Location of Repository

An evaluation of an educational intervention to reduce inappropriate cannulation and improve cannulation technique by paramedics

By Aloysius Niroshan Siriwardena, Mohammad Iqbal, Smita Banerjee, Anne Spaight and John Stephenson


Background: Intravenous cannulation enables administration of fluids or drugs by paramedics in prehospital settings. Inappropriate use and poor technique carry risks for patients, including pain and infection. We aimed to investigate the effect of an educational intervention designed to reduce the rate of inappropriate cannulation and to improve cannulation technique.\ud Method: We used a non-randomised control group design, comparing two counties in the East Midlands (UK)as intervention and control areas. The educational intervention was based on Joint Royal Colleges Ambulance Liaison Committee guidance and delivered to paramedic team leaders who cascaded it to their teams. We analysed rates of inappropriate cannulation before and after the intervention using routine clinical data. We also assessed overall cannulation rates before and after the intervention. A sample of paramedics was assessed post-intervention on cannulation technique with a ‘‘model’’ arm using a predesigned checklist.\ud Results: There was a non-significant reduction in inappropriate (no intravenous fluids or drugs given) cannulation rates in the intervention area (1.0% to 0%) compared with the control area (2.5% to 2.6%). There was a significant (p,0.001) reduction in cannulation rates in the intervention area (9.1% to 6.5%; OR 0.7, 95% CI 0.48 to 1.03) compared with an increase in the control area (13.8% to 19.1%; OR 1.47, 95% CI 1.15 to 1.90), a significant difference (p,0.001). Paramedics in the intervention area were significantly more likely to use correct hand-washing techniques post-intervention (74.5% vs. 14.9%; p,0.001).\ud Conclusion: The educational intervention was effective in bringing about changes leading to enhanced quality and safety in some aspects of prehospital cannulation

Topics: B990 Subjects Allied to Medicine not elsewhere classified, A300 Clinical Medicine
Publisher: BMJ Publishing Group / Cambridge University Press
Year: 2009
DOI identifier: 10.1136/emj.2008.071415
OAI identifier: oai:eprints.lincoln.ac.uk:2047

Suggested articles



  1. (2006). Advanced cardiac life support before and after tracheal intubation—direct measurements of quality. Resuscitation doi
  2. Ambulance paramedic activities in North Ayrshire: a five-year review. doi
  3. (2000). Appropriateness of intravenous cannulation by paramedics: a London study. Prehosp Emerg Care doi
  4. (1997). Cardiovascular morbidity and mortality among hypertensive patients in general practice: the evaluation of long-term systematic management. doi
  5. (2004). Clinical effectiveness and costeffectiveness of prehospital intravenous fluids in trauma patients. Health Technol Assess
  6. Clinical epidemiology and outcomes of peripheral venous catheter-related bloodstream infections at a university-affiliated hospital. doi
  7. (2006). Colleges Ambulance Liaison Committee, Ambulance Service Association. UK ambulance service clinical practice guidelines. doi
  8. (1995). Comparison of clinically significant infection rates among prehospital-versus in-hospital-initiated I.V. lines. Ann Emerg Med doi
  9. Experimental methods in health research. In:
  10. Health outcomes of asthma and COPD patients: the evaluation of a project to implement guidelines in general practice. doi
  11. (1998). Is routine replacement of peripheral intravenous catheters necessary? Arch Intern Med doi
  12. Methods for evaluating area-wide and organisation-based interventions in health and healthcare: a systematic review. Health Technol Assess 1999;3:27–32. doi
  13. (2000). Out-of-hospital intravenous cannulation: the perspective of patients treated by London Ambulance Service paramedics. Acad Emerg Med doi
  14. Peripheral intravenous catheters started in prehospital and emergency department settings. doi
  15. (1993). Prehospital cardiac arrest survival and neurologic recovery. doi
  16. (1998). Prevention of peripheral venous catheter complications with an intravenous therapy team: a randomized controlled trial. doi
  17. (2009). Releasing the potential of health services: translating clinical leadership into healthcare quality improvement. Qual Prim Care 2006;14:128.
  18. (2006). SPSS 14.0 guide to data analysis. Upper Saddle River,
  19. The effects of an awareness-raising program for patients and primary care physicians on the early detection of gastro-oesophageal cancer. doi
  20. The PAMINO-project: evaluating a primary care-based educational program to improve the quality of life of palliative patients. doi
  21. (2008). The time cost of prehospital intubation and intravenous access in trauma patients. Prehosp Emerg Care doi
  22. (2008). To cannulate or not to cannulate? Variation, appropriateness and potential for reduction in cannulation rates by ambulance staff [conference abstract]. Emerg Med J

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.