Register      Login
Australian Health Review Australian Health Review Society
Journal of the Australian Healthcare & Hospitals Association
Shopping Cart: ( empty )
You are here: Home > Journals > AH > AH24176
RESEARCH ARTICLE
Online Early

Hospital staff perspectives on the cost and efficiency of peripheral intravenous catheter use: a case study from three Australian hospitals

Kathleen McFadden A * , Claire M. Rickard B C D E , Christine Brown B C D , Amanda Corley B D E F , Jessica A. Schults B C D G , Alison Craswell https://orcid.org/0000-0001-8603-3134 D H I and Joshua Byrnes A
+ Author Affiliations
- Author Affiliations

A Centre for Applied Health Economics, School of Medicine and Dentistry, Menzies Health Institute Queensland, Griffith University, Brisbane, Qld, Australia.

B School of Nursing, Midwifery and Social Work, UQ Centre for Clinical Research, The University of Queensland, Brisbane, Qld, Australia.

C Herston Infectious Diseases Institute (HeIDI), Metro North Health, Brisbane, Qld, Australia.

D Schools of Nursing and Midwifery and Pharmacy and Medical Sciences, Alliance for Vascular Access Teaching and Research, Griffith University, Brisbane, Australia.

E Nursing Midwifery Research Centre, Royal Brisbane and Women’s Hospital, Brisbane, Qld, Australia.

F Adult Intensive Care Services and Critical Care Research Group, The Prince Charles Hospital, Brisbane, Qld, Australia.

G Child Health Research Centre, The University of Queensland, Brisbane, Qld, Australia.

H The University of the Sunshine Coast, Sunshine Coast Health Institute, Birtinya, Qld, Australia.

I Caboolture and Kilcoy Hospitals and Woodford Corrections, Caboolture, Qld, Australia.

* Correspondence to: k.mcfadden@griffith.edu.au

Australian Health Review https://doi.org/10.1071/AH24176
Submitted: 23 April 2024  Accepted: 29 July 2024  Published: 26 August 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of AHHA.

Abstract

Peripheral intravenous catheters (PIVCs) are required by most hospitalised patients. Difficult intravenous access (DIVA) makes insertion challenging, with poor patient outcomes, treatment delays and resource waste from multiple insertion attempts, often by multiple clinicians. This exploratory qualitative case study aimed to investigate how clinical and executive hospital staff view PIVC insertions for patients with DIVA from a cost and efficiency perspective. Fifteen semi-structured interviews were conducted with staff from three large, urban Australian hospitals. Data was thematically analysed, with four themes generated: (1) PIVCs are not considered from a cost or resource use perspective; (2) resources required for successful PIVC insertion are variable and unpredictable; (3) limited funding and support exist for advanced skill and ultrasound-guided insertion; and (4) processes for PIVC training and competency are inefficient. Investment in advanced PIVC inserters (with ultrasound-guided cannulation skills, and ability to train and assess novice inserters), with clear escalation pathways to these clinicians may reduce inefficiencies and waste associated with difficult PIVC insertions.

Keywords: Australia, catheterisation, hospital costs, health economics, peripheral, qualitative, resource use, vascular access devices.

References

1  Alexandrou E, Ray-Barruel G, Carr PJ, Frost SA, Inwood S, Higgins N, et al. Use of Short Peripheral Intravenous Catheters: Characteristics, Management, and Outcomes Worldwide. J Hosp Med 2018; 13(5):.
| Crossref | Google Scholar | PubMed |

2  Australian Commission on Safety and Quality in Health Care. Management of Peripheral Intravenous Catheters Clinical Care Standard. Sydney; 2021.

3  Whalen M, Maliszewski B, Baptiste D-L. Establishing a Dedicated Difficult Vascular Access Team in the Emergency Department: A Needs Assessment. J Infus Nurs 2017; 40(3): 149-154.
| Crossref | Google Scholar | PubMed |

4  Hadaway L, Wise M, Orr M, Bayless A, Dalton L, Guerin G. Making the business case for infusion teams: the purpose, people, and process. J Infus Nurs 2014; 37(5): 321-46.
| Crossref | Google Scholar | PubMed |

5  van Loon FH, Leggett T, Bouwman AR, Dierick-van Daele AT. Cost-utilization of peripheral intravenous cannulation in hospitalized adults: An observational study. J Vasc Access 2020; 21(5): 687-93.
| Crossref | Google Scholar | PubMed |

6  Tuffaha HW, Rickard CM, Webster J, Marsh N, Gordon L, Wallis M, et al. Cost-effectiveness analysis of clinically indicated versus routine replacement of peripheral intravenous catheters. Appl Health Econ Health Policy 2014; 12(1): 51-8.
| Crossref | Google Scholar | PubMed |

7  Shokoohi H, Loesche MA, Duggan NM, Liteplo AS, Huang C, Al Saud AA, et al. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open 2020; 1(6): 1660-8.
| Crossref | Google Scholar | PubMed |

