Effects of vapocoolant spray on skin sterility prior to intravenous cannulation

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Summary

Background

Alkane vapocoolant sprays evaporate rapidly, lower skin temperature and result in a temporary interruption in pain sensation. They reduce the pain of intravenous cannulation. However, concern exists that they may recontaminate the sterile cannulation site.

Aim

To determine the effects of vapocoolant spray on skin sterility prior to cannulation.

Methods

Fifty patients from the emergency department of a large tertiary metropolitan hospital were enrolled in this study. Bacterial skin swabs were taken from the dorsum of both hands of each patient. From one hand, a swab was taken following standard chlorhexidine disinfection, and a second swab was taken following the application of vapocoolant spray. From the other hand, a swab was taken from unprepared (non-disinfected) skin, and a second swab was taken following vapocoolant application. Skin swabs were sent for microbiological culture and quantitative comparison.

Findings

The administration of vapocoolant after skin disinfection did not increase the bacterial colony count significantly: median 0.0 [interquartile range (IQR) 0.0] vs 0.0 (IQR 0.0) (P = 0.71). The administration of vapocoolant to the unprepared skin decreased the colony count significantly: median 33.5 (IQR 68) vs 3.0 (IQR 11) (P < 0.001).

Conclusion

Alkane vapocoolant spray does not recontaminate the skin after disinfection, and should pose no increased risk of infection when used as an anaesthetic agent prior to intravenous cannulation following disinfection. While it does have inherent bactericidal activity, this is not sufficient for it to be used as the sole disinfectant.

Introduction

Intravenous (IV) cannulation is an invasive procedure in which a cannula is inserted into a vein to provide venous access.1 It is one of the most common procedures undertaken in the hospital setting.2 However, approximately one-half of patients report moderate pain and anxiety when no anaesthesia is administered.2, 3, 4 Much cannulation pain is avoidable with the administration of a local anaesthetic agent.3, 4, 5 A range of anaesthetic techniques have been compared, although none has proven to be superior in all outcome measures.2, 3, 4, 5 Accordingly, less than 20% of medical and surgical doctors use a local anaesthetic agent for the insertion of commonly used cannulae (20 gauge), and less than one-half use a local anaesthetic agent for the insertion of large-bore cannulae.6

Hijazi et al.5 reported that the administration of a topical alkane spray (vapocoolant), immediately prior to cannulation, reduces the pain of cannulation significantly. Page and Taylor7 compared vapocoolant spray with subcutaneous lignocaine. They reported that vapocoolant causes less administration pain, has reduced preparation and administration time, requires less technical skill, avoids the risk of needlestick injury, has greater cannulation success and is more cost-effective.7 They concluded that vapocoolant is, arguably, the superior agent.

There are anecdotal reports that a spray film dressing, when applied to sterile wounds following cardiac surgery, is associated with increased incidence of wound infection (L. Grayson, personal communication, 2014). It is thought that bacteria are transmitted from the spray nozzle directly to the wound. There are concerns, therefore, that spray applications such as vapocoolant may contaminate the sterile cannulation site, thereby increasing the risk of local and systemic infection. The present authors hypothesized that, given the very cold skin temperatures induced by vapocoolant, contamination is unlikely, and that vapocoolant may, in fact, have bactericidal properties of its own. These hypotheses were explored by comparing bacterial colony counts from the skin of patients who had been prepared for cannulation in a variety of ways. The findings will better inform clinicians as to the safety of vapocoolant in regard to the potential for infection.

Section snippets

Methods

A single-blinded, controlled experimental study was undertaken in the emergency department (ED) of a large tertiary metropolitan hospital between February 2014 and April 2014. Patients served as their own controls with four skin swabs taken from each patient. The study was approved by the Institutional Human Research Ethics Committee, and all patients provided informed written consent to participate.

Patients were eligible for inclusion if they were relatively well with uncomplicated

Results

Of the 66 patients who were deemed eligible to participate in the study, 16 declined to participate. Those who declined did not differ from those who participated in terms of sex (69% vs 56% male, respectively, P = 0.54) or mean age {50 [standard deviation (SD) 17.7] vs 41 (SD 14.8) years, respectively, P = 0.07}.

In Part 1 of the study, no significant difference in cfu count was found following administration of vapocoolant spray on to the disinfected dorsum hand (Table I). In four Part 1

Discussion

As many as 80% of patients will have a peripheral IV cannula inserted at some stage during their hospital admission.10 It has been reported that infection following cannulation is a major contributor to a patient's morbidity and mortality, hospital length of stay and hospital cost.11 The most common route of infection for peripherally inserted, short-term cannulae is through the migration of skin organisms at the cannulation insertion site passing into the cannulation tract with colonization of

Conclusion

Alkane vapocoolant spray does not contaminate the skin with bacteria after disinfection. It should not, therefore, pose an increased risk of infection when used as the anaesthetic agent prior to IV cannulation following disinfection. While alkane vapocoolant does have a considerable inherent bactericidal effect on skin flora, this is not sufficient for it to replace standard disinfection with chlorhexidine/alcohol preparations prior to cannulation.

Conflict of interest statement

None declared.

Funding sources

None.

References (14)

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Cited by (7)

  • Prospective, double blind, randomized, controlled trial comparing vapocoolant spray versus placebo spray in adults undergoing intravenous cannulation

    2017, Scandinavian Journal of Pain
    Citation Excerpt :

    This prospective, double-blind, randomized, placebo-controlled trial demonstrated a significant decrease in the acute pain of PIV cannulation in adult ED patients after application of topical vapocoolant spray (1,1,1,3,3-pentafluoropropane and 1,1,1,2-tetrafluoroethane) compared with placebo spray and safety with no visible skin abnormalities 5–10 min after spray application. Other studies have considered the issue of skin sterility with application of a vapocoolant spray and concluded there was no increased risk of infection when a topical vapocoolant spray was used [25,26]. The analgesic effect of vapocoolants is thought to be via rapid cooling [27] by decreasing “both initiation and conduction impulses in surrounding (peripheral) sensory nerve”, thereby interrupting the nocioceptive input into the spinal cord and raising the pain threshold [28].

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