Advertisement

Adherence to Two Large-Bore Intravenous Lines in Acute Gastrointestinal Bleeding Is Low

  • Mohammad BilalEmail author
  • Osama Alhajjar
  • Matthew Madisetty
  • Vamsi Kantamaneni
  • Shailendra Singh
  • Michael Babich
  • Anastasios Kapetanos
Fellows and Young GIs Section

Abstract

Background

While the available literature recommends placement of two large-bore intravenous (2LBIV) lines in every patient presenting with acute GIB, the adherence and impact of this recommendation have never before been reported.

Aims

We designed a quality improvement project to assess whether the patients presenting to our institution with acute GIB have appropriate intravenous (IV) access or not.

Methods

We conducted a prospective, observational study, of all patients presenting to our emergency department with overt GIB over a 2-month period. Data analysis was performed, and based on the results, an intervention plan was developed and executed. Post-intervention data collection was done over a 3-month period. Our interventions included physician and nursing education, placing posters in the emergency department, and creation of an order set in the electronic medical record system.

Results

A total of 46 patients were in the pre-intervention group, and 71 patients were in the post-intervention group. The presence of 2LBIV lines in the pre-intervention group was only 19.5%, which improved to 36.6% in the post-intervention group (p = 0.049). Factors associated with placement of 2LBIV lines were being in the post-intervention group and admission to the intensive care unit.

Conclusion

The relatively simple and cost-effective intervention of placing 2LBIV lines is not often executed. We suggest that specific mention of 2LBIV placement in guidelines from national gastroenterology societies might improve compliance in this aspect.

Keywords

Intravenous access Gastrointestinal bleeding Quality improvement Adherence 

Notes

Author’s contribution

MBilal, OA, MM, and VK performed the entire data collection. MBilal, MBabich, and AK conceived the project. MBabich and AK provided expert opinion and edited the manuscript. SS assisted with statistical analysis and wrote portions of the manuscript.

Compliance with ethical standards

Conflict of interest

The authors of the above manuscript have no relevant conflicts of interest or financial disclosures.

References

  1. 1.
    Baradarian R, Ramdhaney S, Chapalamadugu R, et al. Early intensive resuscitation of patients with upper gastrointestinal bleeding decreases mortality. Am J Gastroenterol. 2004;99:619–622.CrossRefGoogle Scholar
  2. 2.
    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107:345–360. (quiz 361).CrossRefGoogle Scholar
  3. 3.
    Bethea ED, Travis AC, Saltzman JR. Initial assessment and management of patients with nonvariceal upper gastrointestinal bleeding. J Clin Gastroenterol. 2014;48:823–829.PubMedGoogle Scholar
  4. 4.
    Strate LL, Gralnek IM. ACG clinical guideline: management of patients with acute lower gastrointestinal bleeding. Am J Gastroenterol. 2016;111:459–474.CrossRefGoogle Scholar
  5. 5.
    Garcia-Tsao G, Sanyal AJ, Grace ND, et al. Prevention and management of gastroesophageal varices and variceal hemorrhage in cirrhosis. Hepatology. 2007;46:922–938.CrossRefGoogle Scholar
  6. 6.
    Cabana MD, Rand CS, Powe NR, et al. Why don’t physicians follow clinical practice guidelines? A framework for improvement. JAMA. 1999;282:1458–1465.CrossRefGoogle Scholar
  7. 7.
    Adler DG, Leighton JA, Davila RE, et al. ASGE guideline: the role of endoscopy in acute non-variceal upper-GI hemorrhage. Gastrointest Endosc. 2004;60:497–504.CrossRefGoogle Scholar
  8. 8.
    Qureshi W, Adler DG, Davila R, et al. ASGE Guideline: the role of endoscopy in the management of variceal hemorrhage, updated July 2005. Gastrointest Endosc. 2005;62:651–655.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Mohammad Bilal
    • 1
    • 2
    Email author
  • Osama Alhajjar
    • 1
  • Matthew Madisetty
    • 1
  • Vamsi Kantamaneni
    • 1
  • Shailendra Singh
    • 3
  • Michael Babich
    • 3
  • Anastasios Kapetanos
    • 1
  1. 1.Department of Internal MedicineAllegheny General HospitalPittsburghUSA
  2. 2.Division of Gastroenterology and HepatologyThe University of Texas Medical BranchGalvestonUSA
  3. 3.Division of Gastroenterology, Hepatology and NutritionAllegheny General HospitalPittsburghUSA

Personalised recommendations