8  Cooke M, Ullman AJ, Ray-Barruel G, Wallis M, Corley A, Rickard CM. Not “just” an intravenous line: Consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS One 2018; 13(2): e0193436.
| Crossref | Google Scholar | PubMed |

9  Marsh N, Webster J, Larsen E, Cooke M, Mihala G, Rickard CM. Observational Study of Peripheral Intravenous Catheter Outcomes in Adult Hospitalized Patients: A Multivariable Analysis of Peripheral Intravenous Catheter Failure. J Hosp Med 2018; 13(2): 83-9.
| Crossref | Google Scholar | PubMed |

10  Umscheid CA, Mitchell MD, Doshi JA, Agarwal R, Williams K, Brennan PJ. Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs. Infect Control Hosp Epidemiol 2011; 32(2): 101-14.
| Crossref | Google Scholar | PubMed |

11  Morgan R, Callander E, Cullen L, Walker K, Bumpstead S, Hawkins T, Kuhn L, Egerton-Warburton D. From little things, big things grow: An exploratory analysis of the national cost of peripheral intravenous catheter insertion in Australian adult emergency care. Emerg Med Australas 2022; 34(6): 877-883.
| Crossref | Google Scholar | PubMed |

12  Schults JA, Marsh N, Ullman AJ, Kleidon TM, Ware RS, Byrnes J, et al. Improving difficult peripheral intravenous access requires thought, training and technology (DART3): a stepped-wedge, cluster randomised controlled trial protocol. BMC Health Serv Res 2023; 23(1): 587.
| Crossref | Google Scholar | PubMed |

13  Palinkas LA, Horwitz SM, Green CA, Wisdom JP, Duan N, Hoagwood K. Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research. Adm Policy Ment Health 2015; 42(5): 533-44.
| Crossref | Google Scholar | PubMed |

14  Seale C, Silverman D. Ensuring rigour in qualitative research. Eur J Public Health 1997; 7(4): 379-84.
| Google Scholar |

15  Braun V, Clarke V, Hayfield N, Terry G Thematic Analysis. In: Liamputtong P, editor. Handbook of Research Methods in Health Social Sciences. Singapore: Springer Singapore; 2019. pp. 843–60.

16  Tong A, Sainsbury P, Craig J. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care 2007; 19(6): 349-57.
| Crossref | Google Scholar | PubMed |

17  Holt D, Dodd-Butera T, Stebel M, Lichtenberger H, Sharpe E. Impact of a Vascular Access Specialty Service on Hospitalized Pediatric Patients: A Pilot Feasibility Study. J Assoc Vasc Access 2024; 29: 8-34.
| Crossref | Google Scholar |

18  Corcuera Martínez MI, Aldonza Torres M, Díez Revilla AM, et al. Impact assessment following implementation of a vascular access team. J Vasc Access 2022; 23(1): 135-144.
| Crossref | Google Scholar | PubMed |

19  Carr P, Moureau N. Specialised Vascular Access Teams. In: Springer C, editor. Vessel Health and Prevention: The Right Approach for Vascular Access. Springer, Cham; 2019. pp. 59–65.

20  Benkhadra M, Collignon M, Fournel I, Oeuvrard C, Rollin P, Perrin M, et al. Ultrasound guidance allows faster peripheral IV cannulation in children under 3 years of age with difficult venous access: a prospective randomized study. Paediatr Anaesth 2012; 22(5): 449-54.
| Crossref | Google Scholar | PubMed |

21  Doniger SJ, Ishimine P, Fox JC, Kanegaye JT. Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care 2009; 25(3): 154-9.
| Crossref | Google Scholar | PubMed |

22  Egan G, Healy D, O’Neill H, Clarke-Moloney M, Grace PA, Walsh SR. Ultrasound guidance for difficult peripheral venous access: systematic review and meta-analysis. Emerg Med J 2013; 30(7): 521-6.
| Crossref | Google Scholar | PubMed |

23  Parker SIA, Benzies KM, Hayden KA. A systematic review: effectiveness of pediatric peripheral intravenous catheterization strategies. J Adv Nurs 2017; 73(7): 1570-82.
| Crossref | Google Scholar | PubMed |

24  Schults J, Rickard C, Kleidon T, Paterson R, Macfarlane F, Ullman A. Difficult Peripheral Venous Access in Children: An International Survey and Critical Appraisal of Assessment Tools and Escalation Pathways. J Nurs Scholarsh 2019; 51(5): 537-46.
| Crossref | Google Scholar | PubMed |

25  Branfield Day L, Miles A, Ginsburg S, Melvin L. Resident Perceptions of Assessment and Feedback in Competency-Based Medical Education: A Focus Group Study of One Internal Medicine Residency Program. Acad Med 2020; 95(11): 1712-1717.
| Crossref | Google Scholar | PubMed |

26  Caverzagie KJ, Nousiainen MT, Ferguson PC, ten Cate O, Ross S, Harris KA, Busari J, et al. Overarching challenges to the implementation of competency-based medical education. Med Teach 2017; 39(6): 588-593.
| Crossref | Google Scholar | PubMed |