A Study of Necessity for Reusable Equipment in
Medical Schools Using Exploratory Design
Presented to
Dr. Ahmad Zargari
Morehead State University
April 29, 2013
________________________________________________________________________
in partial fulfillment
of the requirements
for the course
IET – 698: Research Methods in Technology
________________________________________________________________________
Presented by
Travis Fisher
Contents
Chapter I: General Area of Concern ............................................................................................................. 2
Introduction ............................................................................................................................................... 2
Problem Statement .................................................................................................................................... 2
Significance of the Study .......................................................................................................................... 3
Assumptions.............................................................................................................................................. 5
Limitations ................................................................................................................................................ 5
Definitions and Terms............................................................................................................................... 6
Chapter II: Review of Literature ................................................................................................................... 7
Background Information ........................................................................................................................... 7
Historical Review...................................................................................................................................... 8
Advantages/Disadvantages ....................................................................................................................... 9
Chapter III: Methodology ............................................................................................................................. 9
Research Design........................................................................................................................................ 9
Instrument Used ........................................................................................................................................ 9
Survey/Questionnaire .............................................................................................................................. 10
Population of the Study / Sample............................................................................................................ 10
Data Collection Methods ........................................................................................................................ 10
Data Analysis .......................................................................................................................................... 10
Chapter IV: Findings and Analysis ............................................................................................................. 11
Chapter V: Recommendations and Conclusions ......................................................................................... 12
Bibliography ............................................................................................................................................... 14
Appendices:................................................................................................................................................. 14
Figure 1: Activation of the IV Inserter (Vitality Medical, 2011). ..................................................................................3
Figure 2: Disposal of Medical Equipment Using Sharps Container (Animal Care and Use Program, 2011)................4
Figure 3: Survey Results .............................................................................................................................................. 11
Figure 4: Pie Chart representing the percentages of wasted equipment. ..................................................................... 12
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Chapter I: General Area of Concern
Introduction
Currently the nursing students at Morehead State University insert IV catheters into
practice manikin’s arms towards their research work for various courses in nursing and
preparatory medicine. Since there are no catheters made specifically for training purposes, the
syringes they use to insert the catheter is the BD Insyte Autoguard IV Catheter that features the
push button retracting needle and is the same IV Inserter used in the actual medical field. This
means that the syringes are retractable and can be used only once and are then meant to be
disposed of as per safety regulations.
Problem Statement
Medical schools everywhere are blatantly failing to utilize their equipment to its fullest
potential therefore they are inadvertently wasting time and money properly disposing of and
purchasing new catheters. Even a small issue pertaining to the unnecessary waste of fully
functioning equipment, if neglected long enough, will wreak havoc on an organizations finances.
The problem here is exactly that, a small problem that has gone unattended and is costing the
Morehead State Nursing Department thousands of dollars a year. Due to this leak in
organizational funds caused by unnecessary disposal of good equipment, Morehead State
University and medical schools everywhere are in need of a device that will allow them to safely
reuse catheter needles on manikins with the benefit of cutting back on cost and time.
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Significance of the Study
Medical students all around the world use practice manikins to study the different
techniques used for inserting IV catheters for various intravenous purposes. The problem being
investigated has nothing to do with the functionality of the IV inserter but of its reuse, which is
not recommended by the medical academic industry due to safety concerns and regulations. The
problem that these nursing departments are experiencing occurs after the catheter has been
inserted into the arm and the activation button has been pushed which causes the needle to retract
into the safety barrel as seen in Figure 1 below.
Figure 1: Activation of the IV Inserter (Vitality Medical, 2011).
Once the needle is retracted into the safety barrel it is then deemed unusable and ready for
disposal. This means that a needle that cost the department approximately $2.40 (BD, 2013) a
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piece can only be used one time per student before it must be thrown away. For real life
application, this disposal of the catheter needle after a solitary use is absolutely mandatory due to
health and safety precautions. But since the departments only use them on practice manikins,
sterility is of no major concern. This problem is financially significant to the Morehead State
University Nursing Department because not only is there a tremendous amount of departmental
funds being used on these needles that are not fully utilized, but there is yet another problem that
this misuse causes which pertains to the disposal of this equipment. When discarded these
needles must be placed into a sharps container as seen in Figure 2 below.
