Factors determining success and the cost of materials used in securing intravenous access in an emergency setting: A prospective observational study.

INTRODUCTION: Multiple failed attempts at securing intravenous catheter access cause increased patient dissatisfaction and higher costs. We aimed to identify the factors leading to multiple failed attempts and estimate the cost of resources wasted. METHODS: Participants were recruited from the emergency department for a prospective, observational study. Healthcare workers inserting peripheral intravenous catheters were observed. Patient characteristics and the number of attempts needed were recorded. RESULTS: Three hundred thirty-four patients were enrolled, and an average of 1.74 ± 1.026 (Range: 1 - 5) access attempts were needed per patient. Only 56.28% of the insertions were successful on the first attempt. On multivariate linear regression with attempts as the outcome variable, age (ß = 0.01, 95%CI 0.004 - 0.014, p = 0.0006), catheter calibre (ß 20G = -0.25, 95%CI -0.45 - -0.07, p = 0.008), visibility (ß = 0.23, 95%CI 0.02 - 0.44, p = 0.026) and palpability (ß = 0.44, 95%CI 0.21 - 0.66, p = 0.0001) of the vein were statistically significant predictors. The average total cost of materials required was $6.4 USD per patient, of which $1.76 USD was spent towards unsuccessfully inserted catheters that were consequently thrown away. CONCLUSIONS: Our study shows that securing IV access often requires multiple attempts, with nearly 30% of the total cost amounting towards materials wasted. The risk of multiple attempts is highest for older patients with invisible and non-palpable veins.

Management of Biliary Cysts in Adults: A Single-Center 10-Year Experience.

BACKGROUND: A choledochal cyst is a cystic dilatation of the biliary tree, also termed a biliary cyst, including an intrahepatic cyst as well. Magnetic resonance cholangiopancreatography (MRCP) is the gold standard investigation of choice for this pathology. Todani classification is most commonly used to classify choledochal cysts. MATERIALS AND METHODS: A total of 30 adult patients with choledochal cysts presenting at our center from December 1, 2009, to October 31, 2019, were studied retrospectively. RESULTS: The mean age was 35.13 years ranging from 18 to 62 years with a male-to-female ratio of 1:3.29. Of the patients, 86.6% presented with abdominal pain. Total serum bilirubin was raised in six patients with a mean of 1.84 mg/dL. MRCP was done in all patients, which had almost 100% sensitivity. Two cases had anomalous pancreaticobiliary duct union. In our study, we found only type I and type IVA cysts according to the Todani classification (type IA = 56.3%, IB = 11%, 1C = 16%, and IVA = 17%). The mean size of the cyst was 2.37 cm. Complete cyst excision with Roux-en-Y hepaticojejunostomy was performed in all patients. Four patients had surgical site infections and two had bile leaks. One patient developed hepatic artery thrombosis. All complications were eventually managed conservatively. Mortality was nil in our study with the mean postoperative stay being 7.97 days. CONCLUSION: Adult presentation of biliary cysts is not an uncommon entity in the Indian population and should be considered as a differential diagnosis of biliary pathology in adult patients. Complete excision of cysts with bilioenteric anastomosis is the current treatment of choice.