Assignment: Qualitative Research Article Analysis

P eripheral venous catheters (PVCs) are the most common invasive device inserted in hospitals internationally. Up to 60% of all patients undergoing treatment in a tertiary hospital will have at least one PVC during their hospital admission (New et

al, 2014; Alexandrou et al, 2015). Previous studies have found that insertion of these devices is associated with a range of negative outcomes, from mild discomfort to extreme pain or anxiety (Halter et al, 2000; Wright, 2011). However, patients’ experiences of PVC insertion are under-investigated.

Experiences of peripheral IV insertion in hospital: a qualitative study Emily Larsen, Samantha Keogh, Nicole Marsh, Claire Rickard

ABSTRACT Adult medical and surgical patients admitted to tertiary hospitals regularly have peripheral venous catheters (PVCs) inserted for their treatment. Anecdotally, patients report varying levels of pain and anxiety during the insertion procedure; however, lived experiences of patients are not well documented in the literature. The aim of this study was to gain an understanding of patients’ experiences of PVC insertion. Some 10 participants were purposively sampled for semi-structured interviews, from the medical and surgical wards at a tertiary hospital in Queensland, Australia. Four key themes developed from the interview data: communication between the patient and the inserter; technique of device insertion; competence of the inserter; and location of the device. These themes informed practical ways that nurses might improve the patient experience, including: consultation with patients regarding device insertion preferences; siting the PVC in locations other than the antecubital fossa and hand; ensuring experienced and confident inserters are available to insert PVCs.

Key words: ■ Patients’ experience ■ Qualitative study ■ Catheterisation, peripheral ■ Nursing, medical-surgical

Emily Larsen, Senior Research Assistant, Alliance for Vascular Access Teaching and Research (AVATAR), Menzies Health Institute Queensland (MHIQ), Griffith University, Nathan Campus, Brisbane, Australia

Samantha Keogh, Professor, School of Nursing and Midwifery, Queensland University of Technology, Brisbane, Australia

Nicole Marsh, Research Fellow in Vascular Access, Menzies Health Institute Queensland (MHIQ), Griffith University, Australia

Claire Rickard, Professor, School of Nursing and Midwifery, Griffith University, Australia

Accepted for publication: October 2017

Background PVCs are inserted by medical or nursing staff (Alexandrou et al, 2015) and are typically placed in the upper arm, lower arm, hand or foot, using various size needles (measured by gauges) (O’Grady et al, 2011). Catheter size and location for insertion depend on patient characteristics (e.g. previous medical/ treatment history, comorbidities), infusion/treatment needs, and patient preferences (Sansivero, 2010; Gorski et al, 2016). Insertion may not always be successful, and escalation to a more experienced clinician is sometimes necessary.

Patient risk factors for problematic insertion, such as advancing age (Gabriel, 2012) and obesity (Sebbane et al, 2013), have increased over time. Older people also have reduced suitable vasculature for PVC placement, and often require multiple insertion attempts (Maiocco and Coole, 2012). Further, unsuccessful PVC insertions have increased the use of peripherally inserted central catheters (PICCs) and other central venous access devices (CVADs), which have higher morbidity, mortality and costs (Chopra et al, 2013).

One of the few papers to report the patient experience of PVC insertion was published in 2015 by Robinson-Reilly and colleagues (Robinson-Reilly et al, 2016). This qualitative study of patients’ experiences of PVC insertion used semi-structured interviews with patients in two rural oncology outpatient units within a hermeneutic-phenomenology methodology (Robinson-Reilly et al, 2016). The authors found that patients discussed their negative experiences with others, accepted the insertion as ‘a necessary evil’ and often recalled statements by inserting health professionals about the quality of their veins. This provided useful information; however, it was limited to a rural oncology cohort and might not be widely applicable to the hospital inpatient medical and surgical population.

Methods Design This study used a qualitative design to explore the patient’s experience and develop an understanding of the physical and emotional impact this may have on them during their hospital stay. Semi-structured interviews were conducted using a phenomenological-hermeneutic approach and Gadamer’s Critical Hermeneutic Process was used to inform the research methods (Gadamer, 1975; Fleming et al, 2003).

