To develop expert consensus on peripheral venous access devices (PVAD) and associated care practices, and to formulate guidance recommendations aimed at improving peripheral venous access and management, including the integration of vein visualization technology. This is particularly important for patient populations with peripheral venous depletion, who often present with compromised vasculature that complicates successful PVAD access and increases the risk of complications. Preserving vascular integrity in these patients is essential for maintaining treatment pathways and preventing long-term vascular damage.
Methods:
A multi-phase approach to consensus development was used consisting of the following: (1) a literature review, (2) a survey and consultation with a vascular access expert panel (n = 9), and (3) a consultation meeting with patient and public representatives (n = 2).
Results:
Survey results and consultation findings from the expert panel demonstrated consensus for 14 of 24 statements. Further analysis resulted in a total of four key problem statements on peripheral venous access and care, and 11 recommendations for future development. Following review by patient and public representatives, three additional recommendations were added, and three existing recommendations were refined. The final consensus statement reflects four problem statements with 14 recommendations.
Conclusion:
This expert consensus presents 14 evidence-informed statements designed to strengthen practice, improve patient safety, and enhance clinician confidence and competence. Central to these recommendations is the adoption of routine structured pre-insertion vessel assessment using vein visualization technology where appropriate to minimize vessel trauma, and promote more consistent, high-quality vascular access care.
JunJOjemeniMMKalamaniR, et al. Relationship between nurse burnout, patient and organizational outcomes: systematic review. Int J Nurs Stud2021; 119: 103933.
2.
MeredithLSBouskillKChangJ, et al. Predictors of burnout among US healthcare providers: a systematic review. BMJ Open2022; 12: e054243.
3.
RechMAJonesGMNasemanRW, et al. Premature attrition of clinical pharmacists: call to attention, action, and potential solutions. J Am Coll Clin Pharm2022; 5: 689–696.
4.
SmallwoodNHarrexWReesM, et al. COVID-19 infection and the broader impacts of the pandemic on healthcare workers. Respirology2022; 27: 411–426.
5.
RaudenskáJSteinerováVJavůrkováA, et al. Occupational burnout syndrome and post-traumatic stress among healthcare professionals during the novel coronavirus disease 2019 (COVID-19) pandemic. Best Pract Res Clin Anaesthesiol2020; 34: 553–560.
6.
PoonY-SRLinYPGriffithsP, et al. A global overview of healthcare workers’ turnover intention amid COVID-19 pandemic: a systematic review with future directions. Hum Resour Health2022; 20: 70.
7.
XuGZengXWuX.Global prevalence of turnover intention among intensive care nurses: a meta-analysis. Nurs Crit Care2023; 28: 159–166.
8.
CameronKACohenERHertzJR, et al. Barriers and facilitators to central venous catheter insertion: a qualitative study. J Patient Saf2021; 17: e1296–e1306.
9.
SelbyLMRuppMECawcuttKA.Prevention of central-line associated bloodstream infections: 2021 update. Infect Dis Clin North Am2021; 35: 841–856.
10.
HigginsNIuPCarrP, et al. Techniques to select site of insertion for a peripheral intravenous catheter with vessel locating devices using light, sounds or tactile actions (or palpations). J Clin Nurs2021; 30: 1091–1098.
11.
CookeMUllmanAJRay-BarruelG, et al. Not “just” an intravenous line: consumer perspectives on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries. PLoS One2018; 13: e0193436.
12.
JormAF.Using the Delphi expert consensus method in mental health research. Aust N Z J Psychiatry2015; 49: 887–897.
13.
HsuC-CSandfordBA.The Delphi technique: making sense of consensus. Pract Assess Res Eval2007; 12: 1–8.
GloverKRStahlBRMurrayC, et al. A simulation-based blended curriculum for short peripheral intravenous catheter insertion: an industry–practice collaboration. J Contin Educ Nurs2017; 48: 397–406.
16.
MarshNWebsterJUllmanAJ, et al. Peripheral intravenous catheter non-infectious complications in adults: a systematic review and meta-analysis. J Adv Nurs2020; 76: 3346–3362.
17.
KeleekaiNLSchusterCAMurrayCL, et al. Improving nurses’ peripheral intravenous catheter insertion knowledge, confidence, and skills using a simulation-based blended learning program: a randomized trial. Simul Healthc2016; 11: 376–384.
18.
