A short bevel needle with a very thin tip improves vein puncture performance of peripheral intravenous catheters: An experimental study

Comparative study of peripheral intravenous catheter insertions with capillary, notched, and a grooved needle flashback design

Evidence of the costly effects of first-attempt peripheral intravenous catheter (PIVC) insertion failures continues to mount. This study was conducted to determine if a unique catheter design can improve operative error, promote PIVC first-stick success and reduce the costs of first-attempt failures. In Phase One of this comparative simulation use in vitro study, 16 nurses from acute care hospitals inserted four PIVC types into a training model, each type characterized by distinct timing of flashback occurrence and needle design. Each nurse performed three attempts per catheter type (12 total per inserter). Insertions were video-recorded and analyzed for the effect of the needle on a vessel during insertion, double punctures and catheter placement failure or success. In Phase Two, 100 nurses and 25 purchasing agents nationwide identified items used and associated costs for PIVC insertions. In Phase One, nurses using a grooved needle flashback with a thin-tipped needle were 20% more successful with catheter placement than those using a notched needle flashback and 22% more successful than those placing a capillary flashback design. Catheter placement success with a grooved needle flashback was 15% higher than with a capillary flashback and 13% higher than with a notched needle flashback. Double punctures were highest among nurses using a capillary flashback catheter, and catheter placement failure was highest among nurses using notched needle flashback. In Phase Two, nurses reported an average of 51% first-attempt success. The authors calculated the estimated annual cost of first-stick failure to be $US 35,919.15 per nurse, including labor and materials used in the second and third attempts. In this study, the authors found the insertion technique with grooved flashback needle design reduced operative error, double punctures and improved first-attempt success. This flashback needle design could significantly improve patient outcomes, speed time to treatment and reduce hospital costs.

Impact of arm position compared to tourniquet and general anesthesia on peripheral vein width in supine adult patients: a prospective, monocentric, cross-sectional study

BACKGROUND

IV access is a commonly performed procedure that is often taught based on tradition rather than evidence. The effect of arm retroflexion on vein width, either alone or in combination with a tourniquet or general anesthesia (GA), remains unclear. In this case, the sonographically measured vein width is a surrogate parameter for the success of the puncture.

METHODS

Prospective, cross-sectional study involving 57 patients scheduled for surgery in general anesthesia. We analyzed the impact of arm retroflexion, tourniquet, general anesthesia, and their combinations on the antebrachial veins in supine patients by ultrasound. Measurements were taken awake and during general anesthesia, each with and without the application of a tourniquet, and in three different arm positions (0°, 30°, and max° retroflexion) each. Data are presented as median and interquartile range [IQR].

RESULTS

Tourniquet application (AT) had the greatest single effect on Cubital vein outer diameter compared to the baseline value of all measures (3.9 mm [3.4-5.1]; 4.8 mm [4.1-5.7], P = 0.001, r = 0.515). This effect was surpassed by the combination of AT and GA (5.1 mm [4.6-6.6], P = 0.001, r = 0.889). In contrast, retroflexion alone did not result in an increase at either 30° (4.2 mm [3.7-5.1], p = 1.0, r = 0.12) or max° (4.2 mm [3.6-4.9], p = 0.72, r = 0.23). With GA and AT, no further enlargement was measurable by 30° (5.4 mm [4.6-6.6], p = 1.0, r = 0.15) or max° (5.4 mm [4.6-6.6], p = 1.0, r = 0.07) retroflexion compared to GA-AT-0° (5.1 mm [4.6-6.6], p = 1.0, r = 0.15).

CONCLUSIONS

This study provides evidence that retroflexion of the arm in supine patients, whether alone or in addition to a tourniquet or general anesthesia, does not have any additional effect on vein width as a surrogate parameter for successful IV success. It shows for the first time that general anesthesia effectively increases vein diameter.

TRIAL REGISTRATION

DRKS00029603 (date of registration 07.07.2022).

Assessment of the deformation rate of venous diameter during internal jugular vein puncture using a newly developed thin-tip three-dimensional needle

BACKGROUND

The internal jugular vein (IJV) is one of the most used sites for central venous access. Some authors revealed the association of a higher deformation rate of the IJV wall with posterior wall penetration, which may cause a hemorrhagic complication. A newly developed thin-tip needle (three-dimensional (3D) needle) reduced the deformation rate in an ex vivo study. Therefore, we conducted a clinical study to investigate its efficacy in reducing vessel deformity during IJV puncture.

METHODS

This study retrospectively enrolled 80 adult patients who received central venous port (CVP) implantation via the IJV from April 1, 2022, to November 10, 2023, in our institution. Traditional needle-and-catheter was used for ultrasound (US)-guided IJV puncture (usual group) for the former 40 patients before July 18, 2023. Afterward, the 3D needle was used for the latter 40 patients (3D needle group). US images were stored and analyzed to calculate the deformation rate.

RESULTS

The deformation rate was 58.6% (13.2-100) for the usual needle and 41.8% (10.6-100) for the 3D needle (p = 0.0034). Patients who required several punctures included 2 for the usual needle and 12 for the 3D needle, respectively (p = 0.0032). All patients and the usual needle group demonstrated a weak negative correlation between the deformation rate and pre-puncture vessel diameter (r = 0.24 and 0.41, respectively), with no correlation in the 3D needle group.

CONCLUSION

The deformation rate of the IJV wall was smaller in the 3D needle group than in the usual needle group. The use of a 3D needle would be safer when puncturing the IJV.

Effect of a thin-tipped short bevel needle for peripheral intravenous access on the compressive deformation and displacement of the vein: A preclinical study

BACKGROUND

Peripheral intravenous catheter (PIVC) insertion often fails on the first attempt. Risk factors include small vein size and dehydration, causing vein deformation and displacement due to puncture resistance of the vessel. The authors developed a short, thin-tipped bevel needle and compared its puncture performance with needles of four available PIVCs using an ex vivo model.

METHODS

The PIVC with the thin-tipped short bevel needle was compared to four available PIVCs using an ex vivo model which simulated the cephalic vein of the human forearm. The ex vivo model consisted of a porcine shoulder and porcine internal jugular vein, and was used for evaluation of the rate of vein deformation and vessel displacement during needle insertion.

RESULTS

An ex vivo model was created with a vessel diameter of 2.7-3.7 mm and a depth of 2-5 mm. The thin-tipped short bevel PIVC needle was associated with a significantly lower compressive deformation rate and venous displacement compared to the needles of the other four PIVCs.

CONCLUSION

The thin-tipped short bevel needle induced lower compressive deformation and displacement of the vein than the conventional needles. This needle has the potential to improve the first-attempt success rate of peripheral intravenous catheterization in patients with difficult venous access.