Peripheral IV Cannulation: Technology and Technique Driving Best Practices Mark R Hunter CRNI, VA-BC, RN & Nancy L Trick RN, CRNI, VA-BC Key to best practices in the

art and science of Peripheral IV cannulation is a combination of technology and technique. The impact of repeated failed attempts, exposure to blood borne pathogens and other potential risks associated with prolonged dwell, places patients and clinicians at risk for unintended outcomes. The purpose of this poster is to systematically describe use of evidence-based techniques and technologies designed to reduce infusion related risks of peripheral IV therapy.

Abstract

Objectives

1. Outline three unintended outcomes of peripheral IV cannulation in hospitalized patients

2. Describe a conceptual framework which formalizes nurses' observations inclusive of product performance, in addition to patient and practice variables in healthcare-related research

3. Identify the link between Healthcare and Technology Synergy (HATS) and proactive technology development for peripheral IV cannulation

4. Issue a call to action for Comparative Effectiveness Research (CER) inclusive of differentiated technology, to drive evidence-based product use and practice in peripheral IV cannulation

1

Unintended Outcomes of PIV Cannulation

Documented Complication or Risk

Technique/Technology Risk or Cause

Potential Clinical Impact

Potential Financial Impact

Failed insertion attempts References: Sugita, Hunter, Moureau ,& Trick

• Bedside nurses lack of PIV education & experience

• Differentiated technology to reduce risk historically limited

• Utilizing the wrong catheter on wrong patient at the wrong time

• Reduced patient satisfaction • Vessel trauma • Delayed treatment • Long term impact on vessel

health and availability of veins for chronic treatment (i.e. dialysis)

• Cost of added supplies • Catheters • Skin prep

• Wasted drug • May increase LOS • Human resources

Exposure to blood borne pathogens via needlestick and splash References: Tosini, O’Malley et al, Lee et al, Ansari, American Hospital Association

• Needle stick injuries • Splash, splatter, or

aerosolization during: • Initial insertion of IV catheter • Removal of needle • Connection/ disconnection • Catheter removal

• Physical impact of exposure • Injury • Medication side affects

• Emotional impact of exposure • Internal • Family, Friends, Co-Workers

• Average cost associated with needle stick injuries is $51-$4,838

• $1 Million or more related to lost work time/ disability payments for serious infections

Other potential risks: Dwell beyond effective use of peripheral IV cannula References: Rickard, Doellman et al, Dychter et al

• Failure to monitor • Failure to proactively take

action to mitigate risk

• Infusion related complications affect quality of life, morbidity and mortality • Infiltration • Phlebitis • Extravasation • Infection

• Treatment expense • Increased length of stay • Supplementary treatment

• Litigation expenses • 2.1% all injury claims from 1970 to

2001 related to PIV • Approx. 54% successful litigations • Settlements from $275-$10,050,000

Innovation & Applied Practice

Product development based on

unmet needs of patients, clinicians, and healthcare systems HATS Framework

Cross-collaboration between

industry and clinicians to break down barriers to clinical practice improvements Healthcare System Education Standards & Guideline Development

Evaluation of currently available,

differentiated technology to reduce risks associated with PIV cannulation

The Healthcare and Technology Synergy (HATS)

Framework

Substantiates the combined performance effect between patient, product, and practice

Validates Nurse’s observations inclusive of product performance

Can facilitate design, implementation, and evaluation of Comparative Effectiveness Research to drive improvements in PIV cannulation outcomes

3

Linking The Synergy of Research to Product Development & Applied Practice

Patient/Clinician

Product Practice

4

Technology: Driving Best

Practice

• Passive technology is proven to be more effective than active technology in the prevention of needle-stick injuries

• Passive technology also requires no physical action from the user… • Passive technology eliminates the need for elaborate training… • Which is important because healthcare workers work

o long hours o night shift o and deal with emergent situations

• All of which have been know it increase the risk of needle-stick injuries…

1.31

2.54

4.34

0

1

2

3

4

5

Passive Device Semiautomatic safetyfeature (push button)

Manually sliding shield

Needlestick injuries/ 100,000 devices purchased Passive Needle-Stick Prevention

Blood Borne Pathogen Prevention • Without blood control, there is a risk of blood

exposure during PIV Placement

• Minimizes the risk of blood exposure between needle removal and IV attachment for a cleaner dressing site and IV hub area

• Eliminates the requirements for external digital pressure, facilitating the use of both hands to complete the procedure

~Tosini, et al. 2010

First Flash 1st Flash Of Blood • Once the tip of the needle (stylet)

enters the vein, blood travels through the hollow center to the flash chamber in the handle.

