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



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.


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.


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.


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.


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.

This is a preview of subscription content, log in to check access.


  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.

    Article  PubMed  Google Scholar 

  2. 2.

    Laine L, Jensen DM. Management of patients with ulcer bleeding. Am J Gastroenterol. 2012;107:345–360. (quiz 361).

    Article  CAS  PubMed  Google 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.

    Article  Google 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.

    Article  CAS  PubMed  PubMed Central  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  CAS  PubMed  Google 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.

    Article  PubMed  Google 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.

    Article  PubMed  Google Scholar 

Download references

Author information




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.

Corresponding author

Correspondence to Mohammad Bilal.

Ethics declarations

Conflict of interest

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Bilal, M., Alhajjar, O., Madisetty, M. et al. Adherence to Two Large-Bore Intravenous Lines in Acute Gastrointestinal Bleeding Is Low. Dig Dis Sci 64, 627–631 (2019).

Download citation


  • Intravenous access
  • Gastrointestinal bleeding
  • Quality improvement
  • Adherence