Frontline or Bottom line: IV Catheter Safety Device Selection and Implementation in Practice By Gaylene Fisch RN, BSN, CNOR |
It was in November of 2000 that the Needlestick Safety and Prevention Act passed into law, making it mandatory for health care facilities to provide devices engineered with safety mechanisms to address the problem of blood borne pathogen exposure for frontline workers. Since that time, manufacturers have looked for and to some extent have found clever ways of shielding, retracting, and otherwise rendering harmless the sharps that can pass disease to healthcare personnel. Of course, these safety features have added to the cost of various devices and to the overall cost of caring for patients. One example of this is the Peripheral venous access device, or IV catheter. Not only is each safety engineered catheter more expensive but the chances of successfully cannulating the IV on the first try have changed due to the difficulty doctors, nurse and paramedics have with the functionality of the safety devices. This results in patients who have to endure multiple sticks, frustrated caregivers and escalating costs. Ask any nurse or medic who regularly cannulates IV’s on the job and they will tell you that they have problems using the safety devices that are available. Everyone agrees that we have to use catheters that have some method built into them to protect the user from a needle stick injury. What we don’t agree about is which device offers the best protection and why. Although legally required to participate in the selection of safety engineered devices, frontline healthcare providers are not routinely included in the decision making process and this results in product selection based upon group purchasing relationships and pricing rather than usability and actual vs. stated safety features of the device.
The battle field for bottom line achievement has components rooted not only in the price points for certain devices but also within the training and education required to adopt new ESIP’s. Learning curves are expensive and represent an added cost to the facilities that must insure that providers are given the support that they need to utilize new devices correctly and safely. There is more to preventing needle stick injuries than engineering controls; putting ESIP’s into the hands of caregivers will reduce but not eliminate the incidence of injuries unless the appropriate teaching and support is available to nurture the acceptance and intended use of the device. Proof of this phenomenon was detailed in Lynn Hadaway’s article entitled, Sharp Injuries: Infection Control as a Primary Prevention Strategy published in the Winter, 2006 FutureHealthcare when she highlighted the EPINet 2003 statistics that over 31% of sharps injuries that year occurred with a safety designed needle. It is human nature for each of us to become comfortable with a certain way of doing things. This is especially true for providers who are under pressure with a live patient looking to them to perform an invasive procedure flawlessly and confidently. No healthcare professional wants to be faced with starting an IV on a patient using a device whose form or function is not fully understood or practiced. Teaching and training is essential to obtaining a comfort level with any new ESIP; cannulating an IV with a safety device requires learning and developing new techniques that may incorporate or build upon existing skills. We know that old technique can interfere with success rates when used with ESIP IV catheters and can actually cause an injury or blood borne exposure it is intended to prevent. “Most safety-engineered sharps devices help prevent injuries after-not during-their use, so, injuries during use can still occur.” Yet, surprisingly, one in four nurses said they had inadequate or no training at all, in a 2004 survey. Some ESIP IV catheter manufacturers go so far as to boast that their IV catheters require little or no training since the use of the product does not represent a significant change in practice. One must wonder what percentage of the needle stick injuries reported annually resulted from inadequate training and whether comprehensive in-service for clinical providers could have prevented the events. Works Cited Perry, Jane, MA, Robinson, Eileen, RN, MSN, Jagger, Janine MPH, PhD. "Getting to the Point About Preventable Injuries." Nursing 2004 Vol. 34, No. 4, pg 43-47 Joint Commission of Accreditation for Quality in Health Care. Sentinel Event Alert. Issue 22, Aug. 1, 2001 Begany, Timothy. "AMA Report Addresses Needlestick Prevention." Pulmonary Reviews.com Vol. 6, No 7 NIOSH Alert: "Preventing Needlestick Injuries in Health Care Settings." Nov, 1999. DHHS (NIOSH) Pub. No2000-108 |
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