Emerg Med J 26:831-836 doi:10.1136/emj.2008.071415
  • Prehospital care

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

  1. A N Siriwardena1,2,
  2. M Iqbal2,
  3. S Banerjee1,
  4. A Spaight2,
  5. J Stephenson2
  1. 1
    Faculty of Health, Life & Social Science, University of Lincoln, Brayford Pool, Lincoln, LN6 7TS, UK
  2. 2
    East Midlands Ambulance Service NHS Trust, Lincolnshire Divisional Headquarters, Cross O'Cliff Court, Bracebridge Health, Lincoln, LN4 2HL, UK
  1. Correspondence to Professor A Niroshan Siriwardena, Faculty of Health, Life & Social Sciences, University of Lincoln, Brayford Pool, Lincoln LN6 7TS, UK; nsiriwardena{at}
  • Accepted 23 March 2009


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.

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.

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).

Conclusion: The educational intervention was effective in bringing about changes leading to enhanced quality and safety in some aspects of prehospital cannulation.


  • Funding This study was funded as part of an educational initiative and evaluation by the NHS East Midlands (East Midlands Strategic Health Authority).

  • Competing interests None.

  • Ethics approval That this was an evaluation was agreed by Lincolnshire Teaching PCT Research and Development subgroup, which oversees primary and prehospital research in Lincolnshire. Research ethics (National Research Ethics Service) approval was, therefore, not deemed necessary. Approval for Research Management and Governance was sought and gained from East Midlands Ambulance NHS Trust. The study was approved by the ethics committee of the Centre for Clinical and Academic Workforce Innovation, University of Lincoln.

  • Provenance and Peer review Not commissioned; externally peer reviewed.

Relevant Article

Free sample
This recent issue is free to all users to allow everyone the opportunity to see the full scope and typical content of EMJ.
View free sample issue >>

Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.


Among patients with minor TBI (GCS 13-15) getting CT scans ≥ 24 hours after injury, what proportion have a traumatic finding?


0.5% - 43% response rate
3% - 41% response rate
10% - 16% response rate

Related original article: PCT head imaging in patients with head injury who present after 24 h of injury: a retrospective cohort study

Navigate This Article