Multivariate Analysis of Successful Intravenous Line Placement in the Prehospital Setting
Prehospital Emergency Care, Posted online on August 22, 2012.
Intravenous (IV) line placement is an important prehospital advanced life support skill, but IV success rates are variable among providers. For those who want to improve their success rates the answer may be simply increasing the size of the IV cannula you are using.
The authors aimed to identify whether first-pass IV success was associated with the number of attempted or successful previous IV attempts – they hypothesized that IV success is associated with the number of successful IV placements in the preceding year. 800 consecutive charts with an IV attempt from 11 suburban and rural emergency medical services (EMS) agencies over a one-month period were analysed, with success of the first IV attempt identified. Potential predictor variables were collected and analysed, including patient age, systolic blood pressure, history of IV drug abuse or renal disease, traumatic event, catheter size, and location of IV attempt, as well as the individual provider’s numbers of total and successful IV attempts in the preceding year.
Of 602 cases meeting the study criteria, 469 (77.9%) had a successful first-pass IV placement. Significantly associated with IV success in the univariate regression were patient age, trauma, IV catheter size, IV location, and the number of previous successful IV attempts. In the multivariate logistic regression model, however, only IV catheter size had a significant association, with a larger-bore IV catheter size associated with higher success.
The authors concluded that in this retrospective study, larger IV catheter size, but not the prehospital providers’ previous years’ experience, was associated with successful IV placement in adult patients and that the data fail to support requirements for a minimum number of yearly IV placements by full-time paramedics to improve success rates.
http://informahealthcare.com/doi/abs/10.3109/10903127.2012.710717