Spreading antibiotic resistant bacterial infection is rapidly increasing. We have developed a simple method to reduce number of attempts required to insert IV Cannula and catheters

1. Operating Room & Infection Control
U-Cannula ™
Alternative method of cannulation could reduce needlestick
injuries and the spread of hospital-acquired infections
by Martina Benzing, MRCPCH (UK), PhD, and Kadiyali M. Srivatsa, MD
people (i.e., carriers). However, it can cause infections, with
Abstract
clinical manifestations ranging from pustules to sepsis and
Insertion of intravenous cannulae is probably the most
death. In the past the infections were usually simple to clear up
commonly performed invasive medical procedure. Failed
using antibiotics; however, since the 1960s S. aure u s has
attempts cause stress to patients and embarrassment to the
progressively acquired resistance to previously effective
provider and make subsequent attempts increasingly difficult.
antimicrobial agents,1 including methicillin.
Making several attempts increases costs and the risk of
MRSA (methicillin-resistant Staphylococcus aure u s)
introducing infection into the patient. Discarded used needles
infections are becoming increasingly common in healthcare
also pose a risk of needlestick injury to staff, increasing their
settings.1 In certain circumstances—for instance, if a person
chances of contracting HIV and other bloodborne infections.
has breaks in their skin or they are particularly vulnerable to
For the past 10 years Dr. Kadiyali Srivatsa has been
developing a solution—U-Cannula™. Using the device makes infection due to their medical condition or treaent—MRSA
it easy to insert a cannula at the first attempt. It also has an may enter the body, where it can cause infections of varying
important additional benefit of eliminating cannula breakage degrees of severity.
and needlestick injuries, as the needle tip is safely encased Patients on surgical wards and in intensive care units are
within the needle guard after use. particularly vulnerable to infection with MRSA (NISRA and
CDSC, Statistics on MRSA. October 2004). In 1999, 4,744
Introduction patients in U.S. intensive care units were recorded as having
S. aureus is a common pathogen in humans, found in contracted S. aureus infections. Of these patients, 53.5 percent
(2,538) had MRSA.2
the nose or on the skin of about a third of normal, healthy
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2. Operating Room & Infection Control
Less information is available on MRSA in long-term Certain cannulae (e.g., peripheral arterial cannulae)
care facilities, but it is estimated that up to 33 percent of are accessed several times a day to check arterial blood
residents in some homes may be carriers. The incidence of gas or obtain samples for laboratory analysis. This
community-acquired MRSA infections appears to be rising, 3 increases the potential for contamination and subsequent
although little is known about their epidemiology. Most reported clinical infection.
cases are uncomplicated skin infections, although some are In modern medical practice, up to 80 percent of
more severe, including pneumonia and bloodstream infections. hospitalized patients receive intravenous therapy at some
point during their stay. Since Dr. Crile4 used it to manage
Risk factors for infection with MRSA in healthcare
settings include prolonged hospital stay, time spent in an inten- shock in 1915, cannulation has become the most
sive care or burns unit, exposure to multiple antibiotics or commonly performed invasive medical procedure. This
prolonged broad-spectrum antimicrobial therapy, proximity to has been associated with increased incidence of needle-
stick injuries and spread of infections.5 There is a growing
patients colonized or infected with MRSA, use of invasive
devices, surgical procedures, underlying illnesses and MRSA awareness in the medical community that the cannulation
nasal carriage. technique needs to be reviewed.
The incidence of Staphylococcus aure u s infections
Problems
acquired in hospitals has risen in tandem with increased use
Cannula insertion is particularly difficult in certain
of cannulation since the Braunule (cannula) was introduced
cases, including in intravenous drug users, patients having
in 1962.
repeated courses of chemotherapy, infants and children,
Cannulation and dark-skinned or obese patients.
Peripheral venous cannulae are the devices most It is often complicated in patients who are afraid, as
frequently used for vascular access. Although the proportion of fear activates the sympathetic nervous system, provoking
peripheral vasoconstriction.6 Once an initial attempt at
cannulations leading to infections is low, the frequency of the
procedure means that resultant infections do lead to consider- cannulation has failed, nearly all patients experience
able annual morbidity. a degree of sympathetic activation that makes subsequent
attempts increasingly diff i c u l t .
