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Vein cannulation success rates by German paramedics: a single-centre study

02 June 2021
Volume 11 · Issue 2



Gaining intravenous (IV) access is vulnerable to errors and failure, and this study analysed IV procedures by paramedics in the federal state of Hesse in Germany to examine these.


This was a single-centre, observational, pilot study survey on gaining vascular access. As well as identifying the success and failure rate of IV attempts, factors associated with a higher risk of failure were analysed using logistic regression, Χ2 or Fisher's exact test.


A total of 207 vascular access attempts were included in the analysis, of which 90.34% were successful. Significantly associated with higher risk of failure were patients' age (OR 1.05; 95% (CI 1.02–1.10); p=0.041), or when two (OR 3.94; 95% CI (2.39–6.20); p≤0.001) or more than three attempts (OR: 3.26 [95% CI: 1.35; 5.17]; p=0.003) were needed rather than one. In contrast, risk of failure was significantly lower when patients indicate a good (OR 0.02; 95% CI (0.00–0.15); p≤0.001) or moderate (OR 0.04 (95% CI 0.01–0.17); p≤0.001) vein status compared to a bad vein status. Failure rates were higher when paramedics were working a night shift (OR 0.06; 95% CI (0.00–0.98); p=0.005) rather then during the day.


A proportion of IV access attempts by paramedics are unsuccessful and, if paramedics are to provide invasive interventions, non-IV options for drug administration should be available.

The Emergency Paramedic Act (Notfallsanitätergesetz; NotSanG) law, introduced in 2014, restructured the education of German ambulance personnel. The title of paramedic (Notfallsanitär) superseded rescue assistant (Rettungsassistent), which had been introduced in 1989. A transition period to allow time for rescue assistant to upskill to become paramedics and for student paramedics to gain their qualifications is under way.

During the transition period, the two roles are being treated equally as having the mandatory qualification for being a paramedic in charge on an ambulance (Federal Office of Justice, 2014). However, paramedic training has been completely restructured.

The NotSanG was introduced at federal level, so created a framework in which the ambulance service areas of the 16 federal states in Germany can draw up individual guidelines. The local medical director in each ambulance service determines standard operating procedures (SOPs) and medication the ambulance personnel in that area can use (Federal Office of Justice, 2014; Lechleuthner and Neupert, 2015).

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