Multivariable Analysis of Factors Associated With Intravenous Access First Attempt and Overall Success in Hospitalised Medical-Surgical Adults

To determine patient and nursing factors associated with peripheral intravenous access success among hospitalised adults on medical-surgical units. A prospective, cross-sectional, correlational design was guided by STROBE. Within a quaternary care hospital with multiple medical-surgical units, nurses who attempted intravenous access completed case report forms and medical records were reviewed to record 38 factors associated with intravenous access success. After identifying factors associated with first attempt and overall intravenous access success in univariate analyses, prediction models were fit and calibration (based on plots) and discrimination (using the C-statistic) were evaluated using bootstrap sampling. Of 394 adults, 244 (61.9%) had first attempt and 323 (82.0%) had overall intravenous access success. Ultrasound was used in 227 (57.6%) intravenous access attempts and use was associated with less vein visibility and palpability and higher nurse perception of difficult intravenous access. In multivariable modelling, four factors were associated with first attempt intravenous access success: using a wrist vein, higher nurse expertise in intravenous access, nurse use of an ultrasound in patients with high-risk vein characteristics, and higher nurse confidence in first attempt success; model goodness of fit was good. Seven factors were associated with overall intravenous access success: shorter patient hospital length of stay, no history of diabetes, higher patient anxiety level, nurse use of an ultrasound in patients with high-risk vein characteristics, higher nurse expertise in intravenous access, higher nurse confidence in first attempt success, and nurse prediction of difficult intravenous access was low; model goodness of fit was strong. Patients' vein characteristics and nurses' confidence in first attempt intravenous access success were predominant characteristics of intravenous access success. Factors of importance in achieving intravenous access can be easily assessed prior to first attempt and may enhance first attempt and overall success. Authors adhered to relevant EQUATOR guidelines and used the following reporting method: STROBE (The Strengthening the Reporting of Observational Studies).