***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Introduction Peripheral intravenous catheter ( PIVC ) insertion is one of the most common invasive procedures performed in a hospital , but most nurses receive little formal training in this area . Blended PIVC insertion training programs that incorporate deliberate simulated practice have the potential to improve clinical practice and patient care . Methods The study was a r and omized , wait-list control group with crossover using nurses on three medical/surgical units . Baseline PIVC knowledge , confidence , and skills assessment s were completed for both groups . The intervention group then received a 2-hour PIVC online course , followed by an 8-hour live training course using a synergistic mix of three simulation tools . Both groups were then reassessed . After crossover , the wait-list group received the same intervention and both groups were reassessed . Results At baseline , both groups were similar for knowledge , confidence , and skills . Compared with the wait-list group , the intervention group had significantly higher scores for knowledge , confidence , and skills upon completing the training program . After crossover , the wait-list group had similarly higher scores for knowledge , confidence , and skills than the intervention group . Between the immediate preintervention and postintervention periods , the intervention group improved scores for knowledge by 31 % , skills by 24 % , and decreased confidence by 0.5 % , whereas the wait-list group improved scores for knowledge by 28 % , confidence by 16 % , and skills by 15 % . Conclusions Results demonstrate significant improvements in nurses '  knowledge , confidence , and skills with the use of a simulation-based blended learning program for PIVC insertion . Transferability of these findings from a simulated environment into clinical practice should be further explored Background We sought to identify the reasons for  peripheral intravenous cannulae insertion in the emergency department ( ED ) , and the first-time insertion success rate , along with patient and clinician factors influencing this phenomenon . Methods A prospect i ve cohort study of patients requiring peripheral cannulae insertion in a tertiary ED . Clinical and clinician data were obtained . Results A total 734 peripheral intravenous cannula ( PIVC ) insertions were included in the study where 460 insertions were analysed . The first-time insertion success incidence was 86 % . The antecubital fossa ( ACF ) site accounted for over 50 % of insertions . Multivariate logistic regression modelling to predict first-time insertion success for patient factors found : age < 40 versus 80 + years , emaciated versus normal patient size , having a visible or palpable vein/s , and ACF versus forearm insertion site to be statistically significant . Statistically significant clinician factors predicting success were : higher number of prior cannulation procedures performed , and increased clinician perception of the likelihood of a successful insertion . When patient and clinician factors were combined in a logistic regression model , emaciated versus normal , visible vein/s , ACF versus forearm site , higher number of prior PIVC procedures performed and increased clinician perceived likelihood of success were statistically associated with first-time insertion success . Conclusions Peripheral intravenous cannulation insertion success could be improved if performed by clinicians with greater procedural experience and increased perception of the likelihood of success . Some patient factors predict cannulation success : ‘ normal ’ body weight , visible vein/s and cubital fossa placement ; venepuncture may be a cheaper alternative for others if intravenous therapy is not imperative OBJECTIVES To report our success and complication rates with emergency department ( ED ) technician-performed  ultrasound (US)-guided peripheral intravenous ( IV ) catheter placement and to compare our results to similar studies in the literature . METHODS We conducted a retrospective review of a prospect i ve data base of patients who underwent US-guided peripheral IV catheter placement attempts for clinical care in the ED . All patients meeting difficult IV access criteria who had a US-guided peripheral IV catheter placement attempted by a trained ED technician were included .  