Sharing knowledge and bringing vascular access to a higher level

by Ron Stoker

I recently had the opportunity of speaking at the World Congress on Vascular Access (WoCoVA) that was held in Amsterdam, the Netherlands. It was a great opportunity to speak to the movers and shakers of prestigious group of clinicians. This first meeting of WoCoVA was held in the brand new Elicium of Amsterdam RAI Convention Centre. More than 1,000 registrants were in attendance at the meeting.

The WoCoVA organization was established in 2009 as a foundation to create an independent platform to organize worldwide congresses on vascular access. WoCoVA 2010 was the first congress of its kind and brought together vascular access professionals from around the globe. The WoCoVA foundation is a nonprofit organization registered in the Netherlands especially to organize seminars, congresses and improve vascular access. The main goal of WoCoVA is sharing knowledge and bringing vascular access to a higher level. A specialized global scientific committee offered scientific programs with experienced speakers, workshops and product presentations. The WoCoVA foundation works with highly trained specialists who are constantly improving skills and expanding knowledge by research and innovations.

What is Vascular Access?

About 90 percent of patients visiting a hospital will have a need for some sort of vascular access. Vascular access is described as “the ability to enter the vascular system” for administering drugs, fluids or obtaining blood for testing or haemodialysis. The focus of this last WoCoVA Congress was on venous or vein access. The meeting focused on vascular access via veins in the arm, neck, chest or groin area. As most of us are aware, vascular access has a potential risk of infections, thrombosis and tissue damage with long term discomfort.

During the meeting all aspects of vascular access or discussed including:

• indications for the choice of the device,
• insertion techniques,
• tip location methods and prevention and management of all Vascular Access Device (VAD) related complications, including infection, thrombosis, occlusion, pneumothorax, etc.

Program and Keynote Speakers

The Congress was divided up into a scientific program, workshops, educational courses, satellite symposia and poster sessions. One of the main focuses of the meeting was on issues of safety, cost effectiveness and efficiency of vascular access, as well as on the need for world-shared guidelines for clinical practice.

The first day focused on the specific challenges of peripherally inserted central catheters (PICC.) The second day’s focus was on risk management in venous access, and the third and final day was on implanted access ports.

More than 60 speakers participated in the meeting. We were delighted to have two keynote speakers: Dr. Berenholtz and Dr. Maki.

Dr. Sean M. Berenholtz, MD, MHS, FCCM is an associate professor in the Johns Hopkins University Schools of Medicine (Departments of Anesthesiology/Critical Care Medicine and Surgery) and Bloomberg School of Public Health (Department of Health Policy and Management). He earned his master’s degree in clinical investigation from the Johns Hopkins Graduate Training Program in Clinical Investigation at the Bloomberg School of Public

Health. His research interests include applying clinical research methods to improve quality of care in the intensive care unit. Dr. Berenholtz is author of more than 50 articles and chapters in the fields of patient safety, ICU care, evidence-based medicine, and the measurement and evaluation of safety efforts.

Dr. Maki is the Ovid O. Meyer Professor of Medicine, Head of the Section of Infectious Diseases at the University of Wisconsin Medical School in Madison, Wisc., and attending physician in the University of Wisconsin Center for Trauma and Life Support. In his activities as an infectious disease consultant, intensivist and hospital epidemiologist, Dr. Maki has devoted his research career to the study of pathogenesis, diagnosis and prevention of infections, particularly bloodstream infections caused by intravascular devices and the management of septic shock and other life-threatening infections.

It was a rare treat to hear from Doctor Berenholtz and Dr. Maki. They have been a great resource to the infection prevention community. In Dr. Maki’s presentation he discussed how the recent legislation banning te reimbursement for preventable infections has elevated infection preventionists from being outcasts in the hospital setting to being noted colleagues to hospital administrators because of the need to prevent infections instead of primarily just treating them.

Safety Workshop

On the second day I had the opportunity of conducting a 90 minute workshop on safety with Dr. Andreas Wittman from Germany. Dr. Wittman discussed the recent European legislation on sharps safety. The law will require the use of safety products but does not provide real enforcement teeth just yet. It is believed by Dr. Wittman that a number of European countries will become compliant over the next 18 months.

My presentation focused on the importance of prevention. During my presentation I discussed the importance of using passive safety products and that they are usually preferable to active safety products. In passive safety products no active participation by the clinician is required to activate the safety mechanism. Clinicians use the device as they normally would and the safety mechanism is automatically activated. There are no buttons to push or levers to activate, for example auto-retractable syringes. Although the product safety activation is done without active participation by the clinician, there still needs to be both audible and visual feedback that the safety mechanism has been activated. Since the OSHA Bloodborne Pathogen Standard was implemented, the number of safety-engineered sharp devices that have been developed has grown rapidly.

