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Robben N, Dierick-van Daele ATM, Bouwman ARA, van Loon FHJ. Worry as Important "Feelers" in Clinical Anesthesia Practice: A Mixed-Methods Study. J Perianesth Nurs 2024:S1089-9472(24)00011-X. [PMID: 38691073 DOI: 10.1016/j.jopan.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE Worry is an intuitive sense that goes beyond logical reasoning and is valuable in situations where patients' conditions are rapidly changing or when objective data may not fully capture the complexity of a patient's situation. Nurse anesthetists' subjective reasons for worry are quite vague as they are valued inconsistently and not accurately expressed. This study aimed to identify factors playing a role in the emergence of worry during anesthesia practice to clarify its concept. DESIGN Mixed-methods design consisting of quantitative online surveys followed by qualitative focus group interviews including Dutch nurse anesthetists. METHODS Both quantitative and qualitative thematic analyses were performed, followed by data and methodological triangulation to enhance the validity and credibility of findings and mitigate the presence of bias. FINDINGS Surveys (N = 102) were analyzed, and 14 nurse anesthetists participated in the focus group interviews. A total of 89% of the survey respondents reported that at least once have had the feeling of worry, of which 92% use worry during clinical anesthesia practice. Worry was mentioned to be a vital element during anesthesia practice that makes it possible to take precautionary actions to change the anesthetic care plan in a changing situation or patient deterioration. CONCLUSIONS While a clear definition of worry could not be given, it is a valuable element of anesthesia practice as it serves as a catalyst for critical thinking, problem-solving, clinical reasoning, and decision-making. Use of the feeling of worry alongside technological systems to make an informed decision is crucial. Technology has significantly improved the ability of health care providers to detect and respond to patient deterioration promptly, but it is crucial for nurse anesthetists to use their feeling of worry or intuition alongside technological systems and evidence-based practice to ensure quick assessments or judgments based on experience, knowledge, and observations in clinical practice.
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Affiliation(s)
- Noa Robben
- Department of Anesthesiology, Catharina Hospital, Eindhoven, North-Brabant, The Netherlands
| | - Angelique T M Dierick-van Daele
- Institute of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, North-Brabant, The Netherlands; Research Department, Catharina Hospital, Eindhoven, North-Brabant, The Netherlands
| | - Arthur R A Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, North-Brabant, The Netherlands; Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, North-Brabant, The Netherlands
| | - Fredericus H J van Loon
- Department of Anesthesiology, Catharina Hospital, Eindhoven, North-Brabant, The Netherlands; Department of Perioperative Care and Technology of the Institute of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, North-Brabant, The Netherlands.
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Vermeulen MAAP, Hill JM, van Vilsteren B, Brandt-Hagemans SCF, van Loon FHJ. Personality characteristics of Dutch nurse anesthetists and surgical nurses when compared to the normative Dutch population, a quantitative survey study. Appl Nurs Res 2024; 76:151781. [PMID: 38641386 DOI: 10.1016/j.apnr.2024.151781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 03/11/2024] [Accepted: 03/11/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Working in the perioperative context is complex and challenging. The continual evaluation in this environment underscores the need for adaptability to technological advancements, and requires substantial allocation of resources for training and education. This study aimed to explore personality characteristics of nurse anesthetists and surgical nurses that are instrumental for sustainable employability in technologically advanced environment. METHODS Exploratory, cross-sectional survey study including nurse anesthetists and surgical nurses, both certified and in training, and a sample of the normative Dutch population. Personality characteristics were identified with the Big Five Inventory, which consisted of 60 items answered on a five-point Likert scale (strongly disagree to strongly agree). RESULTS Specific personality traits were found for nurse anesthetists and surgical nurses when compared to the normative Dutch population. Traits of both nurse anesthetists and surgical nurses differed significantly on all domains of the Big Five Inventory, with the largest differences found within the dimension negative emotionally. CONCLUSIONS This study highlights the role of specific personality traits in maintaining employability within the rapidly evolving and technologically advanced landscape of healthcare. It emphasizes the relationship between individual traits and professional excellence, being crucial educational strategies for overall improvement in healthcare.
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Affiliation(s)
- Marie-Anne A P Vermeulen
- Faculty of Perioperative Care and Technology, Department of Health Studies, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | - Jonah M Hill
- Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands
| | - Bart van Vilsteren
- Department of Healthcare, Saxion University of Applied Sciences, Enschede, Deventer, the Netherlands
| | | | - Fredericus H J van Loon
- Faculty of Perioperative Care and Technology, Department of Health Studies, Fontys University of Applied Sciences, Eindhoven, the Netherlands.
