Project Description

Photography of the NIC

The NIC is an engineered safety innovation and is the only arterial connector in clinical use which prevents wrong route drug administration into the arterial line

Supported by:

EASHN LogoNHS England Logo

“For the safety and best practice for our patients, I heartily recommend this device should be used on all arterial lines in the NHS”  Professor Sir Bruce Keogh, Cardiothoracic Surgeon, Medical Director, NHS England

WHO recommended actions regarding arterial catheter lines: “Use of catheters with injection ports for these applications is to be avoided.”

Background

In intensive care units (ICU) and operating theatres arterial lines are used to accurately measure a patient’s blood pressure and take numerous and repetitive blood samples.

Problem

The 2008 National Patient Safety Agency Rapid (NPSA) Response Report1 highlights problems with arterial lines that have led to patient harm, such as errors with sampling, arterial line infection and confusion of arterial and venous lines, leading to the error of wrong route drug administration.

Medication must never be given into the arterial line. If this error occurs, it can damage the blood supply to the hand, leading to ischaemia, tissue necrosis and sometimes amputation of the fingers or hand.

This serious harm suffered by the patient can lead to:

  • increased length of stay in the ICU and hospital
  • increase in specialist care and operative procedures required
  • long-term pain problems, affecting patient’s working and social lifestyle

Data from NHS England shows that this error occurs in the NHS on average 2 times per month.2 However, it is well known that this error is under-reported.3

The National Patient Safety Agency, described the need for clear labeling and colour coding and the need for manufacturers to test and develop universal solutions to minimize the error.1

Solution

The NIC is the only arterial connector, available for clinical use, which prevents wrong route drug administration into an arterial line and meets the recommendations of the NPSA arterial safety alert.

The Non-injectable arterial connector is a like for like replacement of your standard arterial connector. It has a one-way valve in its internal chamber – this means clinical staff can always take a blood sample, but never inject into the arterial line.

The NIC:

  • Prevents accidental injection into the arterial line
  • Prevents bacterial contamination of the arterial line
  • Prevent blood spillage during sampling

Training

Training to use the NIC takes 2-3 mins.

  • When the arterial line is placed in situ, a NIC is attached to the sampling port of the 3-way tap, via the luer connection.
  • Taking a blood gas sample from the NIC is via the same method as with standard arterial connectors:

The instruction video shows how simple the NIC is to use.

Procurement/cost

A health economic study found that the NIC is cost saving for the NHS.4 Once connected to the sampling port, the NIC stays on the arterial line for the lifetime of the line (3-7 days) depending on your trust policy.

The NIC meets the criteria for the Innovation and Technology Tariff which ensures that every hospital in NHS England will be fully reimbursed for its use for 2 years, from 1st April 2017. Support from the tariff has the potential to eliminate this error from the NHS. 

The NIC can be procured from Amdel Medical Ltd and Bunzl healthcare supply chain

Clinical Evidence

Engineered solutions: the NIC has been designed to physically prevent wrong route drug administration into the arterial line

A simulation study conducted to determine the risk of injecting into the arterial line showed 66% (10/15) accidentally gave medication into the arterial line (standard connector), and did not realise they had done so.5

A simulation was conducted to determine whether to determine the risk of accidental arterial line drug administration. Junior doctors, who were working on the ICU, were given a stressful and distracting scenario, as would normally occur in their clinical practice. When asked to urgently administer medication to the ‘patient’, we found that in their haste, 10/15 (66%) junior doctors accidentally gave the medication into the arterial line. Many of these doctors did not realise they had made the error, therefore, fail-safe solutions, such as the NIC, are needed to eliminate these errors. http://onlinelibrary.wiley.com/doi/10.1111/anae.12884/full

A laboratory study showed that the NIC prevented bacterial contamination of the arterial line 100% of the time.5

A clinical audit of standard arterial connectors in the ICU, which showed a 6% bacterial colonisation rate and this has the potential to be transmitted to the patient. Laboratory studies replicating arterial blood gas sampling, compared the NIC to a standard arterial connector, and determined the effectiveness of both connectors in preventing bacterial contamination. The NIC was found to prevent bacterial contamination of the arterial line 100% of the time (p<0.0001). http://onlinelibrary.wiley.com/doi/10.1111/anae.12884/full

Patients and Staff opinion

Clinical staff

A survey of >250 clinical staff using the NIC have found that the device is easy to use, is better for identifying the arterial line and prevents this error.4

98% of health care staff surveyed believed it was important to have a device that prevented wrong route drug administration and prevent arterial line infections.

28% of respondents said they have personally seen adverse events in their routine clinical practice when using standard arterial lines in the past and 93% believe these would have been prevented had the NIC been in use.

96.5% of staff said the NIC allows increased identification of the arterial line and >80% said that the NIC was easy to learn and use and is compatible with standard arterial line equipment.

81% wanted to use the connector after the study was completed and they felt that this was due to both ease of use and to promote patient safety.

Patients

We have received excellent patient feedback for the NIC, where 100% of patient’s surveyed strongly agreed that the NIC should be used in ICUs and operating theatres for their benefit and that of their family.4

“Excellent idea, feel confident this would benefit my family, myself and the NHS”

“Not using this device would seem like folly.”  

“NIC is highly innovative of 1st stage design to alleviate costs to problems caused commonly in ICU situation and which improves patient quality of care”

“A wonderful idea that removes all the risk of injecting into an arterial line”  

“Making mistakes impossible keeps people alive and reduces cost per episode.

Awards

The NIC has won patient safety and innovation awards

  • The Association of Anaesthetists of Great Britain and Ireland Innovation Award (2015)
  • The National Patient Safety Award (2012)

References

  1. Problems with infusions and sampling from arterial lines. Rapid Response Report. National Patient Safety Agency. July 2008. NPSA/2008/RRR006 http://www.nrls.npsa.nhs.uk/resources/?entryid45=59891
  2. Personal communication of adverse events data from NHS England 
  3. Accidental intra-arterial injection: an under-reported preventable never event. Critical Care 2015; Supplement A441 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4472680/
  4. Description of a new non-injectable connector to reduce the complications of arterial blood sampling. Anaesthesia 2015; 70(1): 51-55 http://onlinelibrary.wiley.com/doi/10.1111/anae.12884/full
  5. Non-injectable arterial connector. A cost effectiveness assessment to improve arterial line safety. Eastern Academic Health Science Network. 2015. http://www.eahsn.org/our-work/casestudies/