“It’s Not Just a Cannula”: What Patients in an Australian ED Said About PIVC Insertion and Care

Study Overview

Peripheral IV catheters (PIVCs) are inserted constantly in emergency departments, but the patient experience can vary wildly depending on technical skill, communication, and how decisions are made under pressure. This CFIR-guided qualitative study explored what patients actually experience during PIVC insertion and care in an Australian tertiary ED, and what clinicians believe gets in the way of best practice.

Researchers interviewed 13 patients and 9 clinicians in 2025, then analysed themes using CFIR domains to identify barriers and enablers to evidence-based, patient-centred PIVC care.

Key Findings

• Skill and confidence mattered immediately
  • Patients noticed when clinicians were confident and technically strong, and anxiety increased when attempts dragged on or staff seemed unsure. Ultrasound was repeatedly seen as the “gold standard” for difficult cannulation, but access and consistent use were limited.
• Communication was inconsistent, and consent often felt rushed
  • Some patients received clear explanations and choices, while others described little to no explanation, minimal empathy, and a “get it done” approach. Patients wanted to understand why it was going in, where it would go, and what to expect.
• Convenience-driven decisions showed up in site choice and “just in case” cannulas
  • Both patients and clinicians described cannulas being inserted for convenience, sometimes before a clear need existed. Patients particularly disliked antecubital fossa placements due to discomfort and alarms with movement.
• Escalation stigma shaped behaviour
  • Clinicians described a culture where escalating difficult IV access could feel like failure, especially among doctors, leading to more attempts than policy allows.
• Time pressure and workload overrode best practice
  • Staff repeatedly described ED busyness as the reason patient education, empathy, and documentation fall away, even when clinicians know what best practice should look like.
• What helps: mentorship, role modelling, standardised training, and feedback
  • Both groups highlighted the value of senior support, structured escalation pathways, better training (including realistic simulation), and performance feedback that keeps standards visible.

Implications

This study makes it clear that improving ED PIVC care isn’t just about telling people the guideline. The solution needs to be practical and cultural: better technical training (including ultrasound), early escalation that feels normal, and communication that respects patient anxiety and autonomy even in a rushed environment.

Small changes could make a big difference, such as staged education (quick explanation now, deeper info if admitted), patient-friendly resources to support consent, and visible leadership that rewards best practice rather than speed-only behaviour.

Read more: https://doi.org/10.1016/j.ienj.2026.101762

Authors: Hui (Grace) Xu; Jed Duff; Vickii Binnie