CQUniversity researchers calling for patient participants in intravenous study who live in regional, rural or remote areas

Published:28 October 2020

CQUniversity Head of College of Nursing and Midwifery Associate Professor Pauline Calleja

CQUniversity researchers are calling for participants living in regional, rural and remote Australia to participate in a study that aims to inform implementation strategies for intravenous insertion.

Leading the research at CQUniversity is Head of College of Nursing and Midwifery Associate Professor Pauline Calleja.

“An important aspect of our study is to undertake stakeholder interviews with patients who have experience with difficult peripheral intravenous catheter (PIVC) insertion,” Assoc. Prof Calleja said.

“Regional, rural and remote patients who have had failed PIVC attempts are invited to participate in a face-to-face or phone/skype interview where they will be asked a series of open-ended questions for the study. The meetings will last approximately 30 minutes.

“These interviews will help us understand current and desired approaches to PIVC insertion in patients who have difficult venous access with a view to develop a care pathway.

“We believe high quality research is necessary to inform clinical practices, to prevent harm and promote patient-centred care,” she explained.

Peripheral intravenous catheters (PIVCs) are small plastic tubes inserted via needle puncture into the veins (commonly in hand/arm) to administer fluid and medication across all medical specialties.

Needed by almost all consumers of Australia’s 10.6 million hospital admissions each year, they are predominantly inserted by junior medical and nursing staff. PIVC placement can be difficult, painful and time-consuming – 55 to 67 percent of first insertion attempts fail, with some patients having 10 or more attempts (needle punctures).

“Patients at highest risk are those with Difficult IntraVenous Access (DIVA), due to physiology, pathology or damage from previous medication or PIVCs.”

Populations at risk include:

  • Age extremes – both elderly and neonates have small, frail veins that collapse or rupture; 
  • Chronic disease, e.g. kidney disease, diabetes, cancer with resultant poor vein quality; 
  • Obesity and toddlers, whose excess adipose tissue make veins invisible and/or non-palpable;
  • Rural/remote patients, who may have no immediate access to advanced practitioners. 

“Population trends mean one in three ED presentations, and one in two admitted patients who need a PIVC now meet one or more of these criteria, making this a nationally-important problem.

“Ample evidence exists to support ultrasound PIVC insertion as the first approach for DIVA patients and this is now recommended in international guidelines. However, implementation in Australia is negligible and our current workforce and systems require purposeful adaptation to implement this capacity.”

Assoc. Prof Calleja said the advantage of ultrasound was exact visualisation of vein depth, diameter and quality including valves, bifurcations, and blood flow.

“This assists with vein choice and the insertion procedure. Traditionally, PIVC placement uses landmarks - the ‘feel’ of veins through the skin, or ‘seeing’ veins with the naked eye.

“Using this model, patients only receive ultrasound insertion after multiple failed landmark attempts. This outdated model of care results in pain, waste, and treatment delays or cancellation unless an ultrasound skilled inserter can attend.”