Access Granted: Investigating the Outcomes of Emergency Medical Services-Placed Peripheral Intravenous Catheters in Pre-Hospital Care

Document Type

Conference Proceeding

Publication Date

10-2023

Publication Title

Annals of Emergency Medicine

Abstract

Objectives: In the pre-hospital setting, EMS (emergency medical services) providers are responsible for the difficult task of obtaining peripheral intravenous catheter (PIVC) access while transporting patients to definitive care. Given the high complexity, high severity of illness, and the likelihood of hospital admission in this fragile population, establishing reliable and functional vascular access is critical to provide therapeutics in a timely manner. EMS-initiated access is often utilized for field treatment, emergency department (ED), and inpatient care. EMS personnel’s insertion-related choices substantially impact patient outcomes and complications related to vascular access. Currently, there is limited evidence describing the outcomes of EMS-placed PIVCs. It is also unclear if EMS practices adhere to best practice recommendations for PIVC insertions. Our objective is to describe characteristics and outcomes associated with EMS-placed PIVCs. Additionally, we aim to compare current practices to best practice recommendations. Methods: This study was a multicenter observational investigation conducted at four sites ranging from small/midsize community centers to a large academic tertiary care center evaluating outcomes associated with EMS-placed PIVCs. Data were retrieved from the electronic medical record and included using a standardized vascular access flowsheet started and completed by nursing in the ED or inpatient wards. We measured dwell time, the time from PIVC placement to completion of therapy or PIVC removal. Eligible subjects included adults presenting to the ED via EMS transport who had an EMS-placed PIVC. The primary endpoint was PIVC failure. Additionally, compliance with best practice insertion methods was explored. Results: From 1/1/21 to 3/25/23, 21,170 patients had an EMS-placed PIVC. The median age was 69 (IQR 53, 81), with 51.2% being female. Most patients were admitted to the hospital (64.9%), with 43.3% of those admitted requiring ICU or step-down level care during their hospitalization. EMS-placed PIVCs failed before completion of therapy in 56.4% of admitted patients and 16.7% of ED patients. PIVCs placed in admitted patients had a median dwell time of 51.93 hours (IQR 27.53, 90.53). The most common causes of PIVC failure included leaking (47.1%), infiltration (38.3%), and occlusion (14.6%). Regarding insertion practices, EMS PIVCs were most commonly placed in the antecubital fossa (49.5%), followed by the forearm (20.8%). Insertions in the hand/wrist comprised 6.9% of placements. For device selection, 20-gauge catheters were the most commonly used in 63.5% of cases, with 18-gauge catheters in 24.5%. Conclusions: This large-scale investigation overviews the landscape of EMS-inserted PIVCs. As the majority of PIVCs fail before completion of therapy, this represents a potential area of focus for pre-hospital care. Harmonizing current practice and patient’s clinical needs with best practice standards, addressing anatomic site and catheter size, may reduce failure rates in this cohort. Further research on EMS PIVCs is needed to op

Volume

82

Issue

4 Suppl.

First Page

S91

Comments

American College of Emergency Physicians ACEP Research Forum, October 9-12, 2023, Philadelphia, PA

DOI

10.1016/j.annemergmed.2023.08.220

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