Patient safety has been a focus for the National Infusion and Vascular Access Society (NIVAS) over the past few months and we have been privileged to work alongside NHS England and the Medicines and Healthcare products Regulatory Agency (MHRA) on issues relating to IV therapy and vascular access.
We started the year with a problem related to infusion pumps. This related to the sterilisation of giving sets for the Alaris pump. This issue, which is now in the recovery phase, has highlighted the need for organisations to consider how they can avoid being totally reliant on one particular brand of equipment used for the delivery of IV therapy. In fact, the use of only one particular company as a supplier for all IV and vascular access systems has been a problem in my own organisation, and I know from speaking to NIVAS members that it is a problem for other hospitals too.
I had previously always been an advocate of standardisation to one type of device or system, but now I think it is important to use more than one brand of IV device, equipment or product, particularly in specialist areas such as special care baby units, paediatrics and critical care, to avoid calamity if supply issues crop up in the future.
There has recently been an issue with a particular brand of ported peripheral cannula being recalled due to the port leaking. This recall played particular havoc in anaesthetics, maternity, endoscopy and elsewhere where ported cannulas are favoured. The use of ported peripheral cannulas has been a tradition in the UK, but we know now that their use represents a risk in relation to the port itself, which contains dead space that can harbour moisture and bread bacteria. The recall of this ported cannula highlighted the lack of alternative ported cannulas available from other manufacturers. This leads me to believe their availability is on the decline, which may force us to abandon them once and for all.
The other issue that this recall highlighted is the availability of non-safety peripheral cannulas, particularly devices that are available in larger bore sizes. Some organisations opted to use non-safety ported cannulas as a replacement so they could keep the port feature instead of opting for a safety cannula without a port. Opting for a non-safety ported cannula over a safety needle device is concerning, especially as the use of safety cannula has always been about protecting the operator/cannula inserter and other health professionals from needlestick injuries, especially as a used large-bore cannula needle will be loaded with blood and is a significant risk of transmitting blood-borne infections. NIVAS would like to see a phasing out of non-safety peripheral cannulas and our work is ongoing to achieve this.
The use of non-sterile ultrasound gel has been raised nationally as a potential risk for infection. The use of ultrasound in vascular access is standard practice in care now and so practice around the use of ultrasound gel is very important to NIVAS. We are part of a working group with NHS England that is looking at current practices and how we can standardise this to ensure patient safety. This work is in the early stages. Keep an eye on the BJN for future updates.
The final project NIVAS is working on with the MHRA is around needle-free connectors and their compatibility with glass, pre-filled syringes containing drugs such as adrenaline and atropine. There are some needle-free connectors that we know are not compatible with these pre-filled emergency drug syringes and I would urge you to check your organisation to make sure the needle-free systems you use on your vascular access devices are compatible with these pre-filled glass syringes, especially as they are used widely in cardiac arrest and other emergencies. We will be providing more guidance on this in the future.
Stay safe everyone.