Evaluation of the Impact of an Educational Intervention for Staff on the Rate of Peripheral Venous Catheters Inserted and Unused in Emergency Departments.

The placement of peripheral venous catheters (PVC) is a common practice in various hospital departments in France. It is estimated at 25 million per year in France according to the French Society for Hospital Hygiene (SFHH) in 2005.

According to Gledstone-Brown et al., the prescription of catheters "just in case" has been a longstanding practice in emergency departments (ED), initially motivated to improve patient safety. The recurring issue was the need for an emergency catheter placement once the patient was admitted to a hospital ward. Additionally, the hypothesis that an easily insertable catheter, performed concurrently with a blood draw, could facilitate future assessments or intravenous medication administration seemed appealing.

As a result, a significant proportion of catheters are unnecessarily placed, ranging from 23.7% to 60.7% according to studies. Limm et al. conducted a retrospective study in 2013 focusing on PVCs placed in an Australian ED. Emergency reports of all adult patients with a PVC were reviewed, excluding those with life-threatening emergencies or those with a pre-existing PVC upon arrival. A PVC was considered unused if it was not employed for fluid administration, medication, or contrast product. Out of 3829 patients admitted to the ED over 30 days, 570 (14.9%) received a PVC, of which 284 (49.8% [95% CI, 45.6-54.0%]) remained unused. Neurological or gynecological-obstetric consultation reasons were associated with non-utilization of PVC (OR 2.3 [95% CI, 0.69-3.8] and 2.1 [95% CI, 0.99-40.2], respectively), contrasting with gastrointestinal or respiratory difficulty consultations. A similar study by Craigie et al. in Canada in 2017 found that 48% of PVCs were unused, with orthopedic, cardiovascular, and hematology consultations being associated with non-utilization. Other studies, such as Salvetti et al.'s in Italy and Vandenbos et al.'s in Nice in 2000, reported percentages of unused PVCs at 60.7% and 33.8%, respectively.

Lewindon rightly emphasizes the need for more precise data on PVC placements in EDs to identify patients who do not require them. In 2018, Guilhard et al. conducted a prospective descriptive study focusing on PVC placements in the ED of the University Hospital of Saint-Denis in La Réunion, using a methodology similar to the aforementioned studies. Out of 605 included patients in the study month, 207 (34.2%) had a PVC placed, with 57% remaining unused. The study also highlighted intravenous prescriptions for medications with oral alternatives, including Paracetamol (51%), Ketoprofen (15%), Tramadol (13%), and Phloroglucinol (10%). Additionally, 142 out of 185 (77%) patients hospitalized from the ED had a PVC. However, Mailhe et al. showed in 2020 that 60.5% of them had their PVC removed within 24 hours of admission. This prospective study included 614 patients hospitalized from the ED to the infectious diseases department of the hospital-university institute of Marseille over six months. Results indicated that 509 (82.9%) arrived with a PVC, 260 (51.5%) were deemed unnecessary from the start, and 308 (60.5%) were removed within 24 hours. These findings align with those of Lederle et al. in 1992, who reported that, among 484 patients with a PVC, 168 (35% [95% CI, 31-39%]) had their catheter unused for at least 48 hours in a prospective study spanning six weeks in four hospital wards in the United States.

Catheter placement is time-consuming for nursing teams and uncomfortable for patients. Couteaux et al. demonstrated in 2008, through a one-day cross-sectional analysis in two hospitals of the Assistance Publique Hôpitaux de Paris (APHP), that vascular punctures (especially venous) were the leading cause of pain among hospitalized patients, with 38% of 671 painful events associated with this procedure. Catheter placement exposes patients to various adverse effects analyzed by Miliani et al. this multicenter prospective observational study (one surgical department and four medical departments in three hospitals in northern France) conducted between June 2013 and June 2014 analyzed the occurrence of adverse effects after PVC placement and up to 48 hours after removal. Among the 815 PVCs analyzed, 164 phlebitis (20.1% [95% CI, 17.4-23.0%]), including 34 manifest ones (grade ≥3 according to Maddox classification, 4.1% [95% CI, 2.9-5.8%]), 144 hematomas at the puncture site (17.7% [95% CI, 15.1-20.5%]), 107 fluid leaks (13.1% [95% CI, 10.9-15.6%]), 31 edemas (3.8% [95% CI, 2.6-5.4%]), and 3 suspicions of catheter-related sepsis (0.4% [95% CI, 0.1-1.1%]) were noted. Finally, a literature review showed that samples taken from a catheter are more often hemolyzed (3.3% to 77% according to studies) than those obtained directly by venous puncture (0% to 3.8%).