Predictors and Delays Associated with the Need for Advanced Techniques for Intravenous Access

BackgroundThe need for advanced techniques for intravenous access (ATIVA) can lead to delays in care and contribute to emergency department (ED) crowding.ObjectiveIn this article, we estimate the delay and predictors associated with the need for ATIVA.MethodsIn this case-control study, we collected data from ED cases requiring ATIVA and control patients in whom i.v. access was gained by traditional inspection and palpation. We included two control groups-a random retrospective sample and a prospective limited convenience sample. We collected time and acuity data from all groups and data on predictor variables from cases and prospective controls. We analyzed time data using quartile regression and predictor variable data using contingency table analysis and logistic regression.ResultsWe collected data from 116 cases (91 of which had time interval data), 98 retrospective controls, and 144 prospective controls. The median time from triage to i.v. line establishment was 199 min for cases vs. 64 min for prospective controls and 81 min for retrospective controls. The need for ATIVA was associated with a 1.1-greater quartile time interval (95% confidence interval [CI] 0.8-1.3). Two variables-i.v. drug use (IVDU; odds ratio 3.7; 95% CI 1.8-7.3) and prior need for ATIVA (odds ratio 5.2; 95% CI 2.7-9.8)-were associated with a need for ATIVA; obesity, renal failure, and diabetes were not.ConclusionsThe need for ATIVA increases median time to i.v. line placement by 118 to 135 min compared with traditional inspection and palpation. IVDU and prior need for an advanced technique are associated with a need for ATIVA.