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van Rens MFPT, Hugill K, Francia ALV, Macaraig AV, van Loon FHJ, Spencer TR, Bayoumi MAA. Clotted blood samples in the neonatal intensive care unit: A retrospective, observational study to evaluate interventions to reduce blood sample clotting. Nurs Crit Care 2023. [PMID: 37338149 DOI: 10.1111/nicc.12941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling. AIMS To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample. STUDY DESIGN This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112-cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment. RESULTS First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13-1.78, p = .002), 1.46 (95% CI 1.17-1.81, p < .001) and 0.49 (95% CI 0.39-0.63, p < .001), respectively. The majority (87%-95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%-9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34-5.13, p < .001) and 3.11 (95% CI 2.51-3.86, p < .001), respectively. CONCLUSIONS Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings. RELEVANCE TO CLINICAL PRACTICE The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Abraham Victor Macaraig
- Department of Quality Improvement, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H J van Loon
- Anaesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, the Netherlands
- PeriOperative Care & Technology, Fontys University of Applied Sciences, Eindhoven, the Netherlands
| | | | - Mohammad A A Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
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van Rens M, Hugill K, Gaffari MAK, Francia AV, Ramkumar T, Garcia KLP, van Loon FHJ. Outcomes of establishing a neonatal peripheral vascular access team. Arch Dis Child Fetal Neonatal Ed 2023; 108:88-89. [PMID: 34620683 DOI: 10.1136/archdischild-2021-322764] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2021] [Indexed: 12/31/2022]
Affiliation(s)
- Matheus van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Kevin Hugill
- Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar
| | | | - Airene V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Thiruveni Ramkumar
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Krisha L P Garcia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H J van Loon
- Anaesthesiology and Intensive Care, Catharina Hospital, Eindhoven, North Brabant, The Netherlands
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van Rens MFPT, Bayoumi MAA, van de Hoogen A, Francia ALV, Cabanillas IJ, van Loon FHJ, Spencer TR. The ABBA project (Assess Better Before Access): A retrospective cohort study of neonatal intravascular device outcomes. Front Pediatr 2022; 10:980725. [PMID: 36405839 PMCID: PMC9670536 DOI: 10.3389/fped.2022.980725] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/30/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Venous access devices (VADs) play a vital role within the neonatal intensive care unit. However, there are significant risks associated with the use of VADs, with complications such as infection, thrombosis, device occlusion, and infiltration/extravasation frequently contributing to device-related failures and increasing the risk of significant patient harm or injury. This study aimed to explore the relationships between risk factors and different venous access device complications in the neonatal setting, and then use that evidence to develop an algorithm based on observational data. METHODS This is a retrospective, single-center cohort study that was conducted in a large 112-bed neonatal intensive care unit in Qatar. We examined venous access device data from January 2016 to December 2018 for all term and preterm neonates. Descriptive statistics were used to summarize the outcomes, which included a mean and its standard deviation or median and an interquartile range for continuous variables regarding normal distribution, and absolute numbers with percentages for discrete variables. RESULTS The authors recorded a total of 23,858 VADs inserted during the study period. Of these, 21,313 (89%) were peripheral intravenous catheters, 689 (3%) were extended dwell-peripheral intravenous catheters, 1,335 (6%) were epicutaneo-caval catheters, and 521 (2%) were umbilical venous catheters. In total, 51,179 catheter days were registered, with 2.17 catheter days reported per patient. Peripheral device dwell times were significantly shorter when compared with central venous catheter devices (P < 0.001), with mean dwell times of 22 days ± 23 h and 236 days ± 183 h, respectively. After insertion, a complication occurred in 11,177 (51%) of peripheral VADs and 221 (12%) of central VADs. The type of device inserted [P < 0.001, hazard ratio (HR) = 0.52, 95% confidence interval (CI): 0.50-0.54], reason/indication for intravenous therapy (P < 0.001, HR = 0.85, 95% CI: 0.82-0.87), and the side of insertion of the device (P < 0.001, HR = 1.25, 95% CI: 1.24-1.27) had a significant relationship with outcomes. CONCLUSIONS Four subgroups of VADs were identified (peripheral intravenous catheters, extended dwell-peripheral intravenous devices, epicutaneo-caval catheters, and umbilical venous catheters) with outcome-related differences. Central venous access devices (epicutaneo-caval catheters and umbilical venous catheters) had lower complications compared with peripheral VADs. Proper venous access device selection, early insertion, and early removal approaches remain crucial to preventing venous access device complications. Peripheral intravenous devices should be used carefully and closely watched for early detection of complications.
