined as unnecessary if they were either used for phlebotomy only, or solely for IV fluids in patients that could have potentially been hydrated orally (determined against a priori defined criteria). PIVC classified as unused were not used for any purpose.ResultsA total of 1,618 patients were included amongst which 977 PIVCs were inserted. Of the 977 PIVCs, 413 (42%) were necessary, 536 (55%) were unnecessary, and 28 (3%) were unused. Of the unnecessary PIVCs, 473 (48%) were used solely for phlebotomy and 63 (6%) were used for IV fluids in patients that could drink.ConclusionsMore than half of PIVCs placed in the ED were unnecessary in this study. This suggests that clinical decision making about the benefits and risks of PIVC insertion is not being performed on an individual basis.