Just Say no to Just in Case Cannula: Implementing Best Practice for Peripheral Intravenous Cannula (PIVC) Use in Australian Emergency Departments.
A Stepped-wedge Cluster Controlled Trial and Health Economic Analysis
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Evidence & Translation
The Need
Have you or your family ever waited for care in an Emergency Department and had an Intravenous Cannula put in by doctors or nurses?
These devices can be necessary for treatment and are used to perform medical tests and give lifesaving medicines, but up to half of cannulas are not used for any treatment. They are costly, time consuming and often painful to insert.
Unnecessary peripheral intravenous cannulas (PIVCs) are a widespread yet preventable issue in Australian emergency departments (EDs), contributing significantly to patient harm, resource waste, and system inefficiency.
Each year, approximately $594 million is spent on PIVCs, with an estimated $306 million wasted on cannulas that are inserted but ultimately unused, and the equivalent of 11,790 clinician days lost. Beyond these economic and workforce impacts, patients are also exposed to avoidable risks, including serious complications such as bloodstream infections.
We aim to reduce the number of adults who have cannulas inserted and to improve cannula use and safety in Emergency Departments nationally. We plan to reduce this cost to hospitals and the health care systems, reduce waste, and drive change for the better around the nation.
How the PIVC Improvement Project Began
Prof Diana Egerton-Warburton speaks about how the project began, highlighting the need to improve PIVC use in emergency departments and reduce unnecessary cannulation through research, education, and implementation strategies
Our Approach
Deliver Safer, Smarter Care at Scale
This MRFF-funded ($2.9M) national study aims to:
✅ Reduce unnecessary PIVC insertions
✅ Improve patient safety
✅ Embed best practice in ≥50% of EDs
Led by Professor Diana Egerton-Warburton (Monash Health), aligned with he Australian Commission on Safety and Quality in Health Care (ACSQHC) through its PIVC Clinical Care Standard and World Health Organization (WHO) guidelines for preventing intravascular catheter infections, targeting the elimination of PIVC-related bloodstream infections.
Real-World Trial
Testing across 9 EDs to reduce unnecessary insertions and improve safety.
Co-Designed Intervention
Built with clinicians and patients to ensure it works in practice.
Economic & Environmental Impact
Quantifying cost savings and reducing low-value care.
National Scale-Up
Toolkits, partnerships, and engagement to drive adoption nationwide.
What will change
✔ Fewer unnecessary procedures
✔ Safer patient care
✔ Reduced infection risk
✔ Lower costs
✔ Reduced environmental impact
Impact
Primary Outcomes
PRIMARY
- Fewer patients receiving unnecessary PIVCs
CLINICAL
- More appropriate use
- Maintained safety without routine cannulation
- Reduced infection rates
SYSTEM & QUALITY
- Improved clinician competency and decision-making
- Better insertion quality and documentation
- Increased clinician and patient satisfaction
PATIENT-CENTRED CARE
- Patients understand why a PIVC is (or isn’t) needed
- Higher first-attempt success
- Clear clinical indication for every PIVC
Funding
This Implementation Science Trial is funded by Medical Research Future Fund (MRFF)2021 MRFF Clinical Trials Activity . Amount: $2.9 million. Grant Duration: 5 years, 2023-2028
Coordinating Organisation
The School of Clinical Sciences. Faculty of Medicine, Nursing and Health Sciences. Monash University, Victoria, Australia
Clinical Trials Register
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001248651 (Link here)
Officially Endorsed By
Australasian College for Emergency Medicine (ACEM) Clinical Trials Network