Prediction of failure risk on the first attempt of peripheral puncture: Secondary analysis of the SPECTRA control group

Background: The SPECTRA study compared first-attempt success between ultrasound-guided and conventional peripheral intravenous catheter (PIVC) insertion. This subanalysis evaluated the control group results to determine the number of puncture attempts until successful or failed venous device insertion, stratified according to the Adult Difficult IntraVenous Access Scale (A-DIVA). Methods: Secondary analysis of the SPECTRA randomized clinical trial (RCT). Patients from the control group who underwent PIVC insertion without ultrasound guidance were included and stratified as high risk or low/moderate risk according to the A-DIVA. Statistical comparisons between the groups were conducted on the number of puncture attempts, insertion failures, catheter dwell time, and clinical outcomes related to PIVC insertion. Results: Of all 84 patients analyzed, 35 were classified as high risk, and 49 as low/moderate risk; 53 (63.1%) were female, mean age 59 ± 16 years. The main reason for hospitalization was infection; high-risk patients experienced more punctures, with 20 (57%) undergoing four punctures, compared to only 8 (16%) of the low/moderate-risk group, p < 0.001; the overall success rate of PIVC insertion was 17 (48.5%) in high-risk patients versus 43 (88%) in low/moderate-risk patients. Insertion failure occurred in 18 (51.5%) high-risk versus 6 (12%) low/moderate-risk patients, p < 0.001; the high-risk group had a shorter PIVC dwell time: 3 (2–8) days versus 8 (2–8) days in low/moderate-risk group, p = 0.065; PIVC removal due to negative outcomes (obstruction, infiltration, accidental removal) was higher in high-risk patients: 32 (91%) versus 24 (49%), p < 0.001. Conclusions: Patients classified as high risk in the A-DIVA scale required more puncture attempts, had shorter PIVC dwell times, and experienced more negative outcomes. Using technologies such as ultrasound is beneficial for patients at high risk of failure on the first attempt.