Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertions

doi:10.1016/j.hrtlng.2005.04.002

Heart & Lung

Volume 34, Issue 5, September–October 2005, Pages 345-359

https://doi.org/10.1016/j.hrtlng.2005.04.002 Get rights and content

Background

Inserting an intravenous catheter (IV) is one of the most frequently performed invasive procedures by nurses. Little research has been conducted on ways to reduce the difficulty and failure, and enhance the ease and success, of IV insertion. We conducted this study to determine variables associated with IV insertion difficulty, failure, and success, and to learn special techniques nurses use to facilitate IV insertion.

Methods

Data were collected on 339 IV insertions in hospitalized patients by 34 registered nurses. The data included information about the nurse (eg, age, education, and self-rated IV insertion skill); the patient (eg, age and race); the IV (eg, site, gauge, and type); and the IV insertion, (eg, duration and difficulty). Data were analyzed to determine the effects of these variables on IV insertion outcome. In addition, nurses were asked to describe special techniques they used to facilitate IV insertion.

Results

A total of 77% of the IV insertions were successful. Nurses who were older, had more years of experience, were certified in a specialty, and rated themselves higher in insertion skill had significantly more successful insertions than their younger and less-experienced and less-skilled counterparts (P < .001). Successful IV insertions were significantly faster (mean 32 seconds) than unsuccessful ones (mean 66 seconds) (P < .001), and were rated as significantly less difficult (P < .001). Failed IV insertions were associated with higher degrees of difficulty arising from vein variables, such as vein rolled or vein was resistant to puncture, and patient variables, such as tough or dark skin and patient movement. The nurses described a wide variety of techniques to facilitate insertion success. The most frequently mentioned were getting self and patient in a comfortable position, using mechanical stimulation such as tapping the vein, and stabilizing the vein.

Conclusion

Approximately one fourth of the 339 IV insertions in this study were unsuccessful. Repeated insertion attempts are painful and costly. This study identified nurse, patient, and IV variables associated with IV insertion success and failure. Future research is needed to confirm and expand these findings and to develop interventions to improve IV insertion skills and outcomes.

Section snippets

Research questions

The study was conducted to answer the following research questions:

1
Do IV-related variables, such as insertion site, catheter gauge and type, and insertion time, contribute to insertion difficulty and failure?
2
Do patient variables, such as age, sex, race, and vein characteristics, contribute to IV insertion difficulty and failure?
3
Do nurse variables, such as age, years of experience, number of IV catheters inserted per week, specialty certification, educational preparation, and self-rated IV

Method

This descriptive study was conducted at a large urban hospital in the Southwestern United States after approval by the hospital’s institutional review board. All nurse participants gave written consent before taking part in the study. Data were collected from 1997 to 1998.

Results

Data were collected from 34 registered nurses who attempted 339 IV insertions, of which 260 (77%) attempts were successful (Table III). All but three of the nurses provided data for 10 attempted insertions. The other three nurses provided data for four, nine, and 16 attempted insertions each. Twenty-one of the attempted insertions were a second attempt by the same nurse in the same patient after a failed insertion attempt. In two cases, the same nurse made three attempts in the same patient.

Discussion

Twenty-three percent of the 339 IV insertions in this study were unsuccessful. This percentage is within the range of previously reported failure rates of from 9% to 56%.3, 4, 5, 8, 9

Unsuccessful IV insertion attempts can adversely affect patients’ attitudes about the nurse and perceptions about the nurse’s caring. Patients’ perceptions of nurse caring are strongly linked to their beliefs about the nurse’s skill in technical procedures such as IV insertion.10, 11, 12, 13 A widely used patient

Recommendations for practice

Insertion of an IV catheter is one of the most technically difficult procedures a nurse performs.²³ More than 20 years ago, Millam noted that most nurses gain this important skill through “trial and error” (p. 40).²⁴ Most technical skills, whether starting an IV, inserting a nasogastric tube, or auscultating heart and lung sounds, are best learned with an instructor with expertise in the skill, supervised practice, and experience with real patients. Volume does count, as does individualization,

Limitations

This study was conducted in only one hospital with a convenience sample of 34 nurses who collected the data after starting IVs on their patients. We used predominantly self-report measures for characteristics of the IV insertion. Nurse participants’ responses to the items regarding insertion difficulty and difficulty variables may have been influenced by whether the insertion was successful.

Each nurse collected data on approximately 10 IV insertions. Ten insertions may not provide an adequate

Conclusion

Twenty-three percent of the 339 IV insertions in this study were unsuccessful, necessitating further insertion attempts. Repeated insertion attempts are painful and dissatisfying for the patient, inconvenient and frustrating for the nurse, and costly and time-consuming for the institution. Nurses who rated their IV insertion skill higher, performed more frequent IV insertions, were certified in a clinical specialty, and had more years of experience had significantly higher success rates. The

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: Sigma Theta Tau International, Delta Xi Chapter funded this project.

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Variables influencing intravenous catheter insertion difficulty and failure: An analysis of 339 intravenous catheter insertions

Background

Methods

Results

Conclusion

Section snippets

Research questions

Method

Results

Discussion

Recommendations for practice

Limitations

Conclusion

Ann Emerg Med

Heart Lung

Heart Lung

Am J Med

Am J Infect Control

Am J Infect Control

Nursing interventions used in practice (Report on the NIC Project)

Am J Nurs

I can start that IV with one attempt

NITA

Success rates for peripheral IV insertion in a children’s hospital

J Intraven Nurs

Effect of intradermal normal saline, listening to music, and insertion difficulty on pain of IV insertion [dissertation]

Pain during insertion of peripheral intravenous catheters with and without intradermal lidocaine

Clin Nurse Spec

Buffered lidocaineanalgesia for intravenous line placement in children

Pediatrics

Emergency department patients’ perception of nurse caring behaviors

Heart Lung

Important nurse caring behaviors perceived by patients with cancer

Oncol Nurs Forum

Comparison of cancer patients’ and professional nurses’ perceptions of important nurse caring behaviors

Heart Lung