First-attempt insertion success: PIVCs with notched vs non-notched needles

Vascular access devices are widely used in hospitals, given that 60–90% of patients admitted receive a vascular access device (VAD).¹ Peripheral intravenous (IV) catheterisation is not only the most preferred method of vascular access in non-emergency situations but also the most commonly performed emergency procedure.²

In clinical practice, the IV catheter is inserted through the skin and advanced till a flashback of blood is observed by the practitioner. In most current catheters, the blood must flow through the entire length of the needle before the flashback can be seen. Continuing to advance the needle during this critical millisecond time scale may result in the risk of the needle traversing through the opposite wall of the vein.²

The use of a notched needle is thought to improve cannulation success by confirming vein entry at the point of insertion with the immediate flashback of the blood.³ Notched needles have a series of carved notches on their shaft.⁴

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In this study, van Loon et al aimed to assess whether inserting a notched peripheral IV catheter would increase the first-attempt cannulation success rate from a baseline of 82% to 90% in all included patients, compared to the success rates in instances where a peripheral IV catheter without a notched needle is inserted.²

Methods

The study was a block randomised trial, conducted at the Department of Anaesthesiology of the Catharina Hospital at Eindhoven, Netherlands, between September and December 2019. A total of 660 patients were included and divided into two groups – the intervention group (330 patients) and the control group (330 patients).

Two patients in the intervention group were excluded due to incomplete data. The patients in the intervention group got a notched peripheral IV catheter (BD Venflon™ Pro Safety Catheter with InstaFlash™ Needle Technology) while those in the control group were given a traditional non-notched catheter (BD Venflon™ Pro Safety Catheter without InstaFlash™ Needle Technology).

The primary objective was stated as the first attempt success rate of peripheral IV cannulation, with either the notched or non-notched needle. An attempt was defined as a percutaneous needle puncture, regardless of the amount of subcutaneous exploration from a single puncture. Peripheral IV cannulation was successful if saline flush could be injected without compromising the vein, and signs of subcutaneous injection were absent.²

Secondary objectives were the effect of the type of catheter (notched or non-notched needle) on the time (in minutes) needed for successful cannulation, the total number of attempts needed for successful cannulation and the pain score upon IV cannulation ( 0 for no pain and 10 for the worst pain).

Results

The first attempt success rate of the total cohort of included patients was 82%. The first attempt success rate was 79% in the control group and 85% in the intervention group. The median number of successful vascular attempts was 1.0 in both groups.² First attempt success was remarkably higher in the intervention group in patients with a high risk for failed cannulation (29%) compared to the control group (10%).

Conclusion

A first attempt success rate of 90% is denoted as clinically relevant and acceptable in clinical practice. The study was unable to reach a first attempt success of 90%, although the first attempt cannulation success was higher in patients who got a notched needle inserted. Individual patients with a higher risk of failed cannulation due to difficult venous access reported much greater success with notched needles.

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References

1 1. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs 2015; 38(3): 189-203. DOI: 10.1097/NAN.0000000000000100

2 van Loon FH, Timmerman R, den Brok GP, Korsten EH, Dierick-van Daele AT, Bouwman AR. The impact of a notched peripheral intravenous catheter on the first attempt success rate in hospitalized adults: Block-randomized trial. J Vasc Access. 2021 Feb 2:1129729821990217. doi: 10.1177/1129729821990217.

3 Strauss KW, Onia R, Van Zundert AA. Peripheral intravenous catheter use in Europe: towards the use of safety devices. Acta Anaesthesiol Scand. 2008 Jul;52(6):798-804. doi: 10.1111/j.1399-6576.2008.01664.x.

Approval number : BD-56861

4 Khadem M, Rossa C, Usmani N, Sloboda RS, Tavakoli M. Introducing Notched Flexible Needles with Increased Deflection Curvature in Soft tissue. 2016 IEEE International Conference on Advanced Intelligent Mechatronics (AIM); 12–15 July 2016; Banff, Alberta, Canada. DOI: 10.1109/AIM.2016.7576931

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First-attempt insertion success: PIVCs with notched vs non-notched ...

First-attempt insertion success: PIVCs with notched vs non-notched needles

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