Effect of catheter advancement technique on needle tip motion during peripheral intravenous insertion.

In 30 seconds

This prospective, randomized-order, within-subject crossover study compared needle-tip motion during three peripheral intravenous catheter advancement techniques. At a single academic medical center, 78 clinicians advanced 18-gauge catheters into a hand phantom using one-handed self-advancement, two-handed self-advancement, and two-person advancement. Two-handed self-advancement produced the lowest displacement (1.98 ± 1.14 mm), path length (3.93 ± 2.54 mm), and excursion (2.33 ± 1.21 mm). One-handed advancement caused greater motion on these measures and greater radial movement. Participants also rated two-handed self-advancement as easiest and most effective.

Key findings

• Two-handed self-advancement had the lowest needle-tip displacement (1.98 ± 1.14 mm), path length (3.93 ± 2.54 mm), and excursion (2.33 ± 1.21 mm).
• One-handed advancement increased displacement (2.54 ± 1.26 mm, p = 0.012), path length (9.23 ± 5.75 mm, p < 0.001), and excursion (3.44 ± 1.70 mm, p = 0.002) versus two-handed advancement.
• Two-person advancement had greater axial motion than two-handed self-advancement (1.65 ± 1.39 mm vs 0.78 ± 1.71 mm, p = 0.001).
• Participants perceived two-handed self-advancement as the easiest and most effective technique.

Why it matters

Needle-tip movement during catheter advancement may affect placement success and tissue injury. This phantom-based comparison identifies a technique associated with less measured motion, providing a rationale for further evaluation of catheter advancement methods and their effects on patient outcomes. The findings also highlight that perceived ease and effectiveness aligned with the technique showing the least motion.

What to keep in mind

The study measured needle motion during simulated insertion into a hand phantom at a single academic medical center; it did not establish effects on clinical placement success or endothelial injury.