Advice
The technology
The technology
The needle-free arterial non-injectable connector (NIC; Amdel Medical) is connected to the sampling port of a standard 3‑way tap in an arterial line using a Luer connection. The NIC is red in colour to help identify the arterial line. An internal 1‑way valve in the NIC allows fluid to only flow from the arterial line to the sampling syringe. This valve closes completely when pushed downward thereby preventing accidental injection into the patient. The locking Luer connecting the NIC to the 3‑way tap makes it hard to remove the NIC, which also reduces the risk of inadvertent injection into the artery. The NIC injection port has a silicone compressible bung with a central slit, which seals against back pressure but opens when the Luer tip of a sampling syringe is pushed against it. The seal closes once the syringe has been removed, preventing accidental blood loss. The manufacturer of the NIC states that bacterial contamination is also prevented because of the design and configuration of the device. The NIC is intended for single-patient use only.
The innovation
The NIC is the only needle-free arterial connector for the sampling port of a 3‑way tap that can stop intravenous fluids or treatments from being inappropriately given through the arterial line. The NIC may also help to prevent bacterial contamination and blood loss during blood sample collection.
NICE is not aware of any other CE‑marked devices that have a similar function to the NIC.
Other needle-free connectors or caps are available that have closed coverings to prevent blood spillage and bacterial contamination of the arterial line, but these do not specifically stop accidental injection into the arterial line.
Current NHS pathway
Arterial lines are regularly used for adults in critical care units and operating theatres for sampling arterial blood to measure blood gases, glucose and electrolytes, and for monitoring blood pressure. Different types of arterial connectors can be used on the sampling port of the arterial line but these are not designed to prevent inappropriate injection of fluids or drugs intended for administration into a vein. Inappropriate injections into an artery are rare but can have life threatening or life changing consequences. The accidental administration of intravenous medication can cause serious injury (including skin loss, tissue necrosis and loss of limb) and all incidents resulting in severe harm and death must be reported to the National Reporting and Learning System. In 2008, the National Patient Safety Agency recommended that in addition to raising awareness amongst staff, training and the development of local systems to identify arterial lines and infusates, longer-term design solutions are needed to minimise the risks associated with using arterial lines.
Population, setting and intended user
The NIC is intended to replace needle-free connectors or caps currently used in the NHS to cover the sampling port of the arterial line.
The NIC can be used for any adult with an arterial line, but it is not licensed for use in children. It is intended for use in hospital settings where arterial lines are in place (for example, operating theatres and critical care facilities).
The device would be used by the same staff who currently use needle-free connectors or caps on arterial lines. Minimal training is needed to use the NIC.
Costs
Resource consequences
The NIC is currently used in 13 hospitals in England and 1 hospital in Northern Ireland.
No changes to the way that current services are organised or delivered would be needed. No additional facilities or technologies would be needed to use the NIC, although minimal training may be neccesary.