Evaluation Factors Affect Difficult Intravenous Access in the Prehospital Setting

Ehsan Karimialavijeh; Hossein Kermanpour; Sima Bijani; Mozhgan Sadat Hashemi; Pooya Payandemehr; Kamran Shirbache; Ghasem Pishgahi

doi:10.18502/aacc.v8i4.10181

Ehsan Karimialavijeh Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Hossein Kermanpour Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Sima Bijani Emergency Medicine Department, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Mozhgan Sadat Hashemi Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
Pooya Payandemehr Prehospital and Hospital Emergency Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Kamran Shirbache Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.
Ghasem Pishgahi Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/aacc.v8i4.10181

Keywords: Difficult intravenous access; Prehospital; Medical services

Abstract

Background: Environmental factors such as the lighting of the scene, time of the day, and physical surrounding of the patient and healthcare providers in the prehospital setting can affect difficult intravenous access (DIVA). The study aimed to evaluate the association of environment, patient, and emergency medical services (EMS) technicians on the DIVA in the prehospital setting.

Methods: Six-hundred adult patients (aged ≥18 years) who necessitated prehospital peripheral IV access and were transferred to the Sina and Shariati hospitals by EMS technicians from June 2018 to October 2018 were included. There were seven research nurses for interviewing the EMS technicians. Patients were examined using the prepared checklists.

Results: Overall, there were 125 (20.83%) DIVA cases. There was a significant relationship between DIVA and the higher respiratory rate of the patients, lower the blood pressure of the patient, prior cannulation of the targeted limb, time since the last meal of EMS technician, and untidiness of the environment (Odds Ratio=1.75, 1.3, 9.4, 3.84 and 7.01, respectively).

Conclusion: The results showed fasting of EMS technicians affects DIVA and the study suggests it can be resolved by proper scheduling of the working hours of EMS technicians. Also, some risk factors of DIVA can help the paramedics to predict the DIVA and take the necessary measures.