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Second entry into market faring well in first year
Reducing the incidence of occlusion in long-term vascular access devices is a major concern of home infusion providers and nurses. With the recent introduction of its PASV (pressure activated safety valve) line of vascular catheters, Catheter Innovations of Salt Lake City is hoping to give infusion providers a helping hand to win the battle.
Marcia Wise, RN, director of clinical support at Catheter Innovations, says that the products already introduced in the PASV line won’t be the last.
"The PASV technology is currently available in our midlines, PICCs, and tunneled catheters," she says. "We are close to release of another device, called the PASV protector, which is an add-on valve designed to provide the same technology to peripheral IVs and other types of enteral venous catheters. There are also plans to market in implanted port with the PASV technology early next year."
The concept behind the patented technology lies in a small, silicone disc valve housed inside a plastic hub. When infusion begins, the pressure of the fluid flow opens the valve. Or, if you attach a syringe and aspirate, the fluid flow of blood in the catheter opens the valve. Otherwise, it remains closed, reducing the incidence of occlusion.
The benefit of the PASV catheters is that the valve is housed in the external hub so it is not exposed to blood and fibrin. Also, the valve is engineered to control when and if it opens.
"It takes a minimal amount of pressure to open the valve during the infusion, but requires a higher pressure to open during aspiration," says Wise. "This allows aspiration of blood with a syringe, but will prevent blood reflux during situations when the bag runs dry or the patient changes positions."
The catheters are priced between non-valved catheters and the Groshong from Bard, the only other valved catheter on the market.
Wise is waiting for the publication of two studies — one conducted at Harborview Medical Center in Seattle and the other at West Virginia University Medical Center in Morgantown — so Catheter Innovations will have data on the PASV catheters and their effectiveness on reducing occlusions. She notes no comparison studies between the Groshong and PASV catheters have been done.
Some using the catheter say it is just what the doctor ordered.
"I followed five patients that had a tunneled catheter," says Sherry Hoffman, RN, nurse educator for Columbia Homecare, in Salt Lake City. "I’ve also put in about five PICCs and 10 midlines. I felt very confident that the patient was in a safer environment because of the catheters. You don’t have to worry about air embolisms or bleedout if the lines become disconnected."
Romaine Reeves, BSN, MA, MBA, TNCC, IV nurse consultant with PharMerica, of San Antonio, has had similar experiences.
She has used the catheter primarily in long-term care settings in patients ranging from 35 to 95 years old and disease states including urinary tract infections, respiratory infections, nutritional deficiencies, hydration needs, and multiple therapies.
"In long-term care patients I will insert the catheter but not necessarily care for the patient," she explains. "I have more security knowing that the possibility of air embolism is greatly reduced, as well as the fact that bleeding out is a little less likely to occur."
Comfort and security isn’t the only benefit. Reeves, who normally has an infection rate of less than 3%, has a zero infection rate with the PASV catheters.
While Reeves and Hoffman tout the clinical benefits, they add that the additional cost may be worth it in most cases.
"Cost was considerably different; you didn’t have to use the needleless systems because Catheter Innovations advises all hookups be direct to the catheter," says Hoffman.
Wise adds that with the recommended flushing protocol of saline once a week, there are fewer supplies necessary to send to patients’ homes. Hoffman points out that this made patient education much easier, because you only had to teach to flush with saline.
Reeves does note the additional cost could play a factor in some providers being able to afford to switch.
"We need to look at the cost, especially with prospective pay," she says. "At $3 to $15 more per catheter — depending on the catheter you’re comparing it to — if you put in 500 a year, cost could be a major factor."
Hoffman points out when you aspirate blood, there is residue left on the threads of the catheter because it is hooked up directly to the lines.
"I’m teaching people that if they are drawing blood at the same time you’re doing the dressing, use the sterile 4x4 and wipe that off," she says.
Reeves adds that using the catheter may require an alteration in preparing the catheter for insertion.
"You have to put the wire through the catheter, and that is an extra step in preparing the catheter," she says.