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Haemodialysis and guarded fistula needles

 

Clinical bottom line

The use of guarded fistula needles for haemodialysis reduced needlestick injuries to zero.


Reference

J McCleary et al. Guarded fistula needle reduces needlestick injuries in hemodialysis. Nephrology News & Issues, 2002, May: 66-72.

Study

Five haemodialysis clinics in the northwestern USA participated. They all had preexisting systems for reporting needlestick injuries, had historical data, and used unguarded arteriovenous fistula needles. Retrospective data were collected for 15 months before introducing guarded arteriovenous fistula needles, from January 1999.

Prospectively, from April 2000, information was collected after the introduction of guarded arteriovenous fistula needles. Only one design of guarded arteriovenous fistula needles was used, and unguarded needles were prohibited.

During the retrospective period healthcare workers were trained in the clinic's needlestick injury and reporting policy. On the introduction of the guarded arteriovenous fistula needles full training was given, and the reporting policy reaffirmed.

Results

Information on the number of devices used, and the number of needlestick injuries, is shown in Table 1. The number of needlestick injuries per 100,000 devices used fell from 8.6 to zero.

Table 1: Needlestick injuries with unguarded and guarded arteriovenous fistula needles

Device

Number used

Needlesticks

Rate per 100,000

Unguarded

81,534

7

8.6

Guarded

54,044

0

0

Comment

These are impressive results. Haemodialysis carries particular risks.

Haemodialysis requires cannulation into a high pressure and high flow arteriovenous fistula or graft. If the arteriovenous fistula needle is withdrawn without instant haemostasis life-threatening bleeding can occur. The guarded device in this study (Medishield arteriovenous fistula needle with MasterGuard) had a device that allows pressure to be exerted by the fingers while protecting them from the needle.

While the absolute number of needlesticks was small in this study, the reduction to zero needlesticks in 54,000 uses was encouraging.