Active safety products require activation of the safety feature by the clinician. An example of an active safety product would be a needle that requires the user to manually push a button, push a lever, adjust a shield or twist the barrel in order to activate the safety feature. The active safety product, as with the passive safety product, needs to have both audible and visual feedback that the safety mechanism has been activated.

Focus on Huber Needles

Since a whole day was spent at WoCoVA discussing the challenges of conventional Huber needles, I wanted to share some of what was discussed at the meeting. 

In recent years, there has been a substantial increase in the number of patients with implanted ports. An implanted port requires a special needle to be inserted through the skin of the patient and into the port. The most common type of such a needle includes a 90-degree bend. This type of needle is called a Huber needle. Because of the configuration of the needle, removing of the Huber needle at the end of the infusion therapy is particularly dangerous, exposing the medical practitioner to a high degree of risk of inadvertent needlestick injury.

Huber needles are usually designed for longer term infusion therapy. The angular relationship of the needle allows the Huber needle to be more safely anchored to the skin around the port. These needles are commonly left in place for a period of several days, weeks and possibly even months. It is common for the Huber needles to have an attached wing assembly that is often used for securing the Huber needle to the patient by using a catheter securement device or tape.

The procedure of removing a Huber needle from an implanted port commonly produces what is called “rebound effect.” When the needle is inserted into the port, the rubber of the port tightly binds about the needle. A substantial force is required when pulling on the needle in order to get it to release from the port. The stainless steel needle has been sitting in a silicone septum in the port. There is a high coefficient of static friction between the needle and the silicone septum and a substantial force is required when pulling on the needle to get it to release from the port. The clinician, therefore, has to pull hard in order to get the needle to release from the port. Once the needle is released, the muscular movement of the clinician then relaxes and an opposite movement takes place, which is called rebound. Frequently, this rebound effect drives the Huber needle point down and can be driven into the clinician’s hand or arm resulting in a needlestick injury. The needle is contaminated with the blood of the patient. The patient could have a serious transferable disease, such as AIDS. The clinician would then be exposed to the bloodborne pathogen and would be at risk of seroconverting.

It is important, therefore, that safety Huber needles are used to minimize risk to clinicians.

The following are safety Huber needles currently available on the market:

• LiftLoc* Safety-Winged Infusion Set, Bard Access Systems;
• Life-Guard Safety Needle, AngioDynamics;
• Smart Safety Huber Needle, Acacia;
• GRIPPER PLUS™ Safety Needle and Gripper Plus Mini Safety Needle, Smiths Medical;
• Whin® Safety Huber Needle, B Braun Medical;
• K-Shield ® Safety Port Access Infusion Sets, Kawasumi;
• AutoSafe Reflex Safety Huber Needle, AutoSafe;
• Huber Plus^® Safety Huber Needle, Bard Access Systems;
• Safe Step Safety Huber Needle, Bard Access Systems;
• EZ Huber^® Safety Infusion Set, Navilyst Medical;
• Pro-Pierce^®  CT Rated Safety Infusion Set, MedComp;
• PPS FLOW+ Safety HUBER Needle, Perouse  Medical;
• HuberPRO™ Safety Huber Needle Infusion Set, Command Medical;
• Empress  Safety Huber  Needle, Osiris Medical;
• EZ Huber^®, PFM Medical.

Ron Stoker, MS, is the executive director of the International Sharps Injury Prevention Society (ISIPS). He has 29 years experience in the medical device industry as a researcher, marketer, educator, consultant and healthcare worker advocate. He has written more than 200 medical journal articles, primarily on sharps injury prevention, infection control, and hand hygiene. Mr. Stoker has his BS in Pre-Medical Zoology from Brigham Young University, an MS in Bioengineering from the University of Utah and an “honorary doctorate” from the school of hard-knocks. As a result of a surgical mishap he was rendered a quadriplegic in December 2006. Informed that he would never walk again, with tenacity and a “supportive and mean wife,” Mr. Stoker taught himself how to walk again. He says that he walks like an “alcoholic” but is really just a recovering quadriplegic!

Mr. Stoker has conducted workshops and Congresses on sharps safety at national and international meetings for the last 10 years. He is a founder and lecturer for the Infection Preventionist Boot Camp Series. For more information contact Mr. Stoker at info@isips.org.