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Affiliation(s)
- Matheus F P T van Rens
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Mohammad A A Bayoumi
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Agnes van de Hoogen
- Department of Neonatology, Wilhelmina Children's Hospital, University Medical Centre of Utrecht, Utrecht, Netherlands
| | - Airene L V Francia
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Irian J Cabanillas
- Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar
| | - Fredericus H J van Loon
- Department of Science and Technology in Perioperative Nursing, Fontys University of Applied Sciences, Eindhoven, Netherlands
| | - Timothy R Spencer
- Nursing Department, Global Vascular Access, LLC, Scottsdale, AZ, United States
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Cortés Rey N, Pinelli F, van Loon FHJ, Caguioa J, Munoz Mozas G, Piriou V, Teichgräber U, Lepelletier D, Mussa B. The state of vascular access teams: Results of a European survey. Int J Clin Pract 2021; 75:e14849. [PMID: 34516704 DOI: 10.1111/ijcp.14849] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/26/2021] [Accepted: 09/10/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Many European health institutions have appointed multidisciplinary teams for the general management of vascular access to help improve efficiency, patient safety and reduce costs. Vascular access teams (VATs), or infusion teams, are specifically trained groups of healthcare professionals who assess, place, manage and monitor various outcomes and aspects of vascular access care. OBJECTIVE To assess the current landscape of vascular access management as a discipline across Europe. METHODS A Faculty of European VAT leads and experts developed a survey of 20 questions which was disseminated across several European countries. Questions focused on respondent and institution profile, vascular access device selection and placement, monitoring and reporting of complications, and access to training and education. The 1449 respondents included physicians, nurses, anaesthetists, radiologists and surgeons from public and private institutions ranging in size. RESULTS Availability of dedicated VATs vary by country, institution size, and institution type. Institutions with a VAT are more likely to utilise a tool (eg, algorithm or guideline) to determine the appropriate vascular access device (55% vs 38%, P < .0002) and to have feedback on systematic monitoring of complications (40% vs 28%, P = .015). Respondents from institutions with a VAT are more likely to have received training on vascular access management (79% vs 53%, P < .0001) and indicated that the VAT was a source of support when difficulties arise. CONCLUSION The survey results highlight some of the potential benefits of implementing a dedicated VAT including the use of a broader range of vascular access devices, increased awareness of the presence of vascular access policies, increased the likelihood of recent vascular access training, and increased rates of systematic monitoring of associated complications. The study reveals potential areas for further focus in the field of vascular access care, specifically examining the direct impact of vascular access teams.
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Affiliation(s)
- Noemí Cortés Rey
- Hospital Teresa Herrera, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | | | - Jennifer Caguioa
- Kings College Hospital NHS Foundation Trust, London, United Kingdom
| | | | - Vincent Piriou
- Hospices Civils de Lyon, Université Claude Bernard Lyon-1, Lyon, France
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van Loon FHJ, Korsten HHM, Dierick-van Daele ATM, Bouwman ARA. The impact of the catheter to vein ratio on peripheral intravenous cannulation success, a post-hoc analyses. PLoS One 2021; 16:e0252166. [PMID: 34029356 PMCID: PMC8143382 DOI: 10.1371/journal.pone.0252166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/11/2021] [Indexed: 11/24/2022] Open
Abstract
Background Intravenous cannulation is usually the first procedure performed in modern healthcare, although establishing peripheral intravenous access is challenging in some patients. The impact of the ratio between venous diameter and the size of the inserted catheter (catheter to vein ratio, CVR) on the first attempt success rate can be of added value in clinical. This study tries to give insight into the consideration that must be made when selecting the target vein and the type of catheter, and proved the null hypothesis that an optimal CVR would not be associated with increased first attempt cannulation success. Methods This was a post-hoc analyses on adult patients admitted for peripheral intravenous cannulation. Intravenous cannulation was performed according to practice guidelines, by applying the traditional landmark approach. The CVR was calculated afterwards for each individual patient by dividing the external diameter of the inserted catheter by the diameter of the target vein, which was multiplied by 100%. Results In total, 610 patients were included. The median CVR was 0.39 (0.15) in patients with a successful first attempt, whereas patients with an unsuccessful first attempt had a median CVR of 0.55 (0.20) (P<0.001). The optimal cut-off point of the CVR was 0.41. First attempt cannulation was successful in 92% of patients with a CVR<0.41, whereas as those with a CVR>0.41 had a first attempt success rate of 65% (P<0.001). Conclusion This first introduction of the CVR in relation to cannulation success should be further investigated. Although, measuring the venous diameter or detection of a vein with a specific diameter prior to cannulation may increase first attempt cannulation success.