Setting and participants A convenience sample of 10 participants from the medical and surgical wards at the Royal Brisbane and Women’s Hospital

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Table 1. Demographic data of survey participants

Study ID Admission type Gender Age (in years) Number of PVCs this admission prior to interview

LOS prior to interview

1 Surgical (orthopaedic) Male 62 6 8 days

2 Surgical (gastrointestinal) Male 79 2 5 days

3 Surgical (gastrointestinal) Female 51 1 2 days

4 Medical (general) Female 53 1 10 days

5 Medical (endocrine) Female 57 1 2 days

6 Surgical (gastrointestinal) Male 24 2 14 days

7 Medical (gastrointestinal) Male 61 2 4 days

8 Surgical (orthopaedic) Female 62 2 3 days

9 Surgical (urology) Male 67 1 2 days

10 Surgical (orthopaedic) Female 44 4 8 days

LOS: Length of stay; PVC: Peripheral venous catheter

in Queensland, Australia were recruited between May and September 2015. Adult patients who had undergone a PVC insertion were eligible for inclusion. Patients were excluded if they were non-English speaking, confused, or undergoing late-stage palliative treatment. The recruitment number was determined by the point of saturation of themes and concepts.

Initially, the nurse overseeing the patient’s care for that day was consulted to assess the suitability of approaching potentially eligible patients. Patients who agreed to be approached were visited by the researcher, who explained the purpose and nature of the study. A participant information and consent form was provided, and the participant was given ample opportunity to ask questions and clarify their understanding of the study.

Of the 10 interviewed participants, 3 were from a medical unit and 7 were from a surgical unit. There were an equal number of men and women, aged from 24 to 79 years. Further demographic data of the participants is shown in Table 1.

Data generation After the patient had consented, a mutually suitable time for the interview was established. Participants were given the opportunity to choose the location for the interview— at the bedside, or in a private room on their ward. All 10 participants opted to have the interview conducted at the bedside. Those in shared rooms had their curtains drawn for privacy and participants in single rooms were asked if they would like the door completely shut. The digital audio- recording device was in plain view at all times (not concealed) and the participant was advised when it was turned on/off. Consenting participants were asked an initial question ‘What has been your experience of IV insertion?’, with following questions developing as a result of participant responses and conversation, such as ‘and what did you feel?’ and ‘how did this experience compare to your previous device?’ The duration of interviews was 5-26 minutes.

Data analysis The point of saturation of themes was determined by two processes. First, following each interview, the researcher reviewed the recording and identified key findings. Second, at the point that the interviewer believed theme saturation had been achieved (n=8), the transcribed interviews were analysed in more detail and an additional two interviews were conducted. At the completion of these interviews, theme saturation was met. Interviews were transcribed verbatim by an independent party. Transcripts were initially reviewed for a preliminary understanding of the findings, followed by a sentence-by- sentence review approach. Initial themes were derived from the process and verified by co-researchers. Participating individuals, who had opted to do so, were provided with a letter summary of the findings and were given a pre-paid envelope and contact details to respond if they felt the findings did not reflect their experience. There were no responses returned.

Ethical considerations This study was conducted in accordance with the National Statement on Ethical Conduct in Human Research and received Human Research Ethics Committee approval by the Royal Brisbane and Women’s Hospital (HREC/14/QRBW/518) and Griffith University (NRS/46/14/HREC).

Results The understanding gained from the interviews revealed elements of patient satisfaction, as well as fear and mistrust of clinicians who inserted and cared for their PVCs. While some patients wanted to be involved in problem-solving and decision-making processes, others were satisfied to hand all responsibility to the clinician. Participants shared feelings of wanting the most comfortable health care experience possible. For some, this relied on open communication during the device insertion. For others, it was the feeling of a sound sleep without interruption

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by their PVC or infusion machine. Four themes were derived from the data.

Theme 1: communication between the patient and the PVC inserter Communication between the patient and the inserter was highlighted as a key factor in the PVC insertion procedure. Deficits in this communication process were a particularly common finding, emerging from 6 of the 10 interviews. Some patients reflected that, although they expressed concerns or offered advice to the clinician inserting the PVC, their opinions were met with refusal and/or mistrust.

The most emotive and frustrating element of the PVC insertion experience, as reported by 4 of the 10 patients, was an inability to influence the manner in which the procedure was carried out. It related to communication in the preparation, insertion and securement stages of the PVC placement process:

‘They don’t listen when you tell them you’ve got no veins, and they just keeping probing and prodding all over.’

