I. Woelfel3, K. Takabe1,2,4 1Virginia Commonwealth University,Department Of Surgery,Richmond, VA, USA 2Virginia Commonwealth University,Division Of Surgical Oncology,Richmond, VA, USA 3Virginia Commonwealth University,Richmond, VA, USA 4Massey Cancer Center,Richmond, VA, USA
Introduction: Intravenous cannulation (IV) is one of the most basic and essential medical procedures. The Association of American Medical Colleges lists it among the eight procedures in which all graduating medical students should be competent. However, it was reported that 30% of third year, and 23% of fourth year medical students have never placed an IV. IV cannulation can be a source of anxiety for medical students as it is often their first procedural patient care. We sought to investigate what barriers medical students face in successfully honing this skill and what factors have a positive impact on the success rate of IV placement.
Methods: A confidential web-based survey consisting of 12 free response and multiple choice questions was created and distributed via email to total of 367 third and fourth year students at a single US allopathic medical school. The responses were collected over a 2-week period in July 2015. The data were then imported and analyzed by two-tailed, unpaired T-tests.
Results: The response rate was 49.0% (180/367). The mean age of respondents was 25.4 years old, with males making up the predominant sex at 54.8%. 65.5% of the M3 class and 21.8% of the M4 class have never even attempted to place an IV due to lack of opportunity in the hospital environment but this is most likely because the survey was conducted at the beginning of the year. Common difficulties cited include: improper positioning of the needle and failure to identify the most appropriate insertion site. Also contrary to our expectation, prior preparation such as reading, watching videos or lectures did not increase the success rate. Interestingly, 91.6% of students who reported 1 attempt were successful in that first placement. With each successive attempt the mean rate of failure trended down from 50.0% at 2 attempts to 25.6% for over 9 attempts. The success rate was significantly better after 10 attempts than at attempts 2-9. Students who had training prior to medical school demonstrated a significantly higher success rate compared to students without. As we expected the success rate was significantly higher in EMTs (81.4%, p=0.038) but surprisingly it was also higher in lab researchers (86.6%, p=0.014).
Conclusion: A significant percentage of students were not given opportunities to attempt IV cannulation. We found that neither the type of preparation nor the preferred location of placement has any affect on success rate. The first attempt had a high rate of success likely due to an increased level of supervision and attention. Prior experience, not only as an EMT but also as a lab researcher, significantly increases the success rate. Therefore, it is important for medical educators to target those with no prior experience in the healthcare field and ensure adequate training so that this impediment to their success can be overcome.