BD Neonatal Products
Points to Consider
The infusion therapy issues related to the care of the neonatal patient population require thoughtful consideration. The clinical needs and challenges of the infusion therapy process require approaches, tools, and problem solving techniques that ensure potential risks to this vulnerable patient population are significantly reduced. The following sections highlight some of the infusion therapy issues, concerns, and approaches related to catheter selection and the unique needs of the neonatal population. In the text that follows, you'll find integrated and referenced expertise of others who have studied and written about clinical issues of the neonatal patient population.
Definitions
Neonate: an infant from birth to four weeks of life.
Infant: a child in the earliest stage of life, extending from birth to approximately 12 months; some references extend the period to 24 months of age.
Premature infant: an infant born before 37 weeks of gestation, regardless of birth weight.
Low-birth-weight (LBW) infant: an infant whose weight at birth is less than 2,500 grams, regardless of gestational age.
Pediatric: pertaining to a child.
Why is vascular access & IV therapy in the neonate so different from any other patient?
- In the U.S., Newborn Intensive Care Units (NICUs) have only been in existence for about 30 years, so the "learning curve" has been very steep.
- Expertise in care is developed at the bedside for this complex patient. Nursing and medical students’ class curriculums traditionally have only lightly touched on care of the pre-term neonate.
- Neonates cannot verbalize their pain. We must rely on non-verbal signals when assessing tolerance to painful procedures. Only the highly skilled caregivers can identify and correlate these signals. Pain responses to IV therapy may include serious responses such as oxygen desaturation and apnea/bradycardia.
- Organ systems in the preterm infant are immature, so multiple factors must be considered when initiating/maintaining IV therapy. Most notable are the large skin-to-body mass ratio and low tolerance to fluids.
- There is not a lot of literature supporting NICU practices.1 Much of the care practices have been adopted from other patient populations, and not scientifically tested in neonates.
Why do neonates need a specialized IV catheter?
- The pre-term neonate may require longer-term parenteral support when compared to the average hospitalized adult patient. Up to 91% of PIVs are removed prematurely due to catheter complications in this population.2 A technologically specific IV catheter considering the needs of the small neonate may help decrease the number of IV access attempts.
- Veins are small and fragile. The INS Standards of Practice3 recommends the smallest gauge, shortest length catheter to meet IV therapy requirements be used.3 Therefore, a very short, very small catheter should be used. Fragile veins imply low tolerance to pH and osmolality.
- PIV dwell times only average 27-49 hours. Less traumatic insertions and biocompatible catheter material can improve these statistics. Statistics show that up to 77% of NICUs infuse vasoactive drugs peripherally, 73% administer >D10% solutions, and 72% give peripheral calcium infusions.
- Extravasation rates are in excess of 40% in neonatal practice. Tissue sloughing is not uncommon, and only about 60% of NICUs have a procedure for management of PIV infiltration. The amount of trauma to the blood vessel during IV access and dwell will affect this outcome.
What can the neonatal nurse do to improve IV catheter-related outcomes?
- Select a vascular access device that is less traumatic on insertion. Needle sharpness and catheter-tipping features should be considered.
- Select catheter material that has proven improvement in dwell times.4
- Select a catheter that verifies vessel entry quickly, thereby reducing the need to "fish" for the vein.
- Be knowledgeable about IV therapy principles, guidelines, and standards in neonatal care.
Why should I change to a safety IV catheter?
- Technology exists to protect end users from needlestick injuries.
- Over 200,000 new hepatitis C infections (HCV)5,6 occur annually, and estimates show 3.9 million Americans are infected. Forty percent of chronic liver disease is HCV-related. There is no cure for hepatitis C.
- An estimated 1-1.25 million people in the US are infected with hepatitis B (HBV)5,6. 10-85% of infants born to HBV infected mothers are at risk for perinatal infection. Screening pregnant women for hepatitis B surface antigen has failed to identify a high proportion of HBV-infected mothers. Children of HBV infected mothers have a high risk of acquiring chronic HBV infection during the first 5 years of life. There is no cure for hepatitis B.
- Hepatitis Delta (HDV) can cause co-infection or superinfection in an HBV carrier. All hepatitis viruses can cause active and chronic hepatitis. Annually, 4,000-5,000 people die of chronic liver disease while waiting for a liver transplant.
- Infectious disease statistics show that 28% of HIV infected adults have children.6 Up to 22% of HIV-infected mothers gave birth after diagnosis. There is no cure for HIV.
- Other high-risk occupations require the use of safety devices to protect workers. Consider the use of hard hats in the construction industry, protective goggles and gloves in the steel-working industry, or seat belts in automobiles. The use of all of these safety devices has proven results. Healthcare workers deserve proven protection from occupational risk also.
- Many states have legislated the use of safety devices on hollow bore needles used to access vessels and draw blood, and this trend is gaining speed.
- The federal government has legislated this movement toward safety.
- Worker’s compensation statistics show using safety devices in the workplace decreases occupational injuries.
- Worker’s compensation payouts are finite for on the job injuries. Healthcare expenses after acquiring a bloodborne disease are not finite.
- Your job should not cost you your life.
Why should I use the BD Insyte-N Autoguard shielded IV catheter on my patients?
- The catheter material has proven
improvement in patient outcomes.
- The catheter is appropriately sized for the small neonate.
- The notched needle feature provides nearly instantaneous vessel entry confirmation.
- BD IV catheters have notched needle technology.
- The safety feature is proven
to reduce needlestick injuries.7
- It’s smarter, better, safer IV therapy for the small neonate.
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