Background
Inserting an intravenous catheter (IV) is one of the most frequently performed invasive
procedures by nurses. Little research has been conducted on ways to reduce the difficulty
and failure, and enhance the ease and success, of IV insertion. We conducted this
study to determine variables associated with IV insertion difficulty, failure, and
success, and to learn special techniques nurses use to facilitate IV insertion.
Methods
Data were collected on 339 IV insertions in hospitalized patients by 34 registered
nurses. The data included information about the nurse (eg, age, education, and self-rated
IV insertion skill); the patient (eg, age and race); the IV (eg, site, gauge, and
type); and the IV insertion, (eg, duration and difficulty). Data were analyzed to
determine the effects of these variables on IV insertion outcome. In addition, nurses
were asked to describe special techniques they used to facilitate IV insertion.
Results
A total of 77% of the IV insertions were successful. Nurses who were older, had more
years of experience, were certified in a specialty, and rated themselves higher in
insertion skill had significantly more successful insertions than their younger and
less-experienced and less-skilled counterparts (P < .001). Successful IV insertions were significantly faster (mean 32 seconds) than
unsuccessful ones (mean 66 seconds) (P < .001), and were rated as significantly less difficult (P < .001). Failed IV insertions were associated with higher degrees of difficulty arising
from vein variables, such as vein rolled or vein was resistant to puncture, and patient
variables, such as tough or dark skin and patient movement. The nurses described a
wide variety of techniques to facilitate insertion success. The most frequently mentioned
were getting self and patient in a comfortable position, using mechanical stimulation
such as tapping the vein, and stabilizing the vein.
Conclusion
Approximately one fourth of the 339 IV insertions in this study were unsuccessful.
Repeated insertion attempts are painful and costly. This study identified nurse, patient,
and IV variables associated with IV insertion success and failure. Future research
is needed to confirm and expand these findings and to develop interventions to improve
IV insertion skills and outcomes.
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References
- Nursing interventions used in practice (Report on the NIC Project).Am J Nurs. 1994; 94: 59-64
- Comparison of patient and practitioner assessments of pain from commonly performed emergency department procedures.Ann Emerg Med. 1999; 33: 652-658
- Intradermal normal saline, self-selected music, and insertion difficulty effects on IV insertion pain.Heart Lung. 1999; 28: 114-122
- I can start that IV with one attempt.NITA. 1984; 7: 377-378
- Success rates for peripheral IV insertion in a children’s hospital.J Intraven Nurs. 1998; 21: 160-165
Grady NP, Alexander M, Dellenger EP, et al. Guidelines for the prevention of intravascular catheter-related infections. MMWR 2002;51(RR10):1-26. Available at: http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5110a1.htm. Retrieved April 5, 2005.
- Effect of intradermal normal saline, listening to music, and insertion difficulty on pain of IV insertion [dissertation].in: Texas Woman’s University: Dissertation Abstracts International, Denton TX1995: B4815 (56-09)
- Pain during insertion of peripheral intravenous catheters with and without intradermal lidocaine.Clin Nurse Spec. 1999; 13: 283-285
- Buffered lidocaine.Pediatrics. 1995; 95: 709-712
- The importance of nurse caring behaviors as perceived by patients receiving care at an emergency department.Heart Lung. 2002; 31: 67-75
- Emergency department patients’ perception of nurse caring behaviors.Heart Lung. 1993; 22: 356-364
- Important nurse caring behaviors perceived by patients with cancer.Oncol Nurs Forum. 1984; 11: 46-50
- Comparison of cancer patients’ and professional nurses’ perceptions of important nurse caring behaviors.Heart Lung. 1987; 16: 187-193
- Inpatient satisfaction survey.Press, Ganey Associates, Inc, South Bend, IN2001
- The job of IV insertion by expert nurses.Presented at the Midwest Nursing Research Society Conference, Cleveland, OH2001 (March)
- Efficacy of catheter needles with safeguard mechanisms.Anaesthesia. 2002; 57: 572-577
- Traditional versus new needle retractable IV catheter in children.Anesth Analg. 2003; 96: 387-391
- Predictors of nurses’ acceptance of an intravenous catheter safety device.Nurs Res. 2003; 52: 249-255
http://www.osha.gov/SLTC/needlestick. Retrieved January 7, 2005.
- How to teach good venipuncture technique.Am J Nurs. 1993; 93: 38-41
- The epidemiology of peripheral vein infusion thrombophlebitis.Am J Med. 2002; 113: 146-151
- Peripheral I.V. starts.Nursing. 2003; 33: 17
- On the road to successful I.V. starts.Nursing. 2003; 33: 1-14
- Tips for improving your venipuncture techniques.Nursing. 1983; 8313: 40-41
- Prevalence of safer needle devices and factors associated with their adoption.Public Health Rep. 2002; 117: 340-349
- Evaluation of the acceptability of a needleless vascular-access system by nurses.Am J Infect Control. 1997; 25: 434-438
- Factors promoting consistent adherence to safe needle precautions among hospital workers.Infect Control Hosp Epidemiol. 2004; 25: 548-555
- Reduction in nosocomial intravenous device-related bacteremias after institution of an intravenous therapy team.J Intraven Nurs. 1996; 19: 103-106
- The role of the I.V. specialist in health care reform.J Intraven Nurs. 1995; 18: 130-144
- Risk factors for infusion-related phlebitis with small peripheral venous catheters.Ann Intern Med. 1991; 114: 845-854
- The impact of an I.V. team on the occurrence of intravenous-related phlebitis.J Intraven Nurs. 1992; 15: 100-109
- Impact of a dedicated intravenous therapy team on nosocomial bloodstream infection rates.Am J Infect Control. 1998; 2: 388-392
- Prevention of peripheral venous catheter complications with an intravenous therapy team.Arch Intern Med. 1998; 158: 473-477
Article info
Footnotes
Sigma Theta Tau International, Delta Xi Chapter funded this project.
Identification
Copyright
© 2005 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
