Blood sampling by venepuncture or intravenous cannula in moderate acuity emergency department patients.

Adult patients (>18 years) admitted to the emergency department whose health condition requires a blood sample to be drawn, the insertion of a peripheral intravenous cannula (PIVC), and the possibility of hospital admission will be approached to participant in the study. On gaining written informed consent participants, will be randomised into either the interventional group where blood will only be sampled from the PIVC or randomised into the control group where the blood sample will be obtained only by venepuncture. Insertion of the PIVC will follow clinical practice guidelines observed at the study site by medical and nursing staff trained in performing the procedure. The choice of cannula gauge will be at the discretion of the treating doctor or nurse. Blood samples will be obtained in the emergency department by an experienced nurse having previously received training by a phlebotomist. Should the participant be admitted to a hospital ward and require additional blood samples the allocation of method of sampling will remain the same for the duration of life of the original PIVC and sampled by a trained phlebotomist, nurse, or doctor. A sign will be placed by the participant’s bedspace to remind ward staff to collect blood samples either by venepuncture and not through the PIVC if randomised to the control group or if randomised to the interventional group through the PIVC and not by venepuncture. All other aspects in the medical management of participants will not be affected by their involvement in the study. Follow-up of the PIVC will occur on day three post emergency department presentation. It is standard practice in Western Australia that after three days (72 hours) all PIVCs are removed and re-sited if there is a continuing need for PIVC access. The original PIVC inserted in the emergency department will be evaluated by the nurse or medical staff on duty for signs of cannula failure and the peripheral intravenous catheter assessment score (PIVAS) used to assess signs of phlebitis and infection. A member of the research team will check the history of the original PIVC on day three following the participant’s emergency department presentation. If discharged from the hospital before the follow-up period, the participant’s medical records will be recalled and PIVC documentation reviewed. Data will be collected from the participant’s medical notes and from data obtained during insertion about the PIVC including site of insertion, cannula gauge size and treatments received through the device.