Intravenous Catheter Selection and Why it Matters

When choosing supplies for a healthcare facility, affordable items help the bottom line; however, when do you bridge the gap between affordable items and the safety of your staff? This article reviews how liability can cost more than supplies. Specialties Infusion Article

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Intravenous Catheter Selection and Why it Matters

The selection of products for regular hospital use comprises three pillars - safety, ease of use and equity. Safety being paramount for both clinicians and patients; however, there is no escape from the financial decisions that must be made to allow business to continue as usual. Intravenous catheters are one such item that have an extensive range of clinical implications as well as financial.

Smith Medical's Jelco IV Catheters are one of the most affordable options at $0.35 per catheter regardless of gauge. This product is described as being multi-use for its ability to achieve both atrial lines and intravenous access. It uses FEP technology for the catheter itself, thereby allowing for higher flow rates with a smaller gauge and ease of use with insertion. Some caveats exist using this catheter. For example, it does not have the technology to prevent blood exposure. Clinicians will need training on venous compression while supplies are attached with a free hand. This could be an attachment of products such as a saline lock, bolus tubing, etc. There also is training required that reminds the clinician that the needle must be manually retracted in its entirety to be safe versus other models that have a "quick" retract. Given the estimation of needle stick injuries being between 600,000 to 800,000 in the United States alone (2005)1, the emphasis on this training cannot be excluded. Time is valuable to clinicians, so having products that have features for safety and speed of insertion can be more cost-effective. However, when arming the same clinicians with training emphasizing safety, the Jelco is a perfectly safe and effective product that can be a simple way to reduce overhead costs of a unit.

BD Becton Dickinson provides a similar style catheter to the Jelco with updated safety features at an average cost of $2.67 per catheter, depending on the gauge. This catheter is called the BD Insyte Autoguard. Per BD's website, this particular type of catheter reduces needle sticks by 95% when compared to its competitors. This is in part due to the button push retraction, which immediately encapsulates the needle in a plastic tube away from the patient and clinician. Additionally, once the needle is removed from the catheter, there is blood-stop technology. This prevents the release of blood into the field until additional tubing or supplies have been attached. Having a safe and clean field allows clinicians to release the area of insertion, allowing two hands to be free for securing the catheter and other supplies. In this instance, an ounce of prevention is worth a pound of cure. Due to the safety features on this item, hospitals can assume decreased costs in liability from less frequent adverse events, I.e., blood exposure and needle stick injuries, as mentioned above.

Both BD and Smith Medical provides an all-in-one catheter. These styles are known as the BD Nexiva closed peripheral IV catheter system and DeltaVen closed system catheter.  The Nexiva comes at an average price of $7.00, while the Deltaven can be found for as much as $11.00, depending on the vendor as well as the gauge of the needle. Before the "sticker shock" sets in, it is important to note that other IV models do not include IV extension sets which are necessary items to create a saline lock. They also include needleless injection ports, another safety option that can be sold separately. Both products certainly pack a punch with all the safety options available. The drawbacks can include clinician discomfort and uncertainty. Adjustments in technique need to be made for those inserting the IV due to the bulk and weight of the item that is not found with other models of catheters. If there has been extended use of the previously mentioned catheters on a floor, there may be refusal to change products due to clinician comfort in accessing a vein on the first attempt. From a patient vantage point, preference for a single lV attempt is optimal, especially in cases where an analgesic is not used. Whether or not the item reduces shrink to hospital stock is yet to be determined but it also is a contributing factor in cost.

Ultimately, between the options available, it would behoove a hospital to explore all three options of intravenous catheters. Different specialty units have an array of requirements and patient needs. Including staff in any decisions made (since they will be the end users) is imperative, and they will be the ones to keep patients safe.

References

1 Virtual Mentor. 2005;7(10):683-686. DOI10.1001/virtualmentor.2005.7.10.cprl1-0510.
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Courtney Lemanski

About Courtney Lemanski, BSN, RN

Courtney Lemanski has 13 years experience as a BSN, RN and specializes in Ambulatory Perianesthesia.

2 Articles   6 Posts

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Specializes in Critical Care.

I don't see how the hospital could use the Smith Jelco unsafe version as there has been the Needlestick Safety and Prevention Act of 2000 in the US that requires the safest needles be used to prevent possible needle sticks.  The technology had been available for over ten years prior, but many hospitals wouldn't spend the money to buy the safer needles and it literally took an act of Congress to protect nurses and healthcare workers. 

I want no part in going back to unsafe needles, nor would I want to reuse such supplies.  I doubt the patients involved would be interested, and I'm sure they wouldn't be told they were being reused, thereby increasing the risk of infectious disease if they weren't sterilized properly!

As a nurse I would not want to work with the cheapest product option available that is so because it increases my risk of a needlestick.  I wonder why you wrote this article.  Are you trying to gaslight fellow nurses that they should be willing to accept these rare, but potentially serious and life altering bloodborne pathogens of HIV and Hep C to save the hospital money!  Seriously!

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Specializes in BSN, RN, CVRN-BC.

We use the BD Nexiva in our Cardiac Stress Testing department and it is wonderful!  The catheters are sturdier which assists with canulation.  They were around $6.00 last time that I looked which is approx 5x more espensive than what the rest of the hospital uses, but I think that we make that up in nursing hours and fewer second attempts.

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Specializes in VA-BC, CRNI.
brandy1017 said:

I don't see how the hospital could use the Smith Jelco unsafe version as there has been the Needlestick Safety and Prevention Act of 2000 in the US that requires the safest needles be used to prevent possible needle sticks.  The technology had been available for over ten years prior, but many hospitals wouldn't spend the money to buy the safer needles and it literally took an act of Congress to protect nurses and healthcare workers. 

I want no part in going back to unsafe needles, nor would I want to reuse such supplies.  I doubt the patients involved would be interested, and I'm sure they wouldn't be told they were being reused, thereby increasing the risk of infectious disease if they weren't sterilized properly!

As a nurse I would not want to work with the cheapest product option available that is so because it increases my risk of a needlestick.  I wonder why you wrote this article.  Are you trying to gaslight fellow nurses that they should be willing to accept these rare, but potentially serious and life altering bloodborne pathogens of HIV and Hep C to save the hospital money!  Seriously!

Unfortunately the law only requires a facility to consider technology, it does not require them to adopt it. 

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SMH...cost of the catheter? When the expense of the infusion thru the catheter dwarfs the few dollars that the catheter costs? If it even costs a few dollars? Talk about re-arranging deck chairs on the Titanic...Sheesh....

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