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Becton, Dickinson and — Technical Presentation (April 2020)
32 slides from Becton, Dickinson and's technical presentation, April 2020
Slide 1: Presentation disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: The A-DIVA Scale
THE A-DIVA SCALE Prediction of a difficult intravenous access in hospitalized adults F.H.J. van Loon MSc CRNA Catharina Hospital Fontys University of Applied Sciences Eindhoven, the Netherlands
Slide 3: Introduction
INTRODUCTION RICK VAN LOON Catharina Hospital ▪ Clinical epidemiologist ▪ Nurse anesthetist Fontys University of Applied Sciences ▪ Lecturer ▪ Research coordinator Conflicts of interest ▪ Member of the EuropeanBoard for Vascular Access Management, as initiated by BD
Slide 4: Peripheral Intravenous Cannulation
PERIPHERAL INTRAVENOUS CANNULATION PREVALENCE Peripheral intravenous cannulation is the most common invasive hospital procedure performed worldwide to administer drugs, fluids, and blood products during their admission. 1,2 In clinical practice, four out of five patients needs an intravenous access,
Slide 5: Failed Cannulation: Definition
FAILED CANNULATION DEFINITION Intravenous cannulation is considered successful if the practitioner is able to inject a saline flush without signs of infiltration or subcutaneous infusion. 5-7 One attempt is determined as a percutaneous needle puncture, regardless the amount of subcutaneous explorati
Slide 6: Failed Cannulation: Consequences
FAILED CANNULATION CONSEQUENCES Peripheral intravenous cannulation is associated with an unacceptable high overall failure rate, posing a burden to: 2,5 ▪ Patients ▪ Caregivers ▪ Healthcare system Moreover, failed cannulation results in an increased: 2,5 ▪ Number of painful and stressful punctures ▪
Slide 7: Failed Cannulation: Consequences – Pain
FAILED CANNULATION CONSEQUENCES – PAIN A previous observational study reported a mean pain score of 3.3±2.2 for peripheral intravenous cannulation. 8 Inserting a smaller sized catheter did not result in a lower pain sensation; the lowest pain score was registered when the catheter was inserted succe
Slide 8: Failed Cannulation: Consequences – Pain
FAILED CANNULATION CONSEQUENCES – PAIN A successful first attempt resulted in both statistically and clinically significant lower pain scores when compared to multiple unsuccessful attempts. 8
Slide 9: Failed Cannulation: Consequences – Pain
FAILED CANNULATION CONSEQUENCES – PAIN Conclusion: to prevent pain must an unsuccessful attempt be avoided. 8
Slide 10: Failed Cannulation: Consequences – Costs
FAILED CANNULATION CONSEQUENCES – COSTS In another study, a mean of 1.37 (±0.77) attempts were needed for a successful cannulation with a mean time of 3.5 (±2.7) minutes across the sample of patients. 9 Costs for peripheral intravenous cannulation were estimated to be €11,67 for each patient. 9
Slide 11: Failed Cannulation: Consequences – Costs
FAILED CANNULATION CONSEQUENCES – COSTS Overall, intravenous cannulation is most frequently performed by nurses, although physician participation increased if the number of failed attempts increased. 9 While successful cannulation on the first attempt was performed by nurses in 93% of patients, when
Slide 12: Failed Cannulation: Consequences – Costs
FAILED CANNULATION CONSEQUENCES – COSTS Total costs for PIVC increased as the number of attempts needed for successful cannulation increased. The costs for PIVC were estimated to be €9,32 with a successful first attempt, but increased to €65,34 when five attempts were needed, based on clinician depl
Slide 13: Failed Cannulation: Consequences – Costs
FAILED CANNULATION CONSEQUENCES – COSTS Conclusion: multiple attempts are a burden for patients and expensive to the healthcare system, and preventable when state of the art techniques are used as applied by nurses to individual patients based on predicted difficult intravenous access, will make the
Slide 14: The Key to Success: Triangle to Success
THE KEY TO SUCCESS TRIANGLE TO SUCCESS
Slide 15: The Key to Success: Triangle to Success