Second Flash 2nd Flash of Blood • Once the catheter enters the vein,

blood travels along the flash back groove allowing the visualization of blood along the catheter.

Mitigating Risk- Failed 1st Attempts 1. Gives a visual indication that the needle (stylet) has entered

the vein! 2. Gives a visual indication that the catheter tip is completely in

the vein, the optimal time to advance the catheter off the needle reducing the risk of failed attempts up to 25% ~Toshihiro, et al. 2010

Model Adopted from “The Healthcare and Technology

Synergy (HATS) Framework” Chernecky, Zadinsy, et al.

5

1. Nursing observations on peripheral IV cannulation product performance will be an integral element of nursing research (HATS)

2. Comparative Effective Research will drive use of differentiated peripheral IV cannula technology to best meet the clinical needs of our patients, and protect healthcare professionals

3. Bedside infusion therapy nurses will collaborate with industry-based infusion nurses to effectively measure product performance during product trials and evaluations

Contact Information: Mark R Hunter RN,CRNI, VA-BC, Senior Product Manager Peripheral Vascular Access Infusion Specialty Disposables CareFusion mark.hunter@carefusion.com

Nancy Trick RN, CRNI, VA-BC Clinical Marketing Manager Infusion Specialty Disposables CareFusion nancy.trick@carefusion.com

References: • Ansari, A. (2012). Comparison of visual vs. microscopic methods to detect blood splatter from an intravascular catheter with engineered sharps injury protection (Doctoral dissertation,

University of South Florida). Retrieved from http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=5147&context=etd • American Hospital Association “Pugliese & Salahuddin” 1999 • Chernecky, C., Zadinsky, J., Macklin, D., & Maeve, M. K. (2013). The healthcare and technology synergy (HATS) framework for comparative effectiveness research as part of evidence-based

practice in vascular access. Journal of the association for vascular access, 18, 169-174. • Doellman, D., Hadaway, L., Bowe0Geddes, L., Franklin, M., LeDonne, J., Pettit, J., Stranz, M. (2009, July/ August). Infiltration and Extravasation update on prevention and management. Journal

of Infuison Nursing, 32, 203-211. • Dychter, S., Gold, D., Carson, D., & Haller, M. (2012, March/April). Intravenous therapy a revew of complications and economic considerations of peripheral access. Journal of Infusion Nursing,

35, 84-91. • Hunter, M. R. (2003, March/ April ). Development of a Vascular Access Team in an Acute Care Setting. Journal of Infusion Nursing, 26, 86-91. • Lee, et al. A systematic review of the economic and humanistic burden of needlestick injury in the united states. American journal of infection control; May 2004 • Moureau, N., Trick, N., Nifong, T., Perry, C., Kelley, C., Carrico, R., ... Phelan, D. (2012, Jull-Sep). Vessel health and preservation (part 1): a new evidence-based approach ot vascular access

selectioin and management. Journal Association of Vascular Access, 13, 351-356. • O’Malley, E., Scott, D., Gayle, J., Dekutoski, J., Foltzer, M., Lundstrom, T., ... Panlilio, A. (2007, July). Cost of management of occupational exposures to blood and blody fluids. Infectioin control

and hospital epidemiology, 28, 774-782. • Rickard, C. (2013, September). Peripheral IV catheters: the new world of clinically indicated replacement. In C. Rickard (Chair), Peripheral IV catheters: the new world of clinically indicated

replacement. Symposium conducted at the Association for Vascular Access, Nashville, TN. Retrieved from http://www.avainfo.org/website/article.asp?id=280986 • Tosini, et al. Needlestick Injury rates According to different types of safety-engineered devices: results of a multicenter study. Infec Con & Epid Vol 31, No. 4 April 2010 p. 402-407 • Sugita, T., Kobayashi, T., Endo, K., Hongo, J., & Endo, M. (2001). Comparison of Surflo and surflo-flash in venipuncture and indwelling of needle. Ohu University Dental Hospital Journal, 28(1),

27-32.

Call to Action