Thursday, 14 August 2014

Half of all IV’s in an ED are Unused? Could this be true?

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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