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. 2022 Dec;34(6):862-870.
doi: 10.1111/1742-6723.14069. Epub 2022 Aug 29.

Review article: Peripheral intravenous catheter insertion in adult patients with difficult intravenous access: A systematic review of assessment instruments, clinical practice guidelines and escalation pathways

Rebecca S Paterson  1   2 , Jessica A Schults  1   2   3 , Eugene Slaughter  1 , Marie Cooke  2 , Amanda Ullman  1   2   4 , Tricia M Kleidon  1   2   4 , Gerben Keijzers  2   5   6   7 , Nicole Marsh  1   2   8 , Claire M Rickard  1   2   3   8
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Review article: Peripheral intravenous catheter insertion in adult patients with difficult intravenous access: A systematic review of assessment instruments, clinical practice guidelines and escalation pathways

Rebecca S Paterson et al. Emerg Med Australas. 2022 Dec.

Abstract

The optimal approach for peripheral intravenous catheter (PIVC) insertion in adult hospitalised patients with difficult intravenous access (DIVA) is unknown. The present study aimed to critically appraise the quality of (i) assessment instruments and (ii) clinical practice guidelines (CPGs) or escalation pathways for identifying and managing patients with DIVA. Cochrane Central Register of Controlled Trials, EBSCO MEDLINE, EMBASE (OVID) and EBSCO CINAHL databases were searched on 22 March 2021. Studies describing a DIVA assessment measure, CPG or escalation pathway for PIVC insertion in adults (≥18 years of age) were included. Data were extracted using a standardised data extraction form including study design, type of resource and reported clinical outcomes. Quality of DIVA assessment instruments were reviewed using the COnsensus-based Standards for the selection of health Measurement Instruments checklist. Methodological quality of CPGs and escalation pathways was assessed using the Appraisal of Guidelines for Research and Evaluation-II (AGREE-II) instrument. Overall, 24 DIVA resources comprising 16 DIVA assessment instruments and nine CPGs or escalation pathways (including one combined assessment instrument and escalation pathway) were identified. Instruments commonly focused on vein visibility and palpability as indicators of DIVA. CPGs and escalation pathways unanimously recommended use of vessel visualisation technology for patients with or suspected of DIVA. Methodological quality of the resources was mixed. Consensus and standardisation of resources to identify DIVA and recommendations for managing patients with DIVA is limited. Adopting consistent, evidence-based CPGs, escalation pathways or DIVA assessment instruments may significantly improve clinical outcomes.

Keywords: adults; clinical decision-making; inpatients; peripheral catheterization.

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Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic reviews and Meta‐Analyses (PRISMA) flow diagram for included studies.
See this image and copyright information in PMC

References

    1. Alexandrou E, Ray‐Barruel G, Carr PJ et al. International prevalence of the use of peripheral intravenous catheters. J. Hosp. Med. 2015; 10: 530–3. - PubMed
    1. Cooke M, Ullman AJ, Ray‐Barruel G et al. Not ‘just’ an intravenous line: consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross‐sectional survey of 25 countries. PLoS One 2018; 13: e0193436. - PMC - PubMed
    1. Jacobson AF, Winslow EH. Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung 2005; 34: 345–59. - PubMed
    1. Sebbane M, Claret PG, Lefebvre S et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J. Emerg. Med. 2013; 44: 299–305. - PubMed
    1. Lapostolle F, Catineau J, Garrigue B et al. Prospective evaluation of peripheral venous access difficulty in emergency care. Intensive Care Med. 2007; 33: 1452–7. - PubMed

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