Factors Associated With Non-First-Attempt Success in Peripheral Intravenous Cannulation by an Intravenous Therapy Team: A Prospective Observational Study.

BACKGROUND

Difficult peripheral intravenous cannulation affects a substantial proportion of hospitalized patients, yet factors associated with cannulation failure among cases assisted by a dedicated intravenous therapy team on general wards remain poorly characterized.

AIM: To identify patient-related, operator-related, and procedural factors independently associated with non-first-attempt success in peripheral intravenous cannulation performed by an intravenous therapy team on general medical and surgical wards.

DESIGN

Prospective observational study and secondary analysis of prospectively collected clinical data.

METHODS

Cannulation events recorded by an intravenous therapy team over a 1-year period were analysed. The primary outcome was non-first-attempt success, defined as requiring two or more insertion attempts. A generalized linear mixed model accounted for repeated events within hospitalizations. Three sensitivity analyses assessed robustness.

RESULTS

Approximately one in five events required two or more attempts. Five factors were independently associated with non-first-attempt success: lower nurse experience, reduced patient mobility, smaller catheter gauge, replacement prompted by difficult access, and lower-limb or trunk insertion sites. Patient age, sex, comorbidity burden, and body mass index were not independently associated. Findings were robust across all sensitivity analyses.

CONCLUSION

Nurse experience, catheter gauge, and insertion site are modifiable factors associated with first-attempt success. Patient mobility emerged as a novel, easily assessable risk indicator.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings can inform intravenous therapy team training priorities, catheter gauge and insertion-site selection protocols, and prospective bedside risk screening to reduce repeated cannulation attempts.

IMPACT: This study clarified which factors drive cannulation failure on general wards, identifying five independently associated factors-three of them modifiable-and highlighting patient mobility as a novel indicator relevant to intravenous therapy teams, ward nurses, and hospitalized adults internationally.

REPORTING METHOD: This study adhered to the STROBE reporting guideline for observational studies.

PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.