Description of a new non‐injectable connector to reduce the complications of arterial blood sampling

Abstract

SummaryArterial cannulation is associated with complications including bacterial contamination, accidental intra-arterial injection and blood spillage. We performed a series of audits and experiments to gauge the potential for these, as well as assess the possible contribution of a new device, the Needle-Free Arterial Non-Injectable Connector (NIC), in reducing these risks. The NIC comprises a needle-free connector that prevents blood spillage and a one-way valve allowing aspiration only; once screwed onto the side port of a three-way tap, the device can only be removed with difficulty. We performed a clinical audit of arterial monitoring systems in our intensive care unit, which showed an incidence of bacterial colonisation of five in 86 (6%) three-way tap ports. We constructed a manikin simulation experiment of the management of acute bradycardia, in which trainee doctors were required to inject atropine intravenously. Ten of 15 (66%) doctors injected the drug into the three-way tap of the arterial monitoring system rather than into the intravenous cannula or the central venous catheter. In a laboratory study, we replicated the arterial blood sampling and flushing sequence from a three-way tap, with the syringes attached either directly to the threeway tap port or to a NIC attached to the port. The first (discard) syringe attached to the three-way tap was contaminated with bacteria. Bacterial growth was found in 17 of 20 (85%) downstream flushed samples (corresponding to the patient's circulation) when the three-way tap was accessed directly, compared to none of 20 accessed via the NIC (p < 0.0001). Growth was found on all of 20 (100%) ports accessed directly compared to none of 20 accessed via the NIC (p < 0.0001). The NIC effectively prevents bacteria from contaminating sampling lines. As its design also prevents accidental intra-arterial injection, we suggest that it can reduce complications of arterial monitoring.

Identifying a list of healthcare ‘never events’ to effect system change: a systematic review and narrative synthesis

“…We excluded another 337 articles after reviewing the full-text citations largely because they neither identified individual NEs nor specified an existing framework (47%), or because they were non-scholarly (eg, media releases; 30%). Thus, our analyses were based on 367 articles 3 4 7–11 18–377. A full list of these articles and the information we extracted from them are found in online supplemental tables 1 and 2.…”

Accidental intra-arterial injection: an under-reported preventable never event

“…Medical errors can be mitigated by consideration of human factors and system engineering to improve patient safety. A focus on clinical awareness, colour coding and training may lead to improvements; however, institutions and clinical directors also bear a responsibility to prevent never events and a number of engineered solutions are now available such as needle-free non-injectable arterial sampling devices to protect the healthcare environment and make this error impossible [2,3]. …”

Handling injectable medications in anaesthesia

“…Medium-to long-term solutions include: bar-coding technology [31,32]; noninjectable connectors with a valve to prevent accidental intra-arterial injection (e.g. needle-free non-injectable connector (NIC), AmDel Medical Ltd, Liverpool, UK) [33];…”

“…Medium‐to long‐term solutions include: bar‐coding technology [31, 32]; non‐injectable connectors with a valve to prevent accidental intra‐arterial injection (e.g. needle‐free non‐injectable connector (NIC), AmDel Medical Ltd, Liverpool, UK) [33]; NRFit® connector to minimise intravenous to neuraxial wrong route errors or vice versa (this will become mandatory in the NHS when a full range of equipment is available) [34]; and electronic prescribing/medicines administration.…”