Peripheral intravenous cannulation decision-making in emergency settings: a qualitative descriptive study.

Abstract

Rates of unused (<i>'</i>idle') peripheral intravenous catheters (PIVCs) are high but can vary per setting. Understanding factors that influence the decision-making of doctors, nurses and paramedics in the emergency setting regarding PIVC insertion, and what factors may modify their decision is essential to identify opportunities to reduce unnecessary cannulations and improve patient-centred outcomes. This study aimed to understand factors associated with clinicians' decision-making on whether to insert or use a PIVC in the emergency care setting. A qualitative descriptive study using in-depth semistructured interviews and thematic analysis. Gold Coast, Queensland, Australia, in a large tertiary level emergency department (ED) and local government ambulance service. Participants recruited were ED clinicians (doctors, nurses) and paramedics who regularly insert PIVCs. From the 15 clinicians interviewed 4 key themes: <i>knowledge and experience, complicated and multifactorial</i>, <i>convenience, anticipated patient clinical course,</i> and several subthemes emerged relating to clinician decision-making across all disciplines. The first two themes focused on decision-making to gather data and evidence, such as <i>knowledge and experience</i>, and decisions being <i>complicated and multifactorial</i>. The remaining two themes related to the actions clinicians took such as <i>convenience</i> and <i>anticipated patient clinical course</i>. The decision to insert a PIVC is more complicated than clinicians, administrators and policy-makers may realise. When explored, clinician decisions were multifaceted with many factors influencing the decision to insert a PIVC. In actual practice, clinicians routinely insert PIVCs in most patients as a learnt reflex with little cognitive input. When considering PIVC insertion, more time needs to be devoted to the awareness of: (1) decision-making in the context of the clinician's own experience, (2) cognitive biases and (3) patient-centred factors. Such awareness will support an appropriate risk assessment which will benefit the patient, clinician and healthcare system.