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PEDIATRIC ANESTHESIA

Traditional Versus New Needle Retractable IV Catheters in Children: Are They Really Safer, and Whom Are They Protecting?

Charles J. Coté, MD, DABA, FAAP^*,, Andrew G. Roth, MD, DABA, FAAP, Melissa Wheeler, MD, DABA, FAAP, DABPM, Carolyn ter Rahe, MD, DABA, Bronwyn R. Rae, MBBS, FANZCA, DCH (Lond), DABA, Richard M. Dsida, MD, DABA, FAAP, and H. J. Przybylo, MD, DABA, FAAP

*Department of Anesthesiology and Pediatrics, Feinberg Medical School, Northwestern University; and Departments of Pediatric Anesthesiology and Anesthesiology, Children’s Memorial Hospital, Northwestern University Medical School, Chicago, Illinois

Address correspondence and reprint requests to Charles J. Coté, MD, Department of Pediatric Anesthesiology #19, Children’s Memorial Hospital, 2300 Children’s Plaza, Chicago, IL 60614. Address e-mail to ccote{at}northwestern.edu

Retractable needle IV catheters are designed to reduce needle-stick injuries; their use is mandated by federal regulations. We undertook a prospective data collection with the "traditional" IV catheters (JELCO) versus the "new" (Angiocath^TM Autoguard^TM). Assignment of catheter type was randomized by week. Data collected included assessment of the difficulty of IV access; number of catheters used; and splatters or spills of blood on skin, linen, floor, clothing, and operating room table. There were 473 attempted insertions in 330 patients over 20 days. No needle-stick injuries occurred. Seventy-seven blood spills or splatters occurred in 42 patients. The number of splatters or spills was four times more with the new compared with the traditional catheters. There were significantly more total splatters or spills and patients who experienced splatters or spills with new catheters when they were placed by attendings but not when placed by trainees. Our study suggests that use of this technology by more experienced anesthesiologists may increase the risk of exposure of health care providers to blood-borne pathogens. Practitioners should choose the IV system that allows the most efficient venous access with the least potential for blood contamination. Hospitals should allow the choice to be made by the individuals using the devices.

IMPLICATIONS:Use of retractable needle safety IV catheters may increase rather than decrease exposure to blood. The choice of IV system should be left to the clinician’s best judgment to balance the efficient establishment of venous access with the least potential for blood contamination.

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