INTRAVENOUS CANNULATION-PLASTIC CATHETERS OR SCALP VEIN NEEDLES

Abstract

Although there are no adequate studies comparing the incidence of complications with plastic catheters versus scalp vein needles, a review of the available literature does permit certain general observations. The use of plastic catheters is accompanied by a high rate of phlebitis, catheter colonization and sepsis. In most studies the rate of these complications increased with the length of time catheters were left in place; when catheters were left in longer than 48 hours, the associated septicemia rate ranged between 2% and 5%. In contrast, only one case of cannula-related septicemia was noted among 535 patients receiving intravenous therapy via scalp vein needles in 4 studies. Moreover, rates of phlebitis and cannula colonization are lower with scalp vein needles than with plastic catheters. Suppurative thrombophlebitis has recently been reported in association with IV therapy via scalp vein needles. In other words, serious infections may be rare, but they do occur, particularly in immunosuppressed patients. The factors responsible for the relative safety of scalp vein needles are unknown; it has been suggested that needles are safer because they tend to infiltrate quickly, forcing changes at frequent intervals. The small teflon catheters now available may be less irritating than previously marketed plastic catheters.

Present information strongly suggests that scalp vein needles should be used for intravenous therapy whenever possible. If the cannula is to be used only for the periodic administration of medications such as antibiotics, a heparin lock is preferred to a "keep open" infusion since intravenous fluid supports the growth of bacteria and thus increases the risk of intravenous-related sepsis. Plastic catheters should be used when a child's life may depend on the reliability of the intravenous cannula as a route for the rapid administration of medications. Both scalp vein needles and plastic catheters should be changed every 48-72 hours.