Figure 2: Disposal of Medical Equipment Using Sharps Container (Animal Care and Use Program, 2011).
Sharps Containers (also referred to as Sharps Disposal Containers, Medical Waste Disposal
Containers, Biomedical Waste Disposal Containers, etc.) are specially made containers used to
contain hazardous "piercing" instruments and reduce the chance of spreading infection. It is
standard practice in developed and even underdeveloped countries for used needles to be placed
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immediately into a sharps container after a single use, with only a few exceptions to the general
rule. Needles are dropped into the container without touching the outside of the container.
Needles should never be pushed or forced into the container, as damage to the container and/or
needlestick injuries may result. Proper use of a sharps container includes pick up by or delivery
to an approved "red bag" or medical waste treatment site. In addition to this pre-existing safety
measure, all U.S. medical and educational staff are federally required to be tested on their
knowledge of bloodborne pathogens (Sharps MD, 2011).
The nursing department at Morehead State uses a wall mount sharps container which
range in their prices anywhere from $19.95 - $199.00 (Sharps MD, 2011). Once these containers
are filled they must also be disposed of by a sharps certified waste management company whose
service is of an additional charge.
If there was a device that could reset these catheter needles, they could be used numerous
times therefore resulting in the department saving thousands of dollars annually. Also the
catheters that are used for practice in Morehead State University are the same ones used in most
universities globally so the worldwide savings are indefinite.
Assumptions
It is assumed that there is a dire need in almost all medical schools to address the
unnecessary waste of fully functional catheter needles and that for every time a student gets to
reuse that needle the department saves approximately $2.40.
Limitations
There are a few factors that limited this study. The most important limitation on this
study is that there is not a sufficient amount of existing work pertaining to this topic; therefore,
most of the information being presented here is an original research. Another limitation is that
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the sample of people being studied here is rather small, so to project any assumptions to a larger
population than just Morehead State University will be complicated without conducting a larger
study which would require much more time.
Definitions and Terms
Catheter: A hollow flexible tube for insertion into a body cavity, duct, or vessel to allow the
passage of fluids or distend a passageway (Free Dictionary, 2013).
Intravenous (IV): Within or administered into a vein.
A drug, nutrient solution, or other substance administered into a vein (Free Dictionary, 2013).
BD Insyte Autoguard: The unique push-button shielding mechanism releases the spring and
allows the needle and flash chamber to quickly retract into the safety barrel. The clinician
maintains control of the process by deciding when to active the push-button shielding
mechanism (BD, 2013).
Needle-stick Injury: A wound caused by accidental penetration of the skin by a needle.
Needlestick injuries can cause transmission of bloodborne pathogens (ToolingU, 2012).
Bloodborne Pathogens: A microorganism present in human blood and other bodily fluids that
can cause disease. Bloodborne pathogens include the hepatitis B virus, hepatitis C virus, and
human immunodeficiency syndrome (ToolingU, 2012).
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Chapter II: Review of Literature
Background Information
Intravenous injection and infusion began as early as 1670. However, Dr. Charles Gabriel
Pravaz of France and Dr. Alexander Wood of Scotland were the first to develop a syringe with a
needle fi ne enough to pierce the skin in 1853. The first hypodermic syringe had a hollow
pointed needle that was made of steel with a hard rubber “slide” hub. From that time forward,
needle development focused on improvements in fashioning the hollow metal cannula, research
into more suitable materials, and refinements in needle point and hub design (BD, 2004).
In 1897 Maxwell W. Becton and Fairleigh S. Dickinson form Becton, Dickinson and
Company (BD). It is believed that the company’s first sale was a luer all-glass syringe imported
from France, at a price of $2.50. BD acquired all the patent rights to the all glass syringe
developed by H. Wulfing Luer of Paris, France for $40. Prior to 1924 improvements in the allglass luer syringe include finger and thumb rests to provide a firmer grip and enable one-handed
injection and aspiration, stronger and better flanges to prevent rolling and give a better hold,
reinforcements to prevent breakage, and a holder to keep the plunger from falling out (BD,
2004).
In 1954 BD produced the first completely disposable syringe, made of glass, for use in a
large-scale field test of the polio vaccine developed by Dr. Jonas Salk. During the late 1950’s,
BD researchers also launched an all-out effort to find a more suitable material for the
manufacture of disposable products. Polypropylene was the answer. BD was the first to
introduce polypropylene syringes and pioneered the use of this material for medical products.
