Aims: To describe the use and outcomes of Vascular Access Devices (VADs) in older patients.
Methods: Prospective observational study of patients admitted under Geriatric Medicine and requiring a VAD (9 month period), evaluating cannulation sites, VAD-administered therapies, documentation, and complications.
Results: Amongst 215 patients- mean age 82.8 (SD 7.7), 60% (128) female, 26% living with dementia- 88% (189) had peripheral intravenous cannula (PIVC) at enrollment (80.9% 1 PIVC; 2 long, 187 short), all inserted in the Emergency Department. Commonest reasons for PIVC included IV medication (51%; 97/189) and blood-taking (50%). A subsequent 26 additional cannulae were inserted (outside ED) and eligible for inclusion.
Overall, 54% (117/215) had one PIVC and 13% ≥3 PIVCs during admission. Overall, 65% (123/189) existing cannulas failed within first 24 hours, with 56.4% of failed cannulas idle, and 44% suffering complications; all bar one had been blind insertions.
Failed PIVCs were commonly in antecubital fossa (51%) or hand/lower forearm (44%); 51% (63/123) of those with failed PIVC required a second PIVC to complete treatment. Absolute risk of failed cannulation increased from ~40% day 1 to 80% day 7. Amongst failed cannulae, median number of cannulation attempts per patient was 7 (IQR 2.75-11). Median delay to second attempt was 150 minutes (9-368). Poor documentation of phlebitis scores and inappropriate device selection further contributed to burden.
Conclusions: The burden of PIVC failure highlights the need for proactive monitoring, timely intervention, and collaboration with vascular access teams, to improve patient care. Cost analysis (planned) will also be helpful.