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Description of a new non‐injectable connector to reduce the complications of arterial blood sampling
Author(s) -
Mariyaselvam M. Z.,
Heij R. E.,
Laba D.,
Richardson J. A.,
Hodges E. J.,
Maduakor C. A.,
Carter J. J.,
Young P. J.
Publication year - 2015
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/anae.12884
Subject(s) - medicine , anesthesia , arterial catheter , syringe , arterial blood , cannula , venipuncture , catheter , surgery , dead space , mechanical ventilation , psychiatry
Summary Arterial 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 three‐way 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.