BD Closed IV Cath

[SliceOfLife]

Has anyone used these catheters in the field yet? http://www.bd.com/infusion/products/ivcatheters/nexiva/index.asp I used them exclusively during my clinical time in the ED. I did in the range of about 200 IV starts during that time.

I loved them and wish my service carried them. A couple big benefits I found:

1. The flash is immediately seen in the transparent catheter over the needle. Which is in your direct line of sight.

2. When performed correctly there is virtually no escape of blood, no need to tamponade the vein proximally.

3. No need to mess around with extension tubing. If it's a good line the blood will freely flow up the attached connection tubing.

I imagine that they cost a bit more, so I was wondering if any service has switched over or tried them out.

 

[NYMedic828]

I used them on my clinicals in 1 or 2 hospital ERs as well. Honestly I didn't like the feel of them and much prefer the standard straight catheters.

As you said the lack of need to tamponade is nice, but for me, the feel of how you have to maneuver the needle and its parts was awkward.
3. No need to mess around with extension tubing. If it's a good line the blood will freely flow up the attached connection tubing.

I also don't like how small the actual "extension set" on it is. It is a very small diameter even with the bigger needles.

Lastly, I really don't think I would be as comfortable establishing an IV with one of those in the back of a moving ambulance. Its easier to feel the opportune moment and take your shot on a straight away with a regular catheter and just tamponade it.

 

[mycrofft]

No, but I used the first and second iterations of their Saf-T-Intima IV system.
http://www.sears.com/shc/s/p_10153_12605_SPM4080818801P?sid=IDx20101019x00001a&ci_src=14110944&ci_sku=SPM4080818801

The original (before "universal precautions") had the needle pull out of the port on the stylette and just wave around. Now they pull into a needle guard. Still a little hokey looking but I liked it.

 

[Scott33]

I use the ones the op mentions all the time. Really easy to use, just make sure you index finger and thumb are holding the white grip towards the rear of the device, and not the colored butterfly-like stabilization platform.

Completely bloodless system.

 

[exodus]

Do I wanna know why sears sells IV caths?

 

[rook901]

I used these at a short stint in a nearby county hospital. These IV caths were about the only thing I miss from my employment there.

They are awkward at first. However, once you get used to them, they are really convenient. NYMedic - the problem with connecting an INT loop to standard caths is not that the blood doesn't flow freely, but that it can flow a little TOO freely if your technique isn't perfect (blood all over the stretcher and patient) and also there have been a couple of times that I've lost lines on fidgety patients while trying to hook up the INT loop to the straight cath.

With these, those issues are not a concern.

On the negative side, some people complain that the cath is not as flexible as some straight catheters. I actually like this and find that it makes it easier to thread, but some people have complained that it makes it harder for them to thread. I guess that's just technique.

The size of the extension is fine, both in length and in diameter. Never had any problems with high flow fluids and never had any issue with blood hemolyzing for labs.

Like I said, I freakin' love these things and wish my current ER used them.

 

[rook901]

Oh, one more negative I just remembered -- sometimes when we would transfer to another hospital (usually pediatrics), the receiving hospital would call us and ask us why we left a butterfly in. We would have to explain to them that it is, in fact, an IV access device and not a lab draw butterfly.

 

[mikie]

The size of the extension is fine, both in length and in diameter. Never had any problems with high flow fluids and never had any issue with blood hemolyzing for labs.

I too have worked with these IV sets in the ED setting (so easy to draw labs!). And the tubing diameter changes with the gauge of the needle (i believe). Never any issues with fluids, rapid infusion, blood, etc.

I noticed at one hospital that used these sets, frequent hemolysis occurred in the labs. At another facility that uses the 'normal' catheters, almost never heard of hemolysis. So I always wondered if these catheters were to blame, poor provider technique (as it recommends using a waste tube), or just their particular lab.

Furthermore, I do wonder what the cost difference is between those and a 'standard' angiocath is.

{I'm awful at tamponading after removing the needle :sad: }

 

[jwk]

I too have worked with these IV sets in the ED setting (so easy to draw labs!). And the tubing diameter changes with the gauge of the needle (i believe). Never any issues with fluids, rapid infusion, blood, etc.

I noticed at one hospital that used these sets, frequent hemolysis occurred in the labs. At another facility that uses the 'normal' catheters, almost never heard of hemolysis. So I always wondered if these catheters were to blame, poor provider technique (as it recommends using a waste tube), or just their particular lab.

I don't use these sets, but just looking at them I can tell you I would never use them routinely. Simple is best - these aren't simple. We've evaluated these types of sets before and have always opted for the simple tried-and-true catheters.

Hemolysis is generally going to be a function of how much suction is applied to draw the blood, so unless you're using a vacutainer set, then hemolysis is going to be an operator-error issue.

I didn't see in the product description that the diameter of the extension set varies with catheter size, but the catheter diameter is generally going to be the limiting step. However, flow is dependent on radius and length of tubing or catheter, so if you have a small radius extension set, that in and of itself will adversely affect flow rates. We would prefer not to have that kind of extension in the OR for that very reason.

Finally, these catheters are only available up to 18ga. Larger catheters would be preferred for trauma cases, although an 18-20 is fine for most medical-related calls.

 

[NomadicMedic]

The Franciscan System in the Seattle area used them. I used them during my paramedic clinical rotations and loved them. Very easy to use and no worries about bleeding the pt.

 

[mycrofft]

Haemolysis: does the introduction needle have the lumen open on the side or the tip of the needle? The Saf-T-Intima has the needle lumen opened on the side, which causes more turbulence than on the tip. If so, wait to collect specimens until the needle is withdrawn and the catheter has a chance to draw some fresh blood. Also, if the cather placement caused local trauma, you will get "busted blood" for a little while...especiually if it is extravasated!