Title: How Many Intravenous (IV) Cannulation Attempts are Required for Skill Proficiency?
Timothy Howey, BA, NREMT-I; David Page, MS, NREMT-P

The current Paramedic National Standard Curriculum (PNSC) recommends that students perform 25 successful intravenous (IV) cannulations during clinical experiences. These recommendations were developed through an informal survey of accredited paramedic program directors.

The current PNSC goal for IV attempts is sufficient for students to become competent in the skill of IV cannulation.

Between January 2001 and December 2003, paramedic students participating in FISDAP, a national computerized student tracking system, used a web page to prospectively report their clinical experiences. The student's preceptors also completed a paper evaluation. Instructors at each of the participating training programs then verified the data by comparing the computerized records to the paper evaluations.
Inclusion criteria consisted of student consent, successful graduation and instructor verification of student records.
A student who maintained a success rate of 80% over 20 IV attempts was considered proficient in the skill.

A total of 875 students met the criteria for inclusion in the study. Of these, 53 student records were found to have obvious data entry errors and were excluded. The remaining 822 (94%) students were analyzed. The average number of IV attempts was 78. Overall, 695 (85%) students demonstrated proficiency. 417 (60%) of these students demonstrated proficiency within 25 attempts. 625(90%) of students demonstrated proficiency within 51 IV attempts.

The current PNSC goal for IV attempts is insufficient. Only three out of five students achieved IV skill competency within 25 attempts. Based on these data, a goal of 51 IV attempts would be required for 90% of students to reach competency. Perhaps more importantly, the goal of the curriculum should be for an individual to achieve a success rate of 80% over twenty attempts, regardless of how many attempts are required to meet that goal. More research is needed to determine if other variables, such as previous experience, clinical setting, and patient acuity influences the number of attempts necessary to reach proficiency.