Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study

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Evison, Hugo
Carrington, Mercedes
Keijzers, Gerben
Marsh, Nicole M
Sweeny, Amy Lynn
Byrnes, Joshua
Rickard, Claire M
Carr, Peter J
Ranse, Jamie
Griffith University Author(s)
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2022
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Abstract

Objectives Rates of unused ( € idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. Design A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. Setting Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. Participants Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. Results From the 15 clinicians interviewed 4 key themes: knowledge and experience, complicated and multifactorial, convenience, anticipated patient clinical course, and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as knowledge and experience, and decisions being complicated and multifactorial. The remaining two themes related to the actions clinicians took such as convenience and anticipated patient clinical course. Conclusion The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.

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BMJ Open

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12

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3

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© Author(s) (or their employer(s)) 2022. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Biomedical and clinical sciences

Health sciences

Psychology

Science & Technology

Life Sciences & Biomedicine

Medicine, General & Internal

General & Internal Medicine

qualitative research

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Evison, H; Carrington, M; Keijzers, G; Marsh, NM; Sweeny, AL; Byrnes, J; Rickard, CM; Carr, PJ; Ranse, J, Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study, BMJ Open, 2022, 12 (3), pp. e054927

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