Interview 4

Patients who were unhappy with the insertion procedure often felt they did not have the ability to impact upon the insertion location of the device.

‘I never thought you could actually say, “Oh, can I have it here or there?”.’

Interview 8

Notwithstanding this, while most patients felt disempowered, they nonetheless had a threshold of tolerance and could be assertive when necessary. One patient stated that, despite feeling her opinion was not valued, there were certain limits she adamantly enforced:

‘They always keep on asking to go to my feet and I won’t let them … No way in the world is anybody sticking any things like that in my feet.’

Interview 4

In that same interview, it emerged that the PVC had been dressed with a product to which the patient was allergic. Though the patient had advised the clinician, the staff member had still insisted on checking the patient’s medical chart prior to the dressing being removed and replaced. That concept of mistrust and disbelief from the treating clinician was mirrored with another patient who had experienced similar situations:

‘It’s when you get someone that’s, um, not met you before or hasn’t worked with you, ah, they just don’t believe you.’

Interview 7

Separate from the process of PVC insertion, dressing and securement, several patients felt that communication prior to insertion was an important—but often lacking—aspect of the procedure. Participants commented on the quality of the warning given prior to device insertion, both positive and negative. While most participants were told what the procedure

would feel like, some felt they were ill-prepared:

‘So when they—when you say—it’s just a little scratch and then there’s massive pain, not a good thing. Because you’re expecting a little pin prick and it hurts like crazy.’

Interview 10

A number of patients with chronic illness and regular re- admissions had experienced multiple PVC insertions. These patients had become experts in the knowledge of their own vasculature. Despite this, clinicians were not always receptive to this advice:

‘You’re the one that knows your body and I know my body back—back to front. But they just don’t take any notice and that’s what they’ve got to learn to do.’

Interview 4

‘And others, they’re almost arrogant with the way they, they just ignore what you say and “I know better than you” sort of thing … the reason I told them that was to save all that drama.’

Interview 7

It was clear in some cases that the patients had been told they had poor vasculature by the inserting clinician. In other cases, it seemed others had formed that conclusion themselves.

‘Because I’ve got no veins. I haven’t had veins at all, um, not even as a kid ... but no, when I come in, they don’t take notice and they just jab wherever they feel like it.’

Interview 4

‘Finding a vein to use is a problem too for me, not everyone’s like that.’

Interview 7

In one interview, the patient acknowledged the inserter ‘had to say something’ when they were experiencing difficulties.

‘They just said the veins aren’t good enough or whatever, yeah … Only when they can’t—they’re having trouble, yeah … Got to say something, aye?’

Interview 5

Theme 2: technique of device insertion The quality and severity of pain varied among participants. The discomfort was amplified with multiple attempts for insertion— this emerged within 6 of the 10 interviews. Patients, while acknowledging the need for the device, were disappointed if a device was not inserted on the first attempt. Multiple insertion attempts were linked with a change in the quality of the pain from a sting to an ache, as well as an increase in pain severity.

‘When they just keep going in and in all the time and moving it around, that’s the part that

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hurts the most ... but they don’t take notice of that, it’s not their arm.’

Interview 4

‘That was really, really sore, because she kept poking at the same place and I was sort of imagining it poking through the vein again and that, and she just kept, push, push, pushing.’

Interview 8

Patients also had preferences related to speed of the insertion process. Five patients felt that a slower, careful insertion would decrease pain intensity and reduce the risk of vein damage. This view was predominantly held by patients receiving ongoing treatment over a number of hospital admissions.

‘They don’t go in slowly, they actually just get there and go bang and that kills, it really does. It hurts like crazy. If they do it slowly and properly like that, people won’t complain.’

Interview 4

‘Maybe they need to take a little more time to make sure they’ve got the—the vein tapped out correctly.’

Interview 1

In contrast, three patients indicated positive experiences associated with faster insertions, although this was typically expressed by those who had experienced a ‘first attempt’ successfully inserted PVC.

‘He could just go straight through with it, it’s done in seconds.’

Interview 3

‘You know, you—you’d just as soon have it fixed and done—done once and not fooling around with it, yeah.’

