20 to 1: New hospital program reduces number of failed IV insertion attempts
Advertisement

20 to 1: New hospital program reduces number of failed IV insertion attempts

Feverish and shaking, Cheryl Tate was relieved to finally be in the hands of the nurses and doctors at Liverpool Hospital. But their multiple attempts to insert a catheter into a vein nearly caused her to scream.

"They tried many, many, many times - on my hands, my feet, my arms, everywhere - but they just couldn't do it," Ms Tate, 60 from Fairfield, said.

Dr Evan Alexandrou uses ultrasound technology to find a vein on patient Cheryl Tate at Liverpool Hospital.

Dr Evan Alexandrou uses ultrasound technology to find a vein on patient Cheryl Tate at Liverpool Hospital.Credit:Dominic Lorrimer

"I just wanted them to stop, I felt like screaming because it was horrible, but I knew it wasn't their fault and they had to do it to get fluids and antibiotics into me."

In a final attempt, a nurse wheeled in an ultrasound machine and used it to guide the catheter into a viable vein near her elbow. It was successful, and notably, pain-free.

Advertisement
Clinical nurse Nicholas Mifflin uses an ultrasound to find a vein in patient Ebony Callaghan at Liverpool Hospital.

Clinical nurse Nicholas Mifflin uses an ultrasound to find a vein in patient Ebony Callaghan at Liverpool Hospital.Credit:Dominic Lorrimer

Over the past two years, the nursing staff at Liverpool Hospital have overhauled the way they deliver intravenous (IV) treatments to patients, reducing the number of failed attempts and therefore the risk of infection.

More than half of all patients admitted to hospital require IV treatment, but more than a third of adults and half of children have veins that are difficult to access - usually because of chronic illness, obesity or malnourishment.

More than half of all the patients admitted to hospital will need an intravenous catheter.

More than half of all the patients admitted to hospital will need an intravenous catheter.

Dr Evan Alexandrou, a clinical nurse consultant at the hospital, said he noticed a rise in the number of patients with chronic and acute diseases presenting to the hospital three years ago.

The medical staff were finding it difficult to find veins - making up to 20 attempts - and increasingly referring patients to the hospital's central venous access team, which specialises in using ultrasound to insert catheters into the head, neck and groin regions.

Dr Alexandrou helped develop a new procedure which requires staff to refer a patient to a senior member after two failed attempts.

The senior member may make up to two further attempts before referring the patient to the team.

"The beauty with ultrasound is that you can visualise the vessel and you can place a catheter in a position where it's not going to move," he said.

"Multiple attempts can cause anxiety, patients can develop phobias. They come to us highly anxious, sometimes crying, and they're essentially at the point of refusing any treatment because of the trauma."

Emergency and resuscitation patients are excluded from this protocol.

Ms Tate, who was taken to Liverpool Hospital by ambulance last Thursday, did not go through this pathway because she was admitted through the emergency department.

Multiple attempts at cannulation and the placement of IV devices in areas such as the wrist and elbow can increase the risk of thrombosis, infection and device failure.

Loading

In a paper published in BMC Nursing, Dr Alexandrou said in 2016, 379 patients were referred to the hospital's after-hours clinical support team for the insertion of a catheter under ultrasound guidance.

His analysis found that in 93 per cent of cases, the nurse was able to successfully insert a catheter on the first go. He also found the average pain score dropped from 7 out of 10, without the use of ultrasound, to 2 out of 10, after referral.

“We have also developed an insertion algorithm to tailor the type of catheter based on the depth of the blood vessel from the skin and the diameter of the vein," he said.

"We also take into account how long the patient may need IV therapy and the type of medication to be infused – all these factors impact on the longevity of the device."

The program has been so successful that it's been rolled out at Campbelltown Hospital and hospitals across the state have expressed interest in developing their own.

Amanda Larkin, CEO of South Western Sydney Local Health District, said research was translating into real benefits for patients.

"This is one of the many innovative practices that our staff have pioneered," she said. "It's a solution to a common problem that's making a big difference.”

Esther Han is a health reporter at The Sydney Morning Herald. She has previously been consumer affairs editor and also covered food and wine.