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Affiliation(s)
- Fredericus H J van Loon
- Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands.,Department of Science and Technology in Anesthesia Nursing Practice, Fontys University of Applied Sciences, Eindhoven, The Netherlands
| | - Hendrikus H M Korsten
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands
| | - Angelique T M Dierick-van Daele
- Department of People and Health Sciences, Fontys University of Applied Sciences, Eindhoven, The Netherlands.,Department of Research and Education, Catharina Hospital, Eindhoven, The Netherlands
| | - Arthur R A Bouwman
- Department of Signal Processing Systems and Electrical Engineering, TU/e University of Technology, Eindhoven, The Netherlands.,Department of Anesthesiology, Intensive Care and Pain Medicine, Catharina Hospital, Eindhoven, The Netherlands
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Loon FHJV, Puijn LAPM, Houterman S, Bouwman ARA. Development of the A-DIVA Scale: A Clinical Predictive Scale to Identify Difficult Intravenous Access in Adult Patients Based on Clinical Observations. Medicine (Baltimore) 2016; 95:e3428. [PMID: 27100437 PMCID: PMC4845841 DOI: 10.1097/md.0000000000003428] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Placement of a peripheral intravenous catheter is a routine procedure in clinical practice, but failure of intravenous cannulation regularly occurs. An accurate and reliable predictive scale for difficult venous access creates the possibility to use other techniques in an earlier time frame. We aimed to develop a predictive scale to identify adult patients with a difficult intravenous access prospectively: the A-DIVA scale. This prospective, observational, cross-sectional cohort study was conducted between January 2014 and January 2015, and performed at the department of anesthesiology of the Catharina Hospital (Eindhoven, The Netherlands). Patients 18 years or older were eligible if scheduled for any surgical procedure, regardless ASA classification, demographics, and medical history. Experienced and certified anesthesiologists and nurse anesthetists routinely obtained peripheral intravenous access. Cannulation was performed regarding standards for care. A failed peripheral intravenous cannulation on the first attempt was the outcome of interest. A population-based sample of 1063 patients was included. Failure of intravenous cannulation was observed in 182/1063 patients (17%). Five variables were associated with a failed first attempt of peripheral intravenous cannulation: palpability of the target vein (OR = 4.94, 95% CI [2.85-8.56]; P < 0.001), visibility of the target vein (OR = 3.63, 95% CI [2.09-6.32]; P < 0.001), a history of difficult peripheral intravenous cannulation (OR = 3.86, 95% CI [2.39-6.25]; P < 0.001), an unplanned indication for surgery (OR = 4.86, 95% CI [2.92-8.07]; P < 0.001), and the vein diameter of at most 2 millimeters (OR = 3.37, 95% CI [2.12-5.36]; P < 0.001). The scoring system was applied in 3 risk groups: 36/788 patients (5%) suffered from a failed first attempt in the low-risk group (A-DIVA score 0 or 1), whereas the medium (A-DIVA score 2 or 3) and high-risk group (A-DIVA score 4 plus), included 72/195 (37%) and 74/80 (93%) patients with a failed first attempt of inserting a peripheral intravenous catheter, respectively. The additive 5-variable A-DIVA scale is a reliable predictive rule that implies the probability to identify patients with a difficult intravenous access prospectively. Dutch Trial Register (ref: 4595).
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Affiliation(s)
- Fredericus H J van Loon
- From the Department of Anesthesiology (FHJL, LAPMP, ARAB), Catharina Hospital Eindhoven, The Netherlands; Department of Research and Education (FHJL, SH), Catharina Hospital Eindhoven, The Netherlands; Fontys University of Applied Sciences (FHJL), Eindhoven, The Netherlands; Department of Signal Processing Systems and Electrical Enginereering (ARAB), TU/e University of Technology, Eindhoven, The Netherlands
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