Factors Associated With Non-First-Attempt Success in Peripheral Intravenous Cannulation by an Intravenous Therapy Team: A Prospective Observational Study.

BACKGROUND: Difficult peripheral intravenous cannulation affects a substantial proportion of hospitalized patients, yet factors associated with cannulation failure among cases assisted by a dedicated intravenous therapy team on general wards remain poorly characterized. AIM: To identify patient-related, operator-related, and procedural factors independently associated with non-first-attempt success in peripheral intravenous cannulation performed by an intravenous therapy team on general medical and surgical wards. DESIGN: Prospective observational study and secondary analysis of prospectively collected clinical data. METHODS: Cannulation events recorded by an intravenous therapy team over a 1-year period were analysed. The primary outcome was non-first-attempt success, defined as requiring two or more insertion attempts. A generalized linear mixed model accounted for repeated events within hospitalizations. Three sensitivity analyses assessed robustness. RESULTS: Approximately one in five events required two or more attempts. Five factors were independently associated with non-first-attempt success: lower nurse experience, reduced patient mobility, smaller catheter gauge, replacement prompted by difficult access, and lower-limb or trunk insertion sites. Patient age, sex, comorbidity burden, and body mass index were not independently associated. Findings were robust across all sensitivity analyses. CONCLUSION: Nurse experience, catheter gauge, and insertion site are modifiable factors associated with first-attempt success. Patient mobility emerged as a novel, easily assessable risk indicator. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Findings can inform intravenous therapy team training priorities, catheter gauge and insertion-site selection protocols, and prospective bedside risk screening to reduce repeated cannulation attempts. IMPACT: This study clarified which factors drive cannulation failure on general wards, identifying five independently associated factors-three of them modifiable-and highlighting patient mobility as a novel indicator relevant to intravenous therapy teams, ward nurses, and hospitalized adults internationally. REPORTING METHOD: This study adhered to the STROBE reporting guideline for observational studies. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.