an Initial Order for a Blood Draw and Placement of an IV Line in the Emergency Department
Conditions
Brief summary
Peripheral venous catheters are frequently inserted in hospitals, with approximately 25 million placed annually in France (HAS data, 2005). The occluded peripheral venous catheter with extension tubing has become the standard in some emergency departments, offering advantages such as patient mobility, the ability to perform repeated blood draws, and the administration of intravenous medications. A 2018 meta-analysis revealed that one in three devices was unnecessary. The placement of a occluded peripheral venous is associated with a more painful insertion, higher cost, and an increased risk of infection and thromboembolism, and blood samples obtained via the occluded peripheral venous catheter are more often hemolyzed than those obtained by direct venipuncture. Communication between physicians and nurses is essential to ensure optimal patient care. A brief intervention by the nurse when a physician prescribes a occluded peripheral venous catheter can help clarify the appropriateness of this prescription, which could lead to reduced pain for the patient, time savings for healthcare providers, and material cost savings for the hospital.
Interventions
OTHERquestion for the prescriber
Once the nurse has received the doctor's order for a blood draw with a KTO, she will ask the prescribing physician: Is the KTO being prescribed for: the administration of medication? The injection of a contrast agent? A second blood draw? For each question, there are three possible answers: Yes? No? Maybe?
Sponsors
University Hospital, Rouen
Study design
Allocation
NA
Intervention model
SEQUENTIAL
Primary purpose
OTHER
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients assigned a triage score of 3A, 3B, or 4 according to the French triage scale, or 3 or 4 according to the CIMU triage scale, by the triage nurse * Patients with a blood draw order involving the placement of an occluded catheter * Age 18 years or older * Patients who have read and understood the information sheet * Patients who have given their verbal consent to participate in the study * Patients enrolled in a social security program
Exclusion criteria
* Patients admitted to the emergency department with a pre-existing intravenous line * Patients treated by the Mobile Emergency and Resuscitation Unit outside the hospital * Patients with a blocked catheter who did not undergo an initial blood draw * Patient with known neurocognitive disorders incompatible with informed consent * Pregnant or breastfeeding woman * Patient under legal guardianship (guardianship or conservatorship) or patient deprived of liberty * Patient refusing to participate in the study * Patient participating in another interventional research study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| the proportion of obturator catheters placed improperly | day 1 | Questions for the prescriber |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Correlation between the physician's final decision and nurse activity | day 1 | Correlation between the physician's final decision and the performance of a repeat biopsy, the administration of contrast dye, or the administration of intravenous treatment |
| Use of the numerical pain scale during obturator catheter placement | at the end of procedure (assessed up to 20 minutes) | pain during obturator catheter placement |
| Micro-costing analysis | at the end of procedure (assessed up to 20 minutes) | Micro-costing analysis of the cost of a standard venous blood draw and a closed-catheter procedure |
| Types of intravenous medications administered | day 1 | Types of intravenous medications administered and available oral alternatives |
| Number of orders for obturator catheters | day 1 | Number of orders for obturator catheters placement during the initial blood draw for each period throughout the entire enrollment period |
Countries
France
Contacts
CONTACTJessica BORTZMEYER, nurse
CONTACTROUSSEL Mélanie, MD
STUDY_CHAIRDéborah LEBEDIEFF, MS
University Hospital, Rouen
Outcome results
None listed