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The new material was inert, nonreactive and did not deteriorate. It was translucent enough that a
scale could be put on the barrel to show the amount of fluid within (BD, 2004).
In 1962 the company decided to go public to fund the mass production of disposable
medical devices, becoming the first syringe and needle manufacturer to make the huge transition
from tool and die mechanical engineering to expertise in the new fields of plastics, sterile
packaging, industrial applications of microbiology, process engineering on a large scale, and
quality assurance. This commitment by BD led to dramatic reductions in bloodborne infections
in hospitals that were associated with improper re-sterilization of reusable devices (BD, 2004).
In 1988 BD introduced the first syringe with a built-in feature to protect healthcare
workers from needlestick injuries. The 3cc BD Safety-Lok syringe was designed with a
protective shield that moves forward and locks in place, eliminating the need for contaminated
needle recapping (BD, 2004).
In 1995 BD introduced the BD Insyte Autoguard IV Catheter with push button retracting
needle. This product became the leading IV catheter used in the U.S., and the leading safety
catheter in the world (BD, 2004).
Since 2004 BD has been developing new technologies that include new “microneedle”
devices that incorporate ultra-tiny needles roughly the diameter of a human hair. In addition to
the potential of minimizing the pain of injection, these devices have the potential of enhancing
the therapeutic effectiveness of vaccines and other injectables. (BD, 2004)
Historical Review
There is not pertinent information to be found regarding the design and development of a
product for the reuse of catheter needles. The only other literature used were from technical
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articles solely explaining the equipment, terminology, and the procedures used in the medical
industry.
Advantages/Disadvantages
The results of this study will ultimately be beneficial to the medical schools that are
performing training exercises using these catheter needles. Once the study can provide an
approximation of how much money the nursing department at Morehead State is wasting by the
premature disposal of this equipment then the design and development of a device that can solve
this problem can begin.
Chapter III: Methodology
Research Design
This research is designed according to an exploratory approach. Although the problem is
clearly defined and there is limited secondary research such as literature and/or data to review,
this study; however, relies heavily on qualitative approaches such as informal discussions with
consumers and even more formal approaches through an in-depth interview. This type of
formulative research is necessary when the purpose of a study is to gain familiarity with a
particular phenomenon and because there is a need for flexibility in approaching the problem.
Instrument Used
The instrument used here to gather information in this study was an in-depth interview
with the Morehead State University Nursing Departments Simulation Specialist, Rebecca
Huffman. This interview included the use of a camera to record pictures and videos of the
needles being used first hand (Huffman, 2012). Along with the in-depth interview, of which this
9
study heavily relies on, a generalized questionnaire was given to anyone who has been involved
in or knows anyone who has been involved in the medical industry. The survey will contain
question types including yes or no and short answer.
Survey/Questionnaire
A copy of the survey used is available in the Appendices section.
Population of the Study / Sample
The population of this study will consist of participants that are most applicable to the
study being conducted. To take the survey the participants are required to at the very least know
someone personally who has been or is currently enrolled in Morehead State University’s
Nursing Department. The majority of the participants involved in this study are therefore local to
the Morehead area and were also students of the university.
Data Collection Methods
The most important information in this study was acquired via the in-depth interview
with the simulations specials of the nursing department. This is where the significance of the
study was realized and the decision to continue researching was made. The data in this study was
gathered by asking anyone relevant to the research being conducted to take the survey. Microsoft
Excel was utilized to assimilate the gathered data and create a basic pie-chart diagram to
represent the significant need of a solution to this problem.
Data Analysis
Once the surveys have been collected Microsoft Excel will be used to digest the data and
create a pie chart. The pie chart will be used to visually represent the distribution of the
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participant’s’ answers to the survey questions and also to prove that the misuse of the catheter
needles is a blatant and significant issue.