AlexandrouERay-BarruelGCarrPJ, et al. Use of short peripheral intravenous catheters: characteristics, management, and outcomes worldwide. J Hosp Med2018; 13: 65–89.
19.
RickardCMMarshNWebsterJ, et al. Dressings and securements for the prevention of peripheral intravenous catheter failure in adults (SAVE): a pragmatic, randomised controlled, superiority trial. Lancet2018; 392: 419–430.
20.
HelmREKlausnerJDKlempererJD, et al. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs2019; 42: 151–164.
CarrPJRippeyJCRCookeML, et al. Factors associated with peripheral intravenous cannulation first-time insertion success in the emergency department. a multicentre prospective cohort analysis of patient, clinician and product characteristics. BMJ Open2019; 9: e022278.
23.
CarrPJRippeyJCRBudgeonCA, et al. Insertion of peripheral intravenous cannulae in the emergency department: factors associated with first-time insertion success. J Vasc Access2016; 17; 182–190.
24.
MingJLiHJWangY, et al. Clinical perspectives on the use of different peripheral intravenous catheters with the implementation of volume-based procurement in China. Sci J Public Health2021; 9: 49–56.
25.
PireddaMFioriniJFacchinettiG, et al. Risk factors for a difficult intravenous access: a multicentre study comparing nurses’ beliefs to evidence. J Clin Nurs2019; 28: 3492–3504.
26.
TaşdelenYÇağlarS.Effect of intravenous infiltration management program on peripheral intravenous catheter success and infiltration in hospitalized infants. J Nurs Care Qual2021; 36: E44–E49.
27.
KleidonTMSchultsJRickardCM, et al. Techniques and technologies to improve peripheral intravenous catheter outcomes in pediatric patients: systematic review and meta-analysis. J Hosp Med2021; 16: 742–750.
28.
Omkar PrasadRChewTGiriJR, et al. Patient experience with vascular access management informs satisfaction with overall hospitalization experience. J Infus Nurs2022; 45; 95–103.
29.
van LoonFHJPuijnLAPMHoutermanS, et al. Development of the A-DIVA scale: a clinical predictive scale to identify difficult intravenous access in adult patients based on clinical observations. Medicine2016; 95: e3428.
30.
ParkerSIABenziesKMHaydenKA, et al. Effectiveness of interventions for adult peripheral intravenous catheterization: a systematic review and meta-analysis of randomized controlled trials. Int Emerg Nurs2017; 31: 15–21.
31.
SteereLFicaraCDavisM, et al. Reaching one peripheral intravenous catheter (PIVC) per patient visit with lean multimodal strategy: the PIV5Rights™ bundle. J Assoc Vasc Access2019; 24: 31–43.
32.
ReddyVKLavoieM-CVerbeekJH, et al. Devices for preventing percutaneous exposure injuries caused by needles in healthcare personnel. Cochrane Database Syst Rev2017; 2017: CD009740.
33.
ZhangMLeeMKnottS.Is clinical performance adversely affected by wearing gloves during paediatric peripheral intravenous cannulation?. Emerg Med Australas2014; 26: 455–460.
34.
PinelliFPittirutiM.The integrated short peripheral cannula: a new peripheral venous access device?. J Vasc Access2023; 24: 353–357.
GoffDALarsenPBrinkleyJ, et al. Resource utilization and cost of inserting peripheral intravenous catheters in hospitalized children. Hosp Pediatr2013; 3: 185–191.
37.
HallamCWestonVDentonA, et al. Development of the UK Vessel Health and Preservation (VHP) framework: a multi-organisational collaborative. J Infect Prev2016; 17: 65–72.
38.
ShokoohiHLoescheMADugganNM, et al. Difficult intravenous access as an independent predictor of delayed care and prolonged length of stay in the emergency department. J Am Coll Emerg Physicians Open2020; 1: 1660–1668.
39.
BresciaFPittirutiMSpencerTR, et al. The SIP protocol update: eight strategies, incorporating Rapid Peripheral Vein Assessment (RaPeVA), to minimize complications associated with peripherally inserted central catheter insertion. J Vasc Access2024; 25: 5–13.
40.
MoureauNL.Vessel health and preservation: the right approach for vascular access. 2nd ed.Cham: Springer International Publishing, 2024.
41.
DychterSSGoldDACarsonD, et al. Intravenous therapy: a review of complications and economic considerations of peripheral access. J Infus Nurs2012; 35: 84–91.
