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Vascular Access/IV

The potential role of through the needle PIVC insertion in reducing early catheter contamination

27 July 2023
Association for Vascular Access
02 July 2023
Volume 32 · Issue 14

Abstract

HIGHLIGHTS

Over-the-needle (OTN) PIVC devices are at inherent risk of insertion related skin contamination.

Through-the-needle (TTN) catheter deployment resulted in no measurable contamination in this study.

OTN catheters were 1.67 times more likely to be contaminated than TTN in this study.

Aim:

To compare a traditional over-the-needle peripheral intravenous catheter device to a through-the-needle (TTN) peripheral intravenous catheter device for early bacterial contamination during insertion.

Methods:

Five TTN test devices (OspreyIV 20 g SkyDance Vascular, Inc) and 5 OTN comparative devices (Insyte Autoguard 20 g Becton Dickinson) were aseptically inserted through targeted zones inoculated with 1 mL aliquot suspension of approximately 1 × 10 CFU of Staphylococcus aureus among 3 healthy sheep. Immediately after insertion, each study catheter was surgically removed from the surrounding tissue and cultured for the presence of Staphylococcus aureus inoculum that may have been transferred to the catheter during insertion.

Results:

Final culture results of the 5 test articles found no bacterial colonies. Final culture results of the 5 comparative articles revealed 2 of 5 were contaminated with bacterial colonies. The absolute risk reduction is 40%, or a 40% rate of contamination drops to a 0% rate of contamination when the TTN catheter deployment was used. The risk ratio achieved was 1.67, indicating catheters placed using the OTN deployment were 1.67 times more like to be contaminated than the TTN deployed catheters.

Conclusion:

In this present ovine study, the data revealed that use of a novel TTN approach resulted in less contamination than the more traditional OTN approach. Traditional OTN devices, developed over 70 years ago, are at inherent risk of insertion-related contact contamination. The results of this research, as well as previously published studies, point toward considering physical catheter protection strategies such as TTN devices as a potential alternative to OTN devices.

Medical devices designed to access the vascular system for the purpose of infusion therapy date back as early as the mid-1600s when Christopher Wren, a renowned anatomist at Oxford University, used a quill and a pig's bladder to create the first working intravenous infusion device. Little progress was made in the field until 1818 when Dr Blundell performed the first successful human-to-human transfusion using a what he termed a ‘Gravitator.’ This device was composed of a syringe attached to a tube which was attached to a funnel. The donor would bleed into the funnel and the blood would, via gravity, travel down the tube and into patient. This approach was ‘to be used when all other options were exhausted’ and did not have a very high success rate; however, it proved that infusions into the bloodstream could serve as a viable method for improving patient outcomes. While intravenous infusions increased in frequency of use during the late 1800s and early 1900s, it was not until in 1950 that a quantum leap forward occurred when Dr David Massa, a resident in anesthesiology, fitted a polyvinyl chloride catheter over a steel introducer needle, creating the first catheter that could be directly threaded into a vessel after percutaneous venipuncture with a needle.1 This discovery sparked an instant revolution in healthcare and forever changed the way intravenous infusions were delivered. In the more than 70 years that followed, Massa's over-the-needle (OTN) catheter configuration inspired a multitude of innovative peripheral intravenous catheter (PIVC) devices. Iterative improvements in catheter materials, patient comfort, blood control, and needle stick safety contributed to making catheter OTN PIVCs the primary vehicle for delivering life-saving intravenous infusions to upwards of 90% of hospitalized patients.2

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Vascular access
Peripheral intravenous catheter
Catheter-related blood stream infection