I understand how the BD Diffusics catheter is different than a standard IV cannula. Its design reduces the destabilizing effects that can cause extravastion during a power injection. Somehow our nurses have come to believe that it also reduces other complications such as phlebitis and infiltration. They have been told they need to give Vancomycin through the 22 gauge Diffusics. Even if this was true I find it curious that only Vancomycin had been identified as irritating and now I am getting calls to replace a perfectly good IV because they need to give Vancomycin and it is not a Diffusics!
I also understand that the Difffusis enables higher flow rates with a smaller catheter and gravity flow rates are improved by about 20 percent. Some nurses have told me they have been told that the 22 is really a 20 gauge and the 20 gauge is really an 18 gauge. I also would like clarification on this because while I understanfd the higher flow rates it does not make sense to me because a 22 is still a 22!
The nurses also told me that they have been told all kinds of things that reduce complications such as there is increased bubbling at the catheter tip, better hemodilution and even something about how the irritating medications do not come into contact with the vein walls. I am finding this hard to believe. I have visited the BD website and can find nothing that indicates this device should be used to administer irritating IV medications
What are your thoughts.
First, my disclosure - I am a paid consultant for BD and do a regular presentation from BD on Mitigating the Risk of Extravasation with Power Injection. Diffusics has 3 holes on the sides of the catheter. This allows plumes of fluid to escape through those holes, decreasing the fluid jet exiting from the catheter tip. Power injection causes this high flow jet - 3-8 mLs per SECOND. A randomized controlled trial from Johns Hopkins has been published showing that both an 18 g regular catheter and a 20 g Diffusics has the same outcomes with this rapid fluid flow, has the same levels of complications for contrast injection and produces the same quality of CT scans. I think a creative sales person has taken this study has stretched it waaaaaayyyyyy too far. The velocity of power injected contrast is decreased from the catheter tip. There are no other studies showing the claims that your nurses are making and I believe these have to come from someone trying to lead them astray. Certainly there is no evidence that it decreases phlebitis and infiltration and no studies on its use with Vancomycin. Smaller catheters will always be better because they decrease the mechanical trauma and allow for more blood flow around the catheter, thus diluting the fluid infusing. But these are big misconceptions of what this catheter will do. Infusion of regular medications are not given under power injection, and more studies would be needed to make these claims.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
I can't thank you enough for responding. I really do love the product for power injection and its level of sharpness but I could not substantiate any of these miraculous claims I was hearing. I was hoping you would respond and I appreciate your expertise and time.
I forgot one more thing. Our nurses have also been instructed to use the 20 gauge Diffusics for therapeutic phlebotomy. They have been told it will make it easier to pull off the blood since there are 3 diffusor holes. It seems to me that is better to use a large gauge catheter since blood is so viscous and of course has the propensity to clot.
Again, no published evidence so your experiences will be the only information you have to rely upon for that question. The additional holes could make a difference but blood viscosity could also be an issue.
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Lynn,
We use the nexivas and love them. BD has recently update the nexivas and now there is no blood return on some of our 20 g 1/34" pivs until the needle is removed. This is ok for we use u/s to place our ivs if we are consulted. The problem is if you are not using u/s you do not think you are in the vein, hence they end up removing the iv when really it was in. This is a problem with the device (it is a certain lot number)
Secondly, BD has promised by spring of 2017 that the 22 g will be available in a longer length (like 1 3/4 " or 2") so we can use it with our u/s guided piv insertion which we badly need. The 20 g is too big and I work in Oncology which most veins in these folks are way too small. Can you tell me when the longer piv will be out? Braun has released a 2 inch 22 g needle. If BD has none, we will switch back
thank you for your help Lynn
Pat
PICCNURSE4
No sorry I don't have any info on when new products will be available. Also please remember that Nexiva and Nexiva Diffusics are not the same catheter. The original post was asking about Nexiva Diffusics. Lynn
Lynn Hadaway, M.Ed., RN, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861