Interview 2

Theme 3: competence of the inserter In 6 of the 10 interviews, patients associated better PVC insertion experiences with those they perceived to be more confident or experienced clinicians.

‘She clearly knew what she was doing. You could tell by the body language.’

Interview 9

In contrast, less experienced inserters were linked to poorer patient experiences.

‘Well, I was a bit—bit nervous when this new nurse, first time she’s ever done it’.

Interview 2

Participant 9 went so far as to explain the qualities she associated with confidence:

‘A person who in my mind is competent has

minimal movement, the movement is very focused and the concentration is very intense and the speed at which the procedure is delivered is very rapid.’

Interview 9

Confidence and success of insertion were often linked with professionals who inserted PVCs regularly as part of their day- to-day practice.

‘Every time I’ve had it put in in the ER with one of the nurses, it’s—you never really feel it. They’re quick. They do ’em all—you know, so many of them a day. Um, generally, if it’s a doctor or someone, they tend to hurt a bit more and fidget more to find a vein I guess, once they’re in.’

Interview 6

Participants were typically aware of the inserter’s profession and indicated either relief or dismay based on this knowledge. While some participants felt secure with a doctor inserting the device, others preferred nurse inserters. This was usually related to previous experiences and prior perceptions of the health professionals’ training, expertise and confidence.

‘I felt a bit more secure with the doctor doing it naturally.’

Interview 2

‘Oh, the doctors are useless … the doctors are—I don’t think they want to do it and it’s always better to get a nurse, because some nurses do a lot, a lot of them. You know, doctor doesn’t do very many of them anyway.’

Interview 7

Theme 4: location of the device Despite the study interview questions relating only to the insertion procedure, 8 of the 10 patients frequently referred to PVC experiences occurring after the insertion procedure. It emerged that these patients were constantly aware of the device placement and found it had an ongoing negative impact on their daily activities and sleeping habits. Patients with devices inserted in either the antecubital fossa or in the hand reported that they could not bend their arms, or had to be vigilant to avoid the risk of the device or its tubing ‘catching’ on their surroundings. In some cases, patients reported intermittent or continuous pain at the PVC insertion site.

One of the primary concerns that emerged from the interviews was the impact that device blockage had upon activities of daily living. Some 3 of the 10 patients reported losing significant sleep time due to blocked devices and the subsequent alarming of infusion machines.

‘I swear it knows when I’m rolling over to go to sleep, that’s why I’m so buggered [sic] in the day, because I can’t keep my eyes open.’

Interview 3 (PVC location: antecubital fossa)

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‘I would, I would, I would ask them if they could try and not do it right in the crook of my arm, because as I say it’s—it’s—it’s—it’s ah, so inconvenient. Because I’m—I’m a light sleeper and um, you know you—I move and then the thing goes off and then you’re awake and I find it hard to get back to sleep and, you know et cetera.’

Interview 2 (PVC location: antecubital fossa)

Three patients interviewed stated they felt pain from the PVC insertion site for the entire time while the device was in place. In some cases, the pain reported after insertion was worse than the insertion procedure.

‘It was in there for a little bit, it hurt the whole time it was in there though.’

Interview 10 (PVC location: hand)

‘When they put it in the wrong place, that’s a— that’s an ache and it really, really hurts, and it builds.’

Interview 1 (PVC location: unidentified)

While some participants found that the device did not cause them any inconvenience, others were constantly aware of the device location.

‘But—I don’t know, at least—by having it there, you’re aware of it more. If it’s further up the arm, you tend to forget it’s there, whereas there it’s a constant reminder. So you tend to be more careful.’

Interview 9 (PVC location: hand)

‘Yeah, and that’s the worse place there, it really is, and it always seems to get caught on things too. You know, like your jackets or your pyjamas or something, always pulling and that.’

Interview 8 (PVC location: forearm)

In summary, the findings of this study can be grouped into four key themes of the patients’ lived experience of PVC insertion and, to some extent, post-insertion experiences. These

are presented in Figure 1. The results indicated that patients identified links between these themes. Location of the device and technique of device insertion could, in many cases, have been informed by better communication between the patient and the inserter. Similarly, patients reported having better experiences with competent, experienced inserters who inserted the devices into the forearm veins, rather than other locations.

