"Knowing Needle Position Is Essential to Safety"

By CATHIE GOSNELL – RN, MS, MBA
Safety Expert, Premier, Inc.

Needlestick injuries can occur at any time during the use or disposal of a needle or sharp device. While many injuries occur after device use and during disposal, up to 40 percent of injuries occur during use. During use injuries can be some of the most difficult to prevent. Most needlestick safety devices are designed to protect the sharp either before or after use; however a needle while in use is necessarily unprotected.

Needlestick safety devices or engineering controls; therefore, offer little protection against injuries that occur during a procedure. Work practice controls have been the primary method to reduce during procedure needlestick injuries. Such methods include:

• Implementing non-invasive techniques that do not require needles whenever possible
• Thorough training to develop practitioner confidence in the use of needles and other sharp devices Limiting interruptions during procedures
• Explaining the procedure to patients to gain their cooperation and avoid potential movement during the procedure
• Asking for assistance with patients that might be uncooperative, such as children

Strategies such as these remain the only method to prevent during the procedure injuries for most procedures. However, the recent availability of phlebotomy devices that include vein entry indication (VEI) technology could provide a reduction in needlestick injuries during blood drawing procedures.

...as a practitioner I am definitely more comfortable and confident using a product with VEI than one without.

—Cathie Gosnell

Most phlebotomy devices currently on the market consist of a blood collection needle, a tube holder and a vacuum tube. With the exception of the butterfly, the blood collection needle is a stainless steel, hollow bore needle that does not allow flashback of blood to be seen upon entering the vein until it is seen filling the vacuum tube that is attached once the vein has been entered. Addition of the tube results in a vacuum developing that begins extracting the blood from the vein; however, in the absence of vein entry indication (VEI) this occurs without the practitioner knowing for sure that they are actually in a vein. Newer devices that allow flashback to be viewed will allow the practitioner to determine that they are indeed in a vein before the vacuum tube is added.

IV catheters use a clear hub on the distal end of a stainless steel needle so the flashback of blood can be viewed and the practitioner can be confident they have entered a vein before hooking up IV fluids. Butterfly needles whether used for IVs or for blood collection, include a short length of clear tubing at the distal end of the needle that allows the practitioner to see the flashback of blood when the vein is entered. Why is it that we have accepted the inability to view this flashback when using blood collection needles to perform phlebotomy procedures?

As a pediatric nurse for more than 25 years, I have had many opportunities to perform venipuncture on patients with difficult to find and access veins. Some venipunctures were to start IVs, while others were for blood collection. When performing venipuncture procedures exclusively for the purpose of collecting blood, I routinely chose to perform the procedure using a butterfly. The ability to see the flashback of blood made me more comfortable and confident in performing the procedure, as I was certain that I was actually in a vein. VEI reduces the need for multiple sticks and unnecessary probing and manipulation to find a vein. Less attempts and less manipulation should also reduce the frequency of needlestick injury. Research is required to be certain of its impact on needlestick injury; however, as a practitioner I am definitely more comfortable and confident using a product with VEI than one without.