Clinical Acceptability, Ease of Use of Closed-System Cannula among Nurses and Its Impact on Workflow Efficiency in Cardiac CTA: A Convergent Parallel Mixed-Method Study in a Tertiary Hospital in Saudi Arabia
DOI:
https://doi.org/10.64397/nepj.v02i01.2026.a38Keywords:
closed-system cannula, extravasation, cardiac computed tomography angiography, technology acceptance model, nurse perception, patient safetyAbstract
Introduction: Cardiac computed tomography angiography (CCTA) requires high-flow contrast injection, which necessitates reliable peripheral intravenous access. Conventional open cannulas are associated with extravasation and occupational exposure to blood. Closed-system fenestrated cannulas may mitigate these risks, yet evidence from nursing practice in CCTA settings remains limited.
Methods: A convergent parallel mixed-methods design was employed at a tertiary cardiac hospital in Riyadh, Saudi Arabia. Twenty-two CCTA nurses completed a validated 15-item survey based on the Technology Acceptance Model, measuring perceived clinical acceptability (10 items) and perceived ease of use (5 items) on 5-point Likert scales. The device evaluated was the B.Braun Introcan Safety® 22-gauge closed-system peripheral intravenous catheter with a fenestrated, multi-port tip and passive needlestick safety mechanism (B. Braun Melsungen AG, Melsungen, Germany). Extravasation data were extracted from hospital records for six months pre-implementation (July–December 2024; 1,030 scans) and six months post-implementation (January–June 2025; 1,171 scans) of the closed-system cannula. Fifteen nurses were purposively selected for semi-structured interviews; transcripts were analyzed using Braun and Clarke's thematic analysis framework.
Results: Median scores for clinical acceptability (5.00, IQR = 0.13) and ease of use (5.00, IQR = 0.10) were very high. Mean scores were 4.70 and 4.80, respectively. Years of experience significantly influenced clinical acceptability (p = .045); nurses with >10 years of experience reported higher scores than those with 1–3 years (adjusted p = .041). No demographic differences were observed for ease of use. Extravasation rates decreased from 3.39% (35/1,030) pre-implementation to 0.43% (5/1,171) post-implementation (p = .028). Qualitative analysis yielded three themes: enhanced patient and staff safety, improved patient comfort, and increased workflow efficiency.
Conclusion: CCTA nurses demonstrated strong acceptance of the closed-system cannula and rated it as highly usable. Implementation was associated with a significant reduction in extravasation, achieving levels within international benchmarks (0.1%–1.2%). Nurses perceived improvements in safety, comfort, and efficiency. These findings support routine adoption of closed-system cannulas for CCTA, although larger multi-centre studies are warranted.
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Copyright (c) 2026 Al-Mudhar Mustafa Emul, BSN, RN, Eddieson A. Pasay-an, PhD, RN (Author)
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