Volume 18 Supplement 1

34th International Symposium on Intensive Care and Emergency Medicine

Open Access

Introducing an arterial non-injectable connector into clinical practice

  • D Laba1,
  • M Mariyaselvam1,
  • R Heij1 and
  • P Young1
Critical Care201418(Suppl 1):P88

https://doi.org/10.1186/cc13278

Published: 17 March 2014

Introduction

The standard arterial system for blood withdrawal provides no impediment to intra-arterial injection [1] and bacterial contamination. We assessed the probability of inadvertent intra-arterial injection, transmission of bacterial contamination and surveyed the nursing staff following introduction of a non-injectable connector (NIC).

Methods

The simulation study data were descriptive. Fifteen junior doctors managed a case of bradycardia. A simulated patient had a peripheral intravenous cannula, central venous catheter and brachial arterial cannula. Atropine was available on request. A laboratory controlled trial compared a transmission of bacteria through standard arterial ports against the NIC when attached to an arterial sampling hub. The colonization rates were compared using a two-tailed Fisher's exact test. A closed-circuit arterial sampling system was designed. A contaminated syringe tip was inserted into the conventional arterial hub or the NIC to take an arterial sample. Transducer flush fluid flowing to the patient bloodstream was cultured. In a survey the nursing staff were asked questions regarding the NIC system, including its manual handling, sampling of the blood and its durability.

Results

In the simulation study 10/15 clinicians (67%) injected atropine directly into arterial cannula via a three-way tap. Five of 15 doctors (34%) injected safely. In the laboratory study, swabbing of the arterial hubs showed bacterial contamination of all of the samples in the standard group (20/20) and no contamination in the NIC group (0/20), P < 0.0001. Eighty-five per cent (17/20) of samples in the standard arterial group showed onward transmission of pathogens to the patient circulation, and none of the patient samples taken from the NIC group were contaminated (0/20), P < 0.0001. In the survey, 80% of the nurses found manual handling of a new device equally simple and 20% even simpler. Sampling of the blood was equally challenging for 87% participants. Ninety-four per cent found similar durability of the new device and better protection against accidental intra-arterial injection. Sixty-six per cent of the nursing staff would replace the standard system with a NIC.

Conclusion

Most of the doctors would inject the drug intra-arterially. Currently, no other device is available to eliminate accidental intra- arterial injection or bacterial transmission. The nursing staff found the management of the NIC equally challenging.

Authors’ Affiliations

(1)
The Queen Elizabeth Hospital

References

  1. Sen S, et al.: Complications after unintentional intraarterial injection of drugs: risks, outcomes, and management strategies. Mayo Clin Proc 2005, 80: 783-795.View ArticlePubMedGoogle Scholar

Copyright

© Laba et al.; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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