A Prospective Randomized Trial of Two Safety Peripheral Intravenous Catheters Bertrand Prunet, MD Eric Meaudre, MD Ambroise Montcriol, MD Yves Asencio, MD Julien Bordes, MD Guillaume Lacroix, MD Eric Kaiser, MD BACKGROUND: To reduce the risk of accidental needlestick injuries, first active then passive safety devices were developed on IV catheters. However, whether these catheters are easy to implement and really protect personnel from accidental needlestick is untested. METHODS: In this prospective randomized survey, we compared a passive safety catheter with an active safety catheter and a nonsafety classic catheter. The main objective was to evaluate the difficulty of inserting the catheters in terms of the number of insertion failures, difficulties introducing the catheter and withdrawing the needle, and the normality of the blood reflux in the delivery system. The second objective was to determine the degree of exposure to patients’ blood evaluated as the number of exposures of the staff and blood splashes of the environment, and the staff’s sense of protection. RESULTS: Seven hundred fifty-nine assessment cards were collected. The number of failures for the three catheter groups was similar and not statistically different. Introduction of the catheter was more difficult with the active safety catheter. Needle withdrawal was more difficult with the passive safety catheter. The blood reflux was abnormal more often with the safety catheters. The staff’s exposure was more frequent with the active safety catheter. The number of blood splashes was more common with the safety catheters. CONCLUSIONS: Safety catheters are not superior with regard to failure rate in the catheter’s placement. Users feel better protected, but find the use of safety catheters more difficult, and their handling generates more splashing of blood into the environment. The passive safety catheter is more efficient than the active safety catheter with regard to ease of introduction of the catheter into the vein and the staff’s exposure to the patient’s blood. (Anesth Analg 2008;107:155–8) Accidental needlestick injuries expose health-care workers to blood-transmitted infectious agents. Expe- rience shows that even an intense educational policy with good organization of the care, staffing, and safety equipment is insufficient to prevent accidental needle- sticks. 1–3 Staff in the anesthesia and emergency depart- ment reception areas are especially prone to exposure. 4–6 To reduce the risk of accidental needlestick with IV catheters, active safety devices were developed during the 1990s. 6 The operator triggers the device using a specific maneuver. In the 2000s, passive safety devices have appeared on the market, which do not require any particular maneuver from the operator because they are automatically triggered. 7 These new types of passive safety IV catheters are placed according to a technique identical to the classic nonsafety catheters, but no randomized prospective survey has ever as- sessed them. The question is whether their insertion is easy and whether they really protect personnel from accidental needlestick. The goal of this prospective randomized survey was to compare a recently mar- keted passive security catheter (Introcan ® Safety™) with an active security catheter (Insyte™ Autoguard™) and a nonsafety classic catheter (Vialon™). The main objec- tive of the survey was to evaluate the difficulty of inserting the catheters. The second objective was to determine the degree of exposure of personnel to patients’ blood. METHODS After agreement of the local ethics committee, a randomized prospective survey was conducted in the operating room and the emergency department over a 5 Mo period to assess 3 peripheral IV 18-gauge diam- eter catheters. Vialon (BD Medical Systems, Le Pont de Claix, France) was the nonsafety catheter usually used in the hospital (18 G, length 30 mm, outer diameter 1.3 mm). Passive safety Introcan Safety catheters (B.Braun Me ´dical, Boulogne, France) have an insertion identical From the Department of Anesthesiology, Military Teaching Hospital Sainte Anne, 83800 Toulon Arme ´es, France. Accepted for publication March 10, 2008. Supported by Sainte Anne Hospital and Department of Anesthesiology. Address correspondence and reprint requests to Bertrand Prunet, De ´partement d’Anesthe ´sie, Ho ˆ pital d’Instruction des Arme ´es Sainte Anne, 83800 Toulon Arme ´es, France. Address e-mail to prunet. bertrand@orange.fr. Copyright © 2008 International Anesthesia Research Society DOI: 10.1213/ane.0b013e318174df5f Vol. 107, No. 1, July 2008 155