Average attempts per success and overall success rates were compared to similar published studies . RESULTS There were 830 participants , with an overall success rate of ED technician- performed US-guided peripheral IV catheter placement of 97.5 % . Clinicians categorized 82.6 % of participants as having difficult IV access and reported that in 46.5 % , a central venous catheter would have been necessary if the US-guided peripheral IV catheter failed . Of successful catheter attempts , 86.8 % were placed on the first attempt ; 11.6 % were placed on the second attempt ; and 1.6 % were placed on the third attempt . For this study , the average number of attempts per success was 1.15 ( 95 % confidence interval , 1.12 - 1.18 ) , which was lower than in 6 other published studies , ranging from 1.27 to 1.70 . The overall success rate of our ED technician-performed attempts was 0.970 ( 95 % confidence interval , 0.956 - 0.983 ) , which was higher than that reported in previous ED technician studies ( 0.79 - 0.80 ) , and closer to that reported for physicians or nurses ( 0.87 - 0.97 ) . The arterial puncture complication rate was 0.8 % , which was also lower than in other published studies ( 1.25%-9.80 % ) . CONCLUSIONS With brief but comprehensive training , ED technicians can successfully obtain US-guided peripheral IV catheter access in patients with difficult IV access Patients with difficult intravenous access ( DIVA ) often experience discomfort because of failed attempts to place peripheral venous catheters ( PVCs ) ; however , ultrasound guidance may improve this problem with catheter placement . The aim of this study was to evaluate the use of ultrasound when operated by nurse anesthetists for these patients . This prospect i ve observational study with a pre/post design focused on in patients with DIVA referred for PVC placement , a service provided by nurse anesthetists in most Sc and inavian hospitals . The rate of success , procedure time , number of skin punctures , discomfort , catheter size , location , and incidence of central venous catheter placement are reported before and after implementation of a training program and a mobile service using ultrasound to place difficult-to-place PVCs . The success rate increased from 0 % ( 0 of 33 patients ) to 83 % ( 58 of 70 patients ) with ultrasound .  Procedure time was reduced from 20 to 10 minutes , discomfort was unchanged , and the median number of skin punctures decreased from 3 to 2 . The incidence of central venous catheter placement dropped from 34 % to 7 % . Implementation of a training program and a mobile service in which nurse anesthetists performed ultrasound-guided PVC placement improved the success rate and quality of care in patients with DIVA Objectives . Ultrasound ( US ) guidance is a safe and effective method for peripheral intravenous ( IV ) catheter placement . However , no studies have directly compared the success rate of emergency medicine ( EM ) residents and nurses at using this technique especially in community hospital setting s. This prospect i ve “ noninferiority ” study sought to demonstrate that nursing staff are at least as successful as EM residents at placing US guided IVs . Methods . A group of 5 EM residents and 11 nurse volunteers with at least two years ' experience underwent training sessions in h and s-on practice and didactic instruction with prospect i ve follow-up . Two failed attempts on a patient using st and ard approach by an emergency department ( ED ) nurse were deemed to be “ difficult sticks ” and r and omly assigned to either a nurse or resident , based on the day they presented . Results . A total of 90 attempts , consisting of trials on 90 patients , were recorded with a success rate of 85 % and 86 % for residents and nurses , respectively . With a p value of .305 , there was no statistically significant difference in the success rate between the residents and nurses . Conclusion . Properly trained nursing staff can be as equally successful as EM residents in placing US guided intravenous lines “ The generation of r and om numbers is too important to be left to chance.”—Robert R Coveyou The r and omized controlled trial ( RCT ) has become the st and ard by which studies of therapy are judged . The key to the RCT lies in the r and om allocation process . When done correctly in a large enough sample , r and om allocation is an effective measure in reducing bias . In this article we describe the r and om allocation process Background Millions of peripheral intravenous catheters are used worldwide . The current guidelines recommend routine catheter replacement every 72–96 h. This practice requires increasing healthcare re source use . The clinical ly indicated catheter replacement strategy is proposed as an alternative . Objectives To assess the cost effectiveness of clinical ly indicated versus routine replacement of peripheral intravenous catheters . Methods A cost-effectiveness analysis from the perspective of Queensl and Health , Australia , was conducted alongside a r and omized controlled trial . Adult patients with an intravenous catheter of expected use for longer than 4 days were r and omly assigned to receive either clinical ly indicated replacement or third-day routine replacement . The primary outcome was phlebitis during catheterization or within 48 h after catheter removal . Re source use data were prospect ively collected and valued ( 2010 prices ) . The incremental net monetary benefit was calculated with uncertainty characterized using