Failed attempts are also
embarrassing for the provider,
causing a degree of nervousness
that also hampers further
attempts. It is therefore important
that a cannula is inserted
quickly the first time. 6
Many doctors claim a
high success rate for inserting
cannulae, but may still require
several attempts to get it right
in certain cases. Cannulation
can prove problematic and
time consuming, which causes
difficulties in urgent situations.7
In emergencies optimal atten-
tion to aseptic technique is not
always feasible and multiple
punctures are more likely to
result in infection, including
U-cannula. Retracting the knob allows
septic thrombophlebitis, endo-
the cannula to move smoothly forward
carditis and other metastatic
in the vein. The tip of the needle is then
protected by the needle guard. i nfections (e.g., lung and
brain abscesses, osteomyelitis
and endophthalmitis).
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3. Operating Room & Infection Control
Ultrasound guidance has been shown not to decrease the attempts required to cannulate. Unsuccessful attempts not
number of attempts at cannulation or the time taken to do it only cause distress to the patient and make cannulation more
successfully. Neither does it lead to improved patient satisfaction.8 d i fficult, but each unnecessary puncture wound provides an
Currently doctors and nurses often try to recannulate by access route for MRSA or other drug-resistant organisms into
reintroducing the needle tip through the hub. In fact some the bloodstream.
cannula manufacturers recommend reusing cannulae up to
Current Cannulation Trends
three times to save costs. However, reusing or reintroducing
Cannulation is a valuable skill and has many advantages
cannula needles increases the risk of introducing infection,
for practitioner and patient. Most doctors assume the currently
cannula tip fracture and embolisation.
used technique is safe and therefore continue to use it,
If a cannula is used for an extended period of time, a
tolerating the frustration of failure and the sadness of causing
patient may be colonized with hospital-acquired org a n i s m s .
distressing to patients.9
The cannula may be manipulated several times a day to take
Some doctors learn to accept failure while others blame
samples or administer fluids, drugs or blood products, and each
the vein, but few think to assess their own technique or that of
contact increases the risk of infection.
others. Most related studies have looked into issues such as
Discarded cannulae pose a risk of needlestick injury to
cannula-associated infections, pain relief or needlestick
medical staff, encouraging the spread of infections, including
injuries,10 rather than insertion techniques or the number of
HIV. Growing concern about this issue has led to a desire to
attempts needed to cannulate a vein. Dougherty (1998)
reassess cannulation techniques. Various cannula manufacturers
suggests that only two cannulation attempts should be
now offer devices designed to reduce needlestick injuries.
permitted before deferring to a more experienced practitioner.11
H o w e v e r, none have claimed to reduce the number of
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4. Operating Room & Infection Control
There is currently a trend in the United Kingdom and the puncture. After use, the guard protects the needle tip, preventing
United States to train nurses and paramedics to cannulate to accidental needlestick injuries to the practitioner. For the safety
reduce time for doctors. However, nurses and paramedics may of the patients, forward movement of the knob is blocked to
lack the skill or experience to cannulate in complex cases.9 reduce cannula fracture and embolisation.
There is also some concern that allowing other staff to carry out The U-Cannula can be used in a variety of ways, requiring
cannulation could, over time, deskill doctors, possibly resulting varying levels of skill. This will make cannulation easier while
in inadequate care in difficult cases. avoiding deskilling practitioners.
Dr. Kadiyali Srivatsa believes he has found the solution, Dr. Srivatsa is currently working to bring the product to
in the form of a unique device that simplifies this life- market. He is determined to make it affordable to developing
saving technique. countries, where it could make an enormous impact, cutting the
transmission of HIV, hepatitis and other serious infections to
The U-Cannula healthcare workers through needlestick injuries.
In 1997, Dr. Srivatsa conducted his own observational To find out more, visit www.u-cannula.com.
study to assess cannulation technique, looking at failure rates
References
and the time taken to cannulate successfully.
1. Lowy FD. Staphylococcus aureus infections. N Engl J Med 1998,
The average number of attempts required by doctors to
339: 520-32.
successfully cannulate a vein was 2.84 (0 to 6 attempts). Junior 2. CDC. Semiannual report: aggregated data from the National
doctors were reluctant to cannulate obese people, children or Nosocomial Infections Surveillance System. September 2001.
