References
Acceptability of external jugular venepuncture for patients with liver disease and difficult venous access
Abstract
Background:
Difficult venous access (DVA) is common in liver patients requiring blood collection using traditional peripheral approaches. This study aimed to understand the experience of DVA for liver patients and the acceptability of peripheral venepuncture versus external jugular venepuncture (EJV). A secondary aim was to explore the impact of EJV on local resource utilization.
Methods:
Semistructured interviews with liver outpatients with DVA (n = 10) requiring venepuncture were firstly themed inductively. We then deductively applied the acceptability framework of Sekhon et al. as a further analytic lens. Audit data from DVA encounters (n = 24) allowed analysis of issues from multiple perspectives. The Consolidated Criteria for Reporting Qualitative Research reporting checklist guides this report.
Results:
Peripheral venepuncture had poor prospective, concurrent, and retrospective acceptability, requiring significant mental and physical preparation. Fear, stigma, pain and distress, poor continuity of care, and poor effectiveness led to service disengagement. While EJV caused initial trepidation, it had high concurrent and retrospective acceptability. The significant improvement in patient experience was corroborated by audit data for both procedure duration (5 versus 15 minutes) and first attempt success (100 versus 28.5%) for EJV versus peripheral venepuncture, respectively. While EJV required a recumbent position, it required less staff.
Conclusions:
EJV is highly acceptable to patients, using less time and staff resources. EJV protocols and staff training should be considered where DVA presentations are common. Individualized care plans and careful care coordination could divert DVA patients needing venepuncture to services that use EJV preferentially.
Peripheral venepuncture results in fear, stigma, pain, & distress for those with DVA.
This poor acceptability of traditional venepuncture leads to service disengagement.
External jugular venepuncture is highly acceptable & improves resource utilization.
Venous access is a taken-for-granted aspect of contemporary disease management, yet for many people with complex health needs, obesity, diabetes, and/or a history of injecting drug use (IDU), venous access is time consuming and painful.1,2,3 Difficult venous access (DVA) is characterized by patient distress,2,4 veins that are difficult to visualize and palpate,5 and in our service, is defined by either 2 failed venepuncture attempts on a single occasion or multiple attempts on previous occasions.
As advanced practice nurses working in a tertiary gastroenterology/liver center, we identified DVA as a significant clinical problem. An earlier survey reported that over one-third of our liver outpatients experienced DVA, nearly one-quarter were reluctant to have venepuncture, and 12% felt bad or discriminated against. Of concern, 12% believed DVA prevented their access to therapy. Figures were worse for our drug health service, where 59% of respondents described DVA, 66% were reluctant to have venepuncture, and 36% felt bad or discriminated against.6
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