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  • Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician 'gestalt' wins again

    Author(s)
    Rippey, James CR
    Carr, Peter J
    Cooke, Marie
    Higgins, Niall
    Rickard, Claire M
    Griffith University Author(s)
    Cooke, Marie L.
    Rickard, Claire
    Higgins, Niall S.
    Carr, Peter J
    Rippey, James
    Year published
    2016
    Metadata
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    Abstract
    Objective Failed attempts at peripheral i.v. cannula (PIVC) insertion in the ED are common. The psychological, physical and economic impact of these failures is significant. We sought to explore whether clinicians of differing experience levels can predict their own likelihood (clinician ‘gestalt’) of first-time cannula insertion success on any given patient. Methods Data analyses from a prospective self-reported study assessing risk factors for first-time insertion success in a tertiary adult ED. We constructed and compared two simple theoretical clinical decision algorithms in an attempt to improve first-time PIVC insertion ...
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    Objective Failed attempts at peripheral i.v. cannula (PIVC) insertion in the ED are common. The psychological, physical and economic impact of these failures is significant. We sought to explore whether clinicians of differing experience levels can predict their own likelihood (clinician ‘gestalt’) of first-time cannula insertion success on any given patient. Methods Data analyses from a prospective self-reported study assessing risk factors for first-time insertion success in a tertiary adult ED. We constructed and compared two simple theoretical clinical decision algorithms in an attempt to improve first-time PIVC insertion success rates. Results This best algorithm identified a subgroup of 18% of the total PIVC population at higher risk of failure. This 18% comprised 57% of all PIVC failures, and implementation would result in a relative risk reduction of PIVC failure by 31%. Conclusions When applied to our sample population, an algorithm relying on clinician gestalt to identify patients at high risk of PIVC failure had the greatest potential impact. These patients would be referred to expert PIVC inserters prior to, rather than after, failed attempts.
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    Journal Title
    Emergency Medicine Australasia
    Volume
    28
    DOI
    https://doi.org/10.1111/1742-6723.12695
    Subject
    Emergency Medicine
    Clinical Sciences
    Public Health and Health Services
    Publication URI
    http://hdl.handle.net/10072/101176
    Collection
    • Journal articles

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