Chapter IV: Findings and Analysis
The survey results are represented in the table below:
Wasted Equipment in Medical Schools
Equipment
Total
Wasted
Needles
27
Wash Cloths
3
Gloves
6
Bed Sheets
4
Microscope Slides
14
Other Equipment
2
Figure 3: Survey Results
From this table it is clear to see that the needles are responsible for the majority of wasted
equipment. It must be understood that because the participants of this study were either (a)
involved in a medical school their selves or (b) knew someone personally who was involved in a
medical school and was therefore familiar with their field of study. Otherwise these numbers
would likely be much different, assuming the average lay person would not consider a needle
being disposed of as a waste but rather a necessity. In other words, the participants of this study
were aware that these needles were being used on manikin bodies so sterility was of no major
concern.
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Wasted Equipment In Medical
Schools
4%
Needles
Wash Cloths
25%
27, 48%
Gloves
Bed Sheets
7%
11%
Microscope slides
Other equipment
5%
Figure 4: Pie Chart representing the percentages of wasted equipment.
In Figure 4 above the pie chart shows just how large of an impact the wasted catheter
needles can potentially have on the nursing department. At 48% the needles are responsible for
nearly half of the departments day to day equipment use. Considering the fact that the
department is spending money on each individual needle along with the proper disposal
container and waste management service, it is easy to imagine that a solution is in order.
Chapter V: Recommendations and Conclusions
There is an outstanding opportunity for the Morehead State University Nursing
Department and even nursing schools all around the world to save an enormous amount of
money each year by reducing the amount of IV Inserter / Catheter Needles being unnecessarily
disposed of. For every single time they reuse a needle on the practice manikins they will
essentially save several dollars. Along with money the departments will inevitably save time and
be spared of the trouble of following the very systematic disposal procedures that can be quite
cumbersome.
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Time and money are two driving factors when it comes to any business or organization
but in this case that organization is university nursing department where the number one driving
factor is the value of education the students are receiving. The understanding of how to properly
insert a catheter into a patients arm might be an overlooked skill that is acquired by nurses but
nonetheless is a crucial part of their profession. Any mishaps here can result in a patient being
injured, so it is vital that these soon-to-be nurses get all the practice time inserting catheters into
manikin arms that they require. Students might not get all the practice they need to be
comfortable with this type of procedure if the department has to pay several dollars for every
single attempt. With a device that could provide a way to reuse these catheter needles the
Morehead State University Nursing Department would not only save time and money but also
the value of education received by the students would see improvement because they would have
the freedom to practice their trade comfortably and with no more financial constraints.
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Bibliography
Animal Care and Use Program. (2011). Retrieved 2013, from Duke University & Medical Center:
http://vetmed.duhs.duke.edu/Photos/sharps2.jpg
Sharps MD. (2011). Retrieved 2013, from Sharps Container, Sharps Disposal Resource:
http://www.sharpscontainers.org/
Vitality Medical. (2011). Retrieved from
http://www.google.com/imgres?q=bd+autoguard+insyte&um=1&sa=N&hl=en&biw=1920&bih=
878&tbm=isch&tbnid=fIRmQPbK2qA3rM:&imgrefurl=http://www.vitalitymedical.com/intraven
ous-shielded-catheter-infusion-sets-insyte-autoguard-by-bd-becton-dickinson.html&docid=uZNj
ToolingU. (2012). Retrieved from Safety Training - Bloodborne Pathogens:
http://www.toolingu.com/definition-850115-19841-needlestick-injury.html
BD. (2013). Retrieved from http://www.bd.com/infusion/products/ivcatheters/autoguard/iag.asp
Free Dictionary. (2013). Retrieved from http://www.thefreedictionary.com/catheter
BD. (2004). Syringe and Needle History. Franklin Lakes, New Jersey, US.
Huffman, R. (2012, January). Simulation Specialist. (T. Fisher, Interviewer)
Appendices:
Questionnaire
1. Have you ever attended medical school in the past or present?
Yes = 30
No = 0
2. Do you know of anyone who has attended medical school?
Yes = 30
No = 0
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3. Do you work in a medical industry where they do in house training of fundamental
medical procedures?
Yes = 30
No = 0
4. In the department you studied or trained in was there a significant amount of wasted
equipment?
a. If yes, then was that wasted material still functional at the point of disposal?
Needles = 27
Wash Clothes = 3
Gloves = 6
Bed Sheets = 4
Microscope slides = 14
Other equipment = 2
5. If yes to number 4, then mainly what kind of equipment was disposed of prematurely and
why?
a. Needles
6. What would be an alternative option to disposing of the equipment and how could it be
better utilized for further training purposes?
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