Discussion The aim of the study was to explore the lived experience of patients having a PVC inserted. This was met using qualitative methodology, which allowed an exploration of this phenomenon to create real understanding. While four themes emerged from these findings, the overarching understanding gained was that it is not the device itself that is of greatest concern to patients, rather it is the inserter, specifically their communication skills, competence and choice of insertion site. Patients need to feel there is responsive and trusting communication with the clinician; they want the inserter to have a technique that reduces severity of pain/discomfort; they want to know that the inserting clinician has adequate experience; and they need the device inserted in a position where it will not be a burden. Perhaps not surprisingly, there was a greater representation of negative or neutral experiences than positive experiences. This does not necessarily reflect that all PVC insertions are negative; rather it may be that patients did not create as much meaning from an experience if it was uneventful.

Communication and trust between the clinician and the patient was found to be associated with the most significant and negative patient experiences surrounding the PVC insertion process. Patients preferred to be warned appropriately of what to expect during insertion, even if they were told to expect something negative. Some patients also felt that they could have improved the insertion process if they had been listened to by the inserting clinician, particularly in relation to the location of the device. This was a key similarity identified with the qualitative study by Robinson-Reilly et al (2016), which explored PVC insertion experiences of patients in rural oncology units. The theme ‘suggestions for improvement’ included a recommendation for improved rapport between patient and clinician (Robinson-Reilly et al, 2016). For clinicians to further increase the role of the patient in PVC insertion, care and maintenance, it is essential that the patient experience of PVC insertion is first understood and valued.

In addition to not feeling included or their prior experience being respected, patients felt ‘blamed’ for challenges with PVC insertion and maintenance. This finding was also supported by Robinson-Reilly et al (2016), who found that 13 of 15 interviewed participants had been told that they had ‘bad’ or ‘difficult’ veins. Ideally, if open and positive communication is used, clinicians would trust patients’ advice about likely procedural difficulty, and decide if their skill or confidence is adequate. Regardless of the patient’s individual vasculature, clinicians should be moving away from the fault placed on patients (‘you have bad veins’) and look to solutions such as referral/consultation with a more competent inserter. Most patients agreed that regular practice was likely to lead to a better Figure 1. Correlations between themes

Patient experience

Competence of the inserter

Communication between the patient

and the inserter

Location of the device

Technique of device insertion

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insertion experience. This belief is supported by Carr et al (2010) who found that frequency of PVC insertion procedures directly linked with confidence (Carr et al, 2010), which in turn is likely to positively impact upon insertion success (Rippey et al, 2016).

Finally, participants with devices inserted in the antecubital fossa or the hand reported a range of negative experiences related to increased pain during insertion, and adverse impacts upon sleep and other daily activities. Previous research has found that PVCs inserted in the hand and antecubital fossa are more likely to fail by both mechanical (e.g. dislodgement) and occlusion/infiltration modes (Wallis et al, 2014). Considering that patients also have poorer lived experiences related to these sites, it is important that clinicians avoid these sites if possible. Patient satisfaction is of increasing importance to healthcare organisations. Positive patient experiences of PVC insertion may improve the perception of care provision.

Limitations This study was conducted using qualitative methodology, which is valuable in developing understanding rather than knowledge. While saturation of four key themes was gained from the included participants, there may be other themes yet to be explored which were not recounted by any of the included patients, due to the included sample. It is therefore not possible to generalise the findings of this study to all patients receiving PVCs. The study was, however, conducted using a robust qualitative methodology and does shed light on key issues which clinicians may recognise in their own practice settings. The onus lies on future researchers to conduct studies into how professionals may understand and improve the phenomenon of the lived experience of PVC insertion.

