A recent paper published in Annals of
Emergency Medicine makes the claim that half of all peripheral IV’s placed in
an Australian ED were unused. Could this be true? Well, maybe... and maybe not.
Either way, this paper got a lot of attention and is certainly worth a closer
look.
In the paper’s introduction, the authors point out the harms
of peripheral IV line placement such as time to insert, discomfort, phlebitis
and sepsis. This is technically correct but is probably overstated.
To determined how often IV’s went unused, two trained
abstractors did a structured electronic medical record review over a one month
period. Their EMR has a mandatory field for recording of IV’s inserted in the
ED. Unused IV’s were defined as “those
that were not used for delivering fluids or drugs, including intravenous
contrast, until discharge from the ED.”
How many went unused? Fifty
percent! Yes, I can hear the gasps.
But there is a catch. Although not meeting the studies
definition of “used”, 92% of patients
had bloods drawn at the time of cannulation. In addition, the authors were
very correct in emphasizing that this study did not address the difference
between unused and unnecessary peripheral IV cannulas.
Yes, we probably overdo IV’s in the ED. But I think this
emphasis is a bit of a storm in a tea-cup.
There are much bigger issues of waste for us to focus our attention. I would
love to see a study that tells us something more important and what we already know
(although this would be a very difficult study to define and conduct); half of
all blood tests and other investigations in an ED are unnecessary and a waste
of time & money. Good luck with this one.
Covering:
Limm EI, Fang X, Dendle C, et al. Half of All Peripheral Intravenous Lines in an Australian Tertiary
Emergency Department Are Unused: Pain With No Gain? Ann Emerg Med
2013;62:521-525.
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