I was very excited when I saw the new Gripper Micro product. It has a holder that has a huber needle with a metal cannula over it. The needle is placed into the port like usual, but then the needle/holder part is completely removed leaving just a dime sized, flush-to-the-skin, easy to secure, piece in the patient with a blunt metal cannula. What I was not expecting is the extreme pain that the patient complained of. I used a 22g device and I used buffered lidocaine for numbing, just like I had done the past three times on this patient with two different products. Normally, she never had any pain with the access, but this time the pain was horrific. I could see why as I placed the needle. The needle had resistance due to the cannula over it, instead of the normal sharp needle. It took the same amount of time to insert, even with the resistance, but she complained of the numbing not working at all. She complained that she "never had a needle hurt so much". Perhaps the design of the product will get better. Maybe they will make the needle/ cannula transition better. In the past few years, the transitions on PIV catheters and PICC introducers have had a lot of improvement. Maybe the same will be true of this product. But for now, I would never subject a patient to it ever again. Has anyone else had a different experience?
Interesting....I just scheduled to meet with the rep. to discuss this new product. He should have contact information from other accounts that are trialing it or have converted. Certainly, if anyone else is having "issues" I along with you would like to know about it before hand.
As a side note, I was always taught to never inject Lidocaine over a port as this breaks and compromise skin integrity. If an anesthetic is needed it should be topical.
I was taught to always offer lidocaine and I always teach to use it. Why would this potential for "compromised skin integrity" be any different than the use of a local for central lines the Doctor's place, or the peripheral or PICC lines that we place? In fact, the risk of compromised skin integrity from a local injection over an implanted port is totally nil. A regular scrub and sterile procedure is performed. There is no reason not to offer local anesthetic, and I stongly feel that it should be offered to everyone. Either buffered lidocaine or bacteriostatic lidocaine can be used. Patients who have had it continue to ask for it with each subsequent access. Topical is excellent for monthly routine access and flush, when the patient knows they will get stuck, but an hour is too long for typical hospital IV nurse visit. I hope you will consider offering a local for all your future accesses.
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]
Michelle Todd, CRNI--Head PICC Nurse, Vibra Specialty Hospital of Portland [email protected]