Peripheral intravenous catheter insertion and use of ultrasound in patients with difficult intravenous access: Australian patient and practitioner perspectives to inform future implementation strategies

• Published in: PloS one Vol. 17; no. 6; p. e0269788
• Main Authors: 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, Cooke, Marie
• Format: Journal Article
• Language: English
• Published: San Francisco Public Library of Science 24.06.2022; Public Library of Science (PLoS)
• Subjects: Adaptation; Biology and Life Sciences; Catheters; Complications and side effects; Data analysis; Decision making; Education; Engineering and Technology; Health care; Health care policy; Health services; Insertion; Interviews; Intravenous administration; Intravenous catheterization; Medical care; Medical instruments; Medical personnel; Medicine and Health Sciences; Patient outcomes; Patients; People and Places; Qualitative research; Quality management; Social Sciences; Ultrasonic imaging; Ultrasonic testing; Ultrasound; Australia; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0269788

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). 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. 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. 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.