Conclusion In summary, there is a clear need for improved communication, insertion technique and device location choice during PVC insertions. While the PVC insertion process is an invasive procedure and therefore inherently inclined to cause pain, health professionals must still endeavour to explore the most effective techniques to minimise pain and discomfort for patients. BJN

Declaration of interest: none

Acknowledgements: the authors would like to acknowledge the support of the participants and staff of the Royal Brisbane and Women’s Hospital

Alexandrou E, Ray-Barruel G, Carr PJ et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med. 2015; 10(8):530–533. https://doi.org/10.1002/jhm.2389

Carr PJ, Glynn RW, Dineen B, Kropmans TJ. A pilot intravenous cannulation team: an Irish perspective. Br J Nurs. 2010; 19(10):S19-27. https://doi. org/10.12968/bjon.2010.19.sup3.48214

Chopra V, O’Horo JC, Rogers MAM, Maki DG, Safdar N. The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2013; 34(9):908–918. https:// doi.org/10.1086/671737

Fleming V, Gaidys U, Robb Y. Hermeneutic research in nursing: developing a Gadamerian-based research method. Nurs Inq. 2003; 10(2):113–120. http:// doi.org/10.1046/j.1440-1800.2003.00163.x

Gabriel J. Venepuncture and cannulation: considering the ageing vein. Br J Nur. 2012; 21(Suppl 1 IV therapy): S22-S28. http://dx.doi.org/doi:10.12968/ bjon.2012.21.Sup1.S22

Gadamer HG. Truth and method. New York: Seabury Press; 1975 Gorski L, Hadaway L, Hagle ME, McGoldrick M, Orr M and Doellman D

Infusion Therapy Standards of Practice. J Infus Nurs. 2016; 39(1S) Halter M, Lees-Mlanga S, Snooks H, Koenig KL, Miller K. Out-of-hospital

intravenous cannulation: the perspective of patients treated by London Ambulance Service paramedics. Acad Emerg Med. 2000; 7(2):127–133. http://doi.org/10.1111/j.1553-2712.2000.tb00514.x

Maiocco G, Coole C. Use of ultrasound guidance for peripheral intravenous placement in difficult-to-access patients: advancing practice with evidence. J Nurs Care Qual. 2012; 27(1):51–55. https://doi.org/10.1097/ ncq.0b013e31822b4537

New KA, Webster J, Marsh NM, Hewer B. Intravascular device use, management, documentation and complications: a point prevalence survey. Aust Health Rev. 2014; 38(3):345–349. https://doi.org/10.1071/ah13111

O’Grady NP, Alexander M, Burns LA et al. Guidelines for the Prevention of Intravascular Catheter-related Infections. Clin Infect Dis. 2011; 52(9):e162– e193. https://doi.org/10.1093/cid/cir257

Rippey JC, Carr PJ, Cooke M, Higgins N, Rickard CM. Predicting and preventing peripheral intravenous cannula insertion failure in the emergency department: Clinician “gestalt” wins again. Emerg Med Australas. 2016; 28(6):658–665. https://doi.org/10.1111/1742-6723.12695

Robinson-Reilly M, Paliadelis P, Cruickshank M. Venous access: the patient experience. Support Care Cancer. 2016; 24(3):1181–1187. https://doi. org/10.1007/s00520-015-2900-9

Sansivero GE. Features and selection of vascular access devices. Semin Oncol Nurs. 2010; 26(2):88–101. https://doi.org/10.1016/j.soncn.2010.02.006

Sebbane M, Claret P-G, Lefebvre S et al. Predicting peripheral venous access difficulty in the emergency department using body mass index and a clinical evaluation of venous accessibility. J Emerg Med. 2013; 44(2):299–305. https:// doi.org/10.1016/j.jemermed.2012.07.051

Wallis MC, McGrail M, Webster J et al. Risk factors for peripheral intravenous catheter failure: a multivariate analysis of data from a randomized controlled trial. Infect Control Hosp Epidemiol. 2014; 35(1):63–68. https://doi. org/10.1086/674398

Wright AJ. Trauma resuscitations and patient perceptions of care and comfort. J Trauma Nurs. 2011; 18(4):231–238. https://doi.org/10.1097/ jtn.0b013e31823a49eb

KEY POINTS ■ Patients want an experienced peripheral venous catheter (PVC) inserter

who listens to them

■ Communication failures and a perceived mistrust of patients’ own knowledge result in frustration and increased discomfort from repeated insertion attempts

■ Patients can clearly identify nurses/other clinicians who are confident and competent PVC inserters

■ Forearm-inserted PVCs result in better patient experiences

CPD reflective questions

■ Should you incorporate patient preferences and decision-making when inserting a PVC?

■ Do you feel confident in the process of inserting PVCs and would this confidence be evident to your patients?

■ Do you know your hospital’s policy relating to escalation following repeated failed attempts at PVC insertion?

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