bootstrap simulations . Additionally , value of information ( VOI ) and value of implementation analyses were performed . Results The clinical ly indicated replacement strategy was associated with a cost saving per patient of AU$7.60 ( 95 % confidence interval [ CI ] 4.96–10.62 ) and a non-significant difference in the phlebitis rate of 0.41 % ( 95 % CI −1.33 to 2.15 ) . The incremental net monetary benefit was AU$7.60 ( 95 % CI 4.96–10.62 ) . The expected VOI was zero , whereas the expected value of perfect implementation of the clinical ly indicated replacement strategy was approximately AU$5 million over 5 years . Conclusion The clinical ly indicated catheter replacement strategy is cost saving compared with routine replacement . It is recommended that healthcare organizations consider changing to a policy whereby catheters are changed only if clinical ly indicated Emergency nurses ( ENs ) typically place peripheral intravenous ( IV ) lines , but if repeated attempts fail , patients usually receive central line access . To measure the effect of ultrasound ( US ) guidance on the perceived difficulty of EN peripheral IV access in Emergency Department patients , a prospect i ve observational study was conducted of ENs in a level I trauma center with a census of 75,000 , performing US-guided IV line placement in difficult stick patients ( difficult or hard stick patients defined as repeated blind IV placement failure or established history of blind IV placement failure ) . ENs trained on an inanimate model after a 45-min lecture . Surveys were filled out after each US-guided IV attempt on a patient . ENs could decline to fill out surveys , which recorded reason for US use , type of patient , success , technique used , and difficulty . Successful cannulation was confirmed by drawing blood and infusion of 100 mL of IV fluids . Student 's t-test was used to compare data . A total of 321 surveys were collected in a 5-month period ; no ENs declined to participate . There were 258 ( 80 % ) of the patients rated as very hard sticks before US , 59 as hard , 3 as easy , and none as very easy . Of the 258 very hard sticks without US , 29 were still rated as very hard even with US use ; 43 changed to hard , 112 changed to easy and 137 to very easy . After a brief tutorial , ultrasound guidance for IV access in emergency patients significantly decreased the perceived difficulty in difficult access patients OBJECTIVES Ultrasound ( US ) has been shown to facilitate peripheral intravenous ( IV ) placement in emergency department ( ED ) patients with difficult IV access ( DIVA ) . This study sought to define patient and vein characteristics that affect successful US-guided peripheral IV placement . METHODS This was a prospect i ve observational study of US-guided IV placement in a convenience sample of DIVA patients in an urban , tertiary care ED . DIVA patients were defined as having any of the following : at least two failed IV attempts or a history of difficult access plus the inability to visualize or palpate any veins on physical exam . Patient characteristics ( demographic information , vital signs , and medical history ) were collected on enrolled patients . The relationships between patient characteristics , vein depth and diameter , US probe orientation , and successful IV placement were analyzed . RESULTS A total of 169 patients were enrolled , with 236 attempts at access . Increasing vessel diameter was associated with a higher likelihood of success ( odds ratio [ OR ] = 1.79 per 0.1-cm increase in vessel diameter , 95 % confidence interval [ CI ] = 1.37 to 2.34 ) . Increasing vessel depth did not affect success rates ( OR = 0.96 per 0.1-cm increase of depth , 95 % CI = 0.89 to 1.04 ) until a threshold depth of 1.6 cm , beyond which no vessels were successfully cannulated . Probe orientation and patient characteristics were unrelated to success . CONCLUSIONS Success was solely related to vessel characteristics detected with US and not influenced by patient characteristics or probe orientation . Successful DIVA was primarily associated with larger vessel , while vessel depth up to > 1.6 cm and patient characteristics were unrelated to success . Clinical ly , if two vessels are identified at a depth of < 1.6 cm , the larger diameter vessel , even if comparatively deeper , should yield the greatest likelihood of success BACKGROUND Emergency physicians ( EPs ) have become facile with ultrasound-guided intravenous line ( USIV ) placement  in patients for whom access is difficult to achieve , though the procedure can distract the EP from other patient care activities . OB 
    Output:
    
The h and s-on training included identification of veins on a life model without cannulating , followed by cannulation of veins using a nonhuman tissue model .
At the end , supervised cannulation of veins on the upper extremity with an ultrasound-guided technique was performed on live patients to show competency