Patient Safety Week: A simple alternative to multiple needle sticks?

Patient Safety Awareness Week 2019

Anesthesiology and patient safety have been interlinked since at least the 1840s. John Snow, a British physician who is considered one of the fathers of modern epidemiology, also was a pioneer in the use of ether and chloroform as surgical anesthetics. Perhaps most famously, he administered chloroform to Queen Victoria for the births of two of her children. He also traced a cholera outbreak in London in 1854, and his findings inspired significant improvements to water and waste systems in London and around the world. Today, anesthesiology is widely recognized as the pioneering leader in patient safety efforts. It was the first medical specialty to champion patient safety as a specific focus, and the Anesthesia Patient Safety Foundation (APSF) was the first independent multi-disciplinary organization (practitioners, equipment and drug manufacturers, and many related professionals) created expressly to help avoid preventable adverse clinical outcomes, especially those related to human error.

Today: A simple alternative to multiple needle sticks?

What if you could reduce the need for multiple needle sticks just by inserting an IV catheter “backwards”?

Andrew Feider, MD, a clinical assistant professor in the Department of Anesthesia, is investigating whether directing an IV catheter toward the fingers instead of toward the shoulder can improve patient comfort and safety by reducing the need for multiple needle sticks.

“In medical school, they teach you the ‘right way’ to place an IV, and that’s it,” Feider says. “Sometimes you need to take multiple blood samples from a patient, and if this (change in needle position) works, it could spare the patient multiple sticks or an arterial catheter to get those samples.”

Feider and Kenichi Ueda, MD, clinical associate professor in the Department of Anesthesia, came up with the idea to study this possibility after observing it during research at the Human Integrative and Cardiovascular Physiology lab. That research is looking at certain chemicals in the blood that increase during exercise.

“The IV catheter was directed toward the fingers to be closer to the muscles in the forearm so we could capture those chemical levels. And we anecdotally observed how well those catheters drew blood samples, and how they continued to do so for several hours,” Feider said. “So we started looking to see if there was anything in the literature about it.”

They didn’t find much, so Feider decided to his own research, with Ueda as his mentor. He is conducting a blinded study comparing ease of blood draw in traditional (antegrade, or toward the shoulder) catheter placement and retrograde (toward the fingers) placement. He expects to complete data collection in late spring or early summer, with a total of 230 patients.

If his theories are correct, retrograde placement could save multiple needle sticks – as well as potential complications such as bleeding, infection, and artery damage – in the operating room for patients whose blood needs to be drawn frequently to check for clotting time, hormone levels, or other blood counts.

“If our hypothesis proves correct, the next step would be to study whether retrograde catheters draw blood more readily for several days, not just hours,” Feider says. ”That could reduce the opportunities for infection, bruising and pain in both surgical and nonsurgical patients who need multiple blood draws.”



Tuesday, March 12, 2019