3. Strausbaugh LJ, Jacobson C, Sewell DL, Potter S and Ward TT.
patients suffering from edema or shock. He also found, perhaps
Methicillin-resistant Staphylococcus aureus in extended-care facili-
surprisingly, that senior doctors were not noticeably better at ties: experiences in a Veterans’ Affairs nursing home and a review of
inserting cannulae, although they were better at acknowledging the literature. Infect Control Hosp Epidemiol 1991, 12: 36-45.
4. George Washington Crile: Medical Innovation in the Progressive Era.
their own failure.
Westport, Connecticut, and London: Greenwood Press, 1980.
Based on this initial work, Dr. Srivatsa invented the 5. Mermel LA. Prevention of intravascular catheter-related infections.
spring-loaded cannulae. He organized clinical trials in which he Ann Intern Med 2000, 132: 391-402.
6. Johnstone M. The effect of lorazepam on the vasoconstriction of fear.
assessed doctors using the device to cannulate 50 infants (92
Anaesthesia 1976, 31: 868-872.
percent weighing less than 4Kg). Cannulation was successful at 7. Cleary M. Peripheral intravenous cannulation. Aust Fam Physician
the first attempt in 94 percent of these cases.12 1991, 20: 1285-1288.
8. McDermott D, George B, Kramer N and Stein J. Ultrasound
Various cannula manufacturers have so far evaluated
Guidance for Difficult Peripheral Intravenous Access: A Randomized
the concept; however, none have yet chosen to manufacture Trial. Academic Emergency Medicine Volume 12, Number 5 suppl 1,
the product for fear of deskilling practitioners. They are 48.
9. Jackson A. Reflecting on the nursing contribution to vascular access.
perhaps also concerned at the prospect of endangering the
British Journal of Nursing 2003, 12, 11, 657-665.
lucrative market for cannula needles, so many of which 10. Wise H and McCormick R. Reinforcing hygiene practices of anaes-
are currently wasted through breakage and unsuccessful thestists. Anaesthesia 1999, 54: 1220-1221.
11. Dougherty L. Intravenous cannulation in A Guide to Intravenous
cannulation attempts.
Therapy. Continuing Education Reader, RCN Publishing, Middlesex;
With the cannulae currently in common use the sharp end 1998, 11-16.
of the needle is exposed, which can result in accidental injury 12. Srivatsa KM. Cannulation of vessels using a spring-loaded device,
Anesth Analg 1992, 75: 867b-868b.
to medical staff and patients. In addition to making it easy to
insert a cannula at the first attempt, U-Cannula has the impor-
tant additional benefit of eliminating needlestick injuries, as the
Dr. Martina Benzing is a Specialist Registrar, Paediatrics
needle is safely encased within the introducer. It also avoids
and Neonates in St. Peters Hospital, Chertsey, United
cannula fracture, reducing wasted time and resources.
Kingdom. Her special interests are in Paediatric and Neonatal
How Does the U-Cannula Work? intensive care. Since she became a mother, she finds it
U-Cannula has been specially designed to help medical traumatic to see doctors perform various practical procedures
s t a ff cannulate with ease, reducing the number of attempts in Paediatrics.
needed to get it right. Dr. Kadiyali M. Srivatsa worked as staff Paediatrician in
The U-Cannula has a knob, connected internally to a plunger. paediatric neonatal and intensive care from 1984 to 1999.
Once the cannula has been placed in the right position in the His vision is to reduce disposable product waste, reducing
vein, retracting the knob moves the needle guard, allowing the e n v i ronmental pollution, and spreading acquired hospital
cannula to move forward in a controlled manner into the lumen infections. Dr. Srivatsa is currently a practicing family
of the blood vessel. This eliminates the accidental jerky physician in the United Kingdom and CEO of Medifix Limited.
forward thrust of the needle tip, reducing the risk of double He invented the cannula introducer and U-Cannula.
Copyright©2006/Workhorse Publishing L.L.C./All Rights Reseved. Reprint with permission from Workhorse Publishing L.L.C.
60 MANAGING INFECTION CONTROL March 2006