When considering the selection and management of vascular access devices (VADs), "quantifiable indicators" such as complication rates, costs, and dwell time from a healthcare professional's perspective tend to lead to significant evidence. However, the psychological burden that peripheral intravenous catheter (PIVC) insertion itself places on patients and their families has not been sufficiently visualized until now. Especially,Difficulty with needle insertion ("difficult venous access": DVA)For patients experiencing this, repeated failed punctures can lead not only to pain but also to refusal of treatment and trauma.
This time, we introduce a qualitative study that carefully depicts the experience of difficult PIVC insertion from the perspective of pediatric patients and their guardians, based on personal accounts.
[Review Article]
The parental, child, and young person experience of difficult venous access and recommendations for clinical practice: A qualitative descriptive study
Sharp R, Muncaster M, Baring CL, Manos J, Kleidon TM, Ullman AJ.
Journal of Clinical Nursing. 2023; Volume 32, Issue 17-18: 6690–6705
https://doi.org/10.1111/jocn.16759
Background
The insertion of peripheral intravenous catheters (PIVCs) is one of the most common invasive procedures in hospitalized children. While it may appear to be a "routine procedure" to clinicians, it can be a highly stressful experience for children and their families, signifying the initiation or resumption of complex treatments.
In children, difficult venous access (DVA) is not uncommon, with more than half requiring two or more attempts, and some cases requiring ten or more. Failed venipuncture not only causes pain and distress but also can lead to delays in time-sensitive treatments such as antibiotics and fluid infusions. However, much of the existing research on patient experiences with DVA has focused on adults, with few high-quality studies exploring the experience of difficult venous access from the perspectives of parents and children/adolescents themselves. This study was conducted to fill this gap and gain insights for clinical improvement from the voices of those directly involved.
【Method】
– Research Design: Qualitative Descriptive Study
– Target Audience: Primary caregivers (parents) of children aged 0-17 with a history of difficult venipuncture, and children/adolescents aged 8 and above themselves
Definition of DVA: History of two or more failed percutaneous needle insertions or blood collection attempts, regardless of anatomical or behavioral factors.
[Result]
Three major themes were extracted from the analysis, along with one predetermined theme (Recommendations for Clinical Practice).
■ Theme 1: Pain – Before, During, and After Treatment
Children and adolescents experienced anticipatory anxiety even before the puncture, and the repeated pain led to treatment refusal. Suffering was influenced by the operator's attitude; intimidating interactions amplified the pain, while calm interactions that offered choices alleviated it. This experience became cumulative trauma (PMTS), which also spread to anxiety in other medical situations.
■ Theme 2: A Family Navigating the System - The Difficult Path from General Practitioner to Specialist
In many facilities, the system was that the physician in charge of the department (often the least experienced one) would attempt the puncture before referring the patient to a specialized vascular access (VA) nurse. Parents recounted experiences of not being believed when explaining past DVAs, or being blamed for dehydration, stating that they "had no choice but to arm themselves with knowledge and negotiation skills to become advocates" to connect with specialists. There were also instances where parents had to intervene to stop unnecessary punctures, later expressing guilt by saying, "I wish I had stopped them sooner." Encountering a specialized VA nurse (who could perform ultrasound-guided punctures, for example) was described as a "blessing."
■ Theme 3: Difficulty with needle insertion affects both treatment and "life outside the hospital"
Repeated needle sticks led to delays in treatment, including chemotherapy, and when combined with waiting times for numbing cream, it resulted in days being entirely consumed by these appointments. Furthermore, early morning departures for hospital visits, balancing childcare for siblings, and supporting parents' work schedules impacted the entire family's life.
■ Theme 4 (Default): Recommendations for Quality Clinical Practice
The recommendations were divided into two categories: individual clinicians (preparation/engagement before insertion, practice and communication during the procedure) and healthcare services (cultural/process transformation, expansion of professionals/resources/training). Specific examples include introducing oneself and clarifying roles, building rapport, confirming previous puncture history, early specialist referral, and implementing trauma-informed care.
Conclusion/Summary
This study, through the voices of those affected, demonstrated that repeated failed attempts at venous access can cause significant psychological distress for both children/adolescents and their families, and can even lead to treatment avoidance. To minimize distress, avoiding multiple punctures is important, as is providing effective interpersonal skills, offering choices, and using non-threatening language. The authors recommend that even clinicians without specialized training should assess each child's experience with venous access and promptly refer to specialists if they have a history of DVA. They argue that this requires a cultural shift and appropriate resource allocation for VA specialists. For patients with DVA, venous access is not a "simple, routine procedure." This report re-evaluates not only technical success rates but also patient and family experiences as quality indicators, offering insights for staff involved in vascular access for patients.
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