42.
PittsSOstroffM.The use of visualization technology for the insertion of peripheral intravenous catheters. J Assoc Vasc Access2019; 24: 10–14.
43.
NickelBGorskiLKleidonT, et al. Infusion therapy standards of practice, 9th edition. J Infus Nurs2024; 47: S1–S285.
44.
MeyerASchreiberJBrinkmannJ, et al. Deterioration in hygiene behavior among fifth-year medical students during the placement of intravenous catheters: a prospective cohort comparison of practical skills. BMC Med Educ2021; 21: 434.
45.
WoelfelIATakabeK.Successful intravenous catheterization by medical students. J Surg Res2016; 204: 351–360.
46.
SchusterCStahlBMurrayC, et al. Development and testing of a short peripheral intravenous catheter insertion skills checklist. J Assoc Vasc Access2016; 21: 196–204.
47.
MasseyDCraswellARay-BarruelG, et al. Undergraduate nursing students’ perceptions of the current content and pedagogical approaches used in PIVC education. a qualitative, descriptive study. Nurse Educ Today2020; 94: 104577.
48.
HigginsNKeoghSRickardC.Evaluation of a pilot educational program on safe and effective insertion and management of peripheral intravenous catheters. J Assoc Vasc Access2015; 20: 37–42.
49.
VizcarraCCassuttCCorbittN, et al. Recommendations for improving safety practices with short peripheral catheters. J Infus Nurs2014; 37: 121–124.
50.
EtafaWWakumaBTsegayeR, et al. Nursing students’ knowledge on the management of peripheral venous catheters at Wollega University. PLoS One2020; 15: e0238881.
51.
SimonettiVComparciniDMiniscalcoD, et al. Assessing nursing students’ knowledge of evidence-based guidelines on the management of peripheral venous catheters: a multicentre cross-sectional study. Nurse Educ Today2019; 73: 77–82.
52.
HawesML.A proactive approach to combating venous depletion in the hospital setting. J Infus Nurs2007; 30: 33–44.
53.
LyonsMGKaskerJ.Outcomes of a continuing education course on intravenous catheter insertion for experienced registered nurses. J Contin Educ Nurs2012; 43: 177–181.
54.
HuoBMacNevinWSmythM, et al. Medical student comfort with procedural skills performance based on elective experience and career interest. Cureus2020; 12: e12374.
55.
KatzLMFinchAMcKinnishT, et al. Teaching procedural skills to medical students: a pilot procedural skills lab. Educ Health2017; 30: 79–83.
56.
MarchionniCConnollyMGauthierM, et al. Innovative approaches to teaching vascular access to nursing students in the COVID-19 era. Br J Nurs2021; 30: S34–S41.
57.
JacobsonAFWinslowEH.Variables influencing intravenous catheter insertion difficulty and failure: an analysis of 339 intravenous catheter insertions. Heart Lung2005; 34: 345–359.
58.
PalefskiSSStoddardGJ.The infusion nurse and patient complication rates of peripheral-short catheters. A prospective evaluation. J Intraven Nurs2001; 24: 113–123.
59.
GallantPSchultzAA.Evaluation of a visual infusion phlebitis scale for determining appropriate discontinuation of peripheral intravenous catheters. J Infus Nurs2006; 29: 338–345.
ZhangZWangXZhangL, et al. Infrared vein imaging for insertion of peripheral intravenous catheter for patients requiring isolation for severe acute respiratory syndrome coronavirus 2 infection: a nonrandomized clinical trial. J Emerg Nurs2022; 48: 159–166.
62.
Bodenham ChairABabuSBennettJ, et al. Association of Anaesthetists of Great Britain and Ireland: safe vascular access 2016. Anaesthesia2016; 71: 573–585.
63.
Franco-SadudRSchnobrichDMathewsBK, et al. Recommendations on the use of ultrasound guidance for central and peripheral vascular access in adults: a position statement of the Society of Hospital Medicine. J Hosp Med2019; 14: E1–E22.
64.
WeathersECazzellMThompsonJA, et al. Vein visualisation technology for peripheral intravenous access in paediatric patients: a clinical decision-making tool. Nurs Open2024; 11: e70054.
65.
BrownRACrookesPAIversonD.An audit of skills taught in registered nursing preparation programmes in Australia. BMC Nurs2015; 14: 68.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
