Maximise first insertion success

Your health service organisation will have a process that describes what your healthcare team should do to avoid too many attempts at inserting your PIVC. For example, if your clinician cannot locate your veins, the process outlines what steps they should follow. They might need to refer you to another clinician or use an ultrasound to help, or use other supportive therapies such as local anaesthetics to help keep you comfortable while your PIVC is inserted.

If they try to insert your PIVC and cannot, it can cause your treatment to be delayed. This is why it is important for your clinician to conduct a thorough assessment of the risk factors that might make inserting your PIVC difficult, and for you to say if you have had any issues with PIVCs in the past.

If the clinical presentation of a patient is such that the likelihood of inserting a PIVC successfully on the first attempt is low given your current experience in PIVC insertion, follow your health service organisation’s policy for guidance on how to maximise first-time insertion success. Strategies to optimise first-time insertion success include escalating to a more experienced clinician, using technology-assisted devices such as ultrasound, or adjunct supportive therapies such as local anaesthetics. For paediatric patients, consider using parental support or child play therapy to maximise the likelihood of successful insertion on the first attempt.

Difficult or unsuccessful insertions can cause bruising, thrombosis, delays in treatment, reduced access to veins for future health needs, and undue pain and anxiety for the patient. This is why it is important to conduct a thorough assessment of risk factors that may contribute to difficult insertion, ask the patient about whether they have had issues with PIVC insertions previously, and escalate as per your health service organisation’s policy when required to maximise first-time insertion success. If more than one attempt to insert the PIVC is required, specify the reason (for example, lack of more experienced staff to escalate to in the after-hours setting, or patient dehydration) in the patient’s medical record and act according to local policy.

Support clinicians and promote a culture of maximising first-time insertion success by having policies describing how to achieve this goal. Policies and processes should include:

• What to do if insertion is likely to be difficult
• Recommendations to escalate before any attempt to insert a PIVC if the complexity of the insertion is outside the clinician’s expertise
• Specified conditions under which more than one attempt may be appropriate (such as lack of more experienced staff in the after-hours setting).

Strategies to support first-time insertion success may involve referring to a more experienced clinician to ensure that the expertise to insert the PIVC matches the complexity of the patient’s clinical presentation, or use of technology-assisted devices such as ultrasound, especially after hours when staffing may be limited. Adequate staff training in the use of technology-assisted devices is required to ensure that they maximise first-time insertion success.