THE KEY TO SUCCESS TRIANGLE TO SUCCESS
Slide 16: The Key to Success: Triangle to Success
THE KEY TO SUCCESS TRIANGLE TO SUCCESS
Slide 17: A-DIVA Study
THE A-DIVA SCALE A-DIVA STUDY The aim of our study was to: 6 1. Identify risk factors for failure of peripheral intravenous cannulation in adult patients; 2. Create a simplified additive scale to calculate the risk of failed intravenous cannulation on the first attempt; 3. Classify patients with a d
Slide 18: A-DIVA Study
THE A-DIVA SCALE A-DIVA STUDY Of the 3587 patients included in our study: 6 ▪ The first attempt of intravenous cannulation was successful in 2923 patients, resulting in a first attempt success rate of 81%; ▪ 425 patients needed 2 attempts (12%); ▪ 138 patients needed 3 attempts (4%); ▪ 33 patients n
Slide 19: The Scale
THE A-DIVA SCALE THE SCALE The A-DIVA scale was created as the Adult Difficult IntraVenous Access scale and included five variables from a multivariate logistic regression analyses. 6
Slide 20: Slide 20
Slide 21: The Scale
THE A-DIVA SCALE THE SCALE Based on the additive scale were patients classified into either a low, moderate, or high-risk group, depending on the existence of risk factors in the individual patient. 6
Slide 22: Risk Classification
THE A-DIVA SCALE RISK CLASSIFICATION ▪ Patients in the low risk group had a relative risk for a failed first attempt of 0.07 (95% CI 0.06 to 0.08). 6 ▪ Patients in the moderate risk group had a relative risk for a failed first attempt of 2.52 (95% CI 2.20 to 2.88). 6 ▪ Patients in the high risk grou
Slide 23: Risk Classification
THE A-DIVA SCALE RISK CLASSIFICATION
Slide 24: Implications
THE A-DIVA SCALE IMPLICATIONS Low risk: no advanced action needed, peripheral intravenous cannulation can be performed by every practitioner.
Slide 25: Implications
THE A-DIVA SCALE IMPLICATIONS Low risk: no advanced action needed, peripheral intravenous cannulation can be performed by every practitioner. Moderate risk: no advanced action needed, peripheral intravenous cannulation must be performed by the most experienced practitioner.
Slide 26: Implications
THE A-DIVA SCALE IMPLICATIONS Low risk: no advanced action needed, peripheral intravenous cannulation can be performed by every practitioner. Moderate risk: no advanced action needed, peripheral intravenous cannulation must be performed by the most experienced practitioner. High risk: use of ultraso
Slide 27: The Key to Success: Implications
THE KEY TO SUCCESS IMPLICATIONS
Slide 28: The Key to Success: In General
THE KEY TO SUCCESS IN GENERAL Peripheral intravenous cannulation requires a multifactorial approach, taking risk factors and opportunities into account.
Slide 29: The Key to Success: In General
THE KEY TO SUCCESS IN GENERAL First attempt cannulation success can be increased by: ▪ Selection of those patients at risk; ▪ Following a strategy to an individual risk profile. This strategy included: ▪ Selection of the right intravenous access device; ▪ The use of the right (advanced) technology;
Slide 30: Conclusion: Take Home Message
CONCLUSION TAKE HOME MESSAGE The five-variable additive A-DIVA scale is a reliable and generalizable predictive scale to identify patients at risk of a difficult intravenous access. A patient’s individual score on the A-DIVA scale will predict the likelihood of failed peripheral intravenous catheter
Slide 31: References
REFERENCES 1. Vlaar, A.P.J.; Hunt, B.J. Improving peripheral intravenous catheter failure rates. Lancet. 2018, 392, 366–367. 2. Helm, R.E.; Klausner, J.D.; Klemperer, J.D.; Flint, L.M.; Huang, E. Accepted but unacceptable: Peripheral IV catheter failure. J. Infus. Nurs. 2015, 38, 189–203. 3. Cooke,
Slide 32: Contact: [email protected]
Santeon is een samenwerking van: Canisius Wilhelmina Ziekenhuis, Nijmegen Catharina Ziekenhuis, Eindhoven Maasstad Ziekenhuis, Rotterdam Martini Ziekenhuis, Groningen Medisch Spectrum Twente, Enschede OLVG, Amsterdam St. Antonius Ziekenhuis, Utrecht/Nieuwegein Contact: rick.v.loon@catharinaziekenhui
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