Schults, Jessica A., Calleja, Pauline, Slaughter, Eugene, Paterson, Rebecca, Rickard, Claire M., Booker, Catriona, Marsh, Nicole, Fenn, Mary, Kelly, Jenny, Snelling, Peter J., Byrnes, Joshua, Keijzers, Gerben, and Cooke, Marie (2022) Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies. PLoS ONE, 17 (6). e0269788.

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Abstract

Objective: To understand healthcare worker and patient experience with peripheral intravenous catheter (PIVC) insertion in patients with difficult intravenous access (DIVA) including the use of ultrasound (US).

Methods: Descriptive study using 1-on-1 semi-structured interviews conducted between August 2020 and January 2021. Purposeful sampling was used to recruit healthcare practitioners (HCPs) and patients with DIVA who had PIVC experience. Data were analysed using inductive thematic analysis. Interview data were than mapped to the implementation theory Behaviour Change Wheel to inform implementation strategies.

Results: In total 78 interviews (13 patients; 65 HCPs) were completed with respondents from metropolitan (60%), regional (25%) and rural/remote (15%) settings across Australia. Thematic analysis revealed 4 major themes: i) Harmful patient experiences persist, with patient insights not leveraged to effect change; ii) ‘Escalation’ is just a word on the front lines; iii) Heightened risk of insertion failure without resources and training; and iv) Paving the way forward–‘measures need to be in place to prevent failed insertion attempts. Themes were mapped to the behaviour change wheel and implementation strategies developed, these included: staff education, e-health record for DIVA identification, DIVA standard of care and DIVA guidelines to support escalation and ultrasound use.

Conclusion(s): DIVA patients continue to have poor healthcare experiences with PIVC insertion. There is poor standardisation of DIVA assessment, escalation, US use and clinician education across hospitals. Quality, safety, and education improvement opportunities exist to improve the patient with DIVA experience and prevent traumatic insertions. We identified a number of implementation strategies to support future ultrasound and DIVA pathway implementation.

Item ID:	81189
Item Type:	Article (Research - C1)
ISSN:	1932-6203
Copyright Information:	© 2022 Schults et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Funders:	National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants:	NHMRC APP1180193
Date Deposited:	22 Nov 2023 23:21
FoR Codes:	42 HEALTH SCIENCES > 4205 Nursing > 420501 Acute care @ 50% 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 50%
SEO Codes:	20 HEALTH > 2001 Clinical health > 200199 Clinical health not elsewhere classified @ 100%
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