Japanese IV Clinic

First of all oxygen bars, then ice bars! Now we have IV clinics offering intravenous drips to stressed and exhausted workers.

A Tokyo clinic treats up to 50 run down businessmen a day. The intravenous drip costs as little as 2000 yen ($20). The cheapest option, a 10-minute drip contains saline solution and vitamins B6, B12 and C.

Jun Kodama, a rundown 37-year-old banker who visited the Tenteki10 clinic recently to treat a hangover with a 10-minute Green Pack, admitted that “it’s probably not sensible or healthy to rely on this sort of treatment too much”. Added Mr Kodama: “I think occasionally it’s OK if I really need to be working efficiently in my job.”

Click here to view the full article.

 

Vascular Access Meeting

The 4th St George’s Hospital Vascular Access Meeting has put out a call for abstract from medical and nursing teams. The meeting is planned for the 19th September 2008. The venue will be the Royal College of Surgeons, London, UK. The theme for the meeting will be ‘Vascular Access Care - Newer Surgical Techniques. Click here for further information.

The deadline for receipt of abstracts in August 18th, 2008.

The cost of attending the meeting is £70.00.

Further details from:

Emma Freund 

DirectLine: 07867906204 

Email: vascularaccess@wlgore.com

Smart infusion

Linda Murdoch and Victoria Cameron from St George’s hospital, London, UK have recently published a smart infusion technology article in the British Journal of Nursing.

Murdoch L.J. and Cameron V.L. (2008) Smart infusion technology: a minimum safety standard for intensive care? British Journal of Nursing. 17(10), p.630-636.

Abstract:

“There is overwhelming evidence that medication errors present a risk to patients. This risk is highest in the intensive care unit (ICU) setting and even greater when medications are administered via an infusion pump. Standard pumps will not alert for, or prevent, drug calculation, drug unit, button push, or multiple of ten errors when medication delivery data is inputted. However, the literature suggests that smart pumps programmed with hard (unchangeable) limits can significantly reduce drug errors at the point of administration. Staff at St George’s Hospital paediatric ICU wanted to implement an infusion pump system that would be immediately effective in reducing medication errors at the point of administration. This article presents an overview of the relevant literature together with clinical examples from the author’s’ ICU, which demonstrates their experiences with smart pumps. It is the authors’ firm belief that smart infusion technology sets a new minimum safety standard for intensive care” (Murdoch and Cameron 2008).

 

Drug calculations for nurses

Kerri Wright a Senior Lecturer at the University of Greenwich, London, UK has written a series of two articles describing the issue of drug calculations.

Wright K. (2008) Drug calculations part 1: a critique of the formula used by nurses. Nursing Standard. 22(36), p.40-42.

Abstract:

“The role of mathematics is integral to nursing practice, and careful and accurate calculations are important to help prevent medication errors. This two-part article examines different methods for solving drug calculation problems. The first part critiques the commonly taught nursing drug calculation formula. Part 2, to be published next week, explores a range of other methods that are used in practice to calculate drug dosages” (Wright 2008).

 

Wright K. (2008) Drug calculations part 2: alternative strategies to the formula. Nursing Standard. 22(37), p.42-44.

 

Abstract:

“Drug calculations are an essential skill for nurses. The clinical skill of performing a drug calculation has come under recent scrutiny, resulting in the development of essential skills clusters in which pre-registration nurses must be competent before qualifying (nursing and Midwifery Council 2007). The focus on drug calculation skills places renewed emphasis on how these skills are taught in higher education institutions and how they are learned by students theoretically and in clinical practice. Part 1 of this article (Wright 2008) examined the frequently cited drug formula as a method of calculating drug dosages, demonstrating the complex mathematical knowledge and skills required to use this method and the potential problems that reliance on this method could pose. Part 2 outlines other methods and straegies that can be used to calculate drug dosages, while keeping the calculation close to the clinical context” (Wright 2008).

 

Home IV therapy

Alison Cousins et al (2008) describe international experiences with home IV treatment for Fabry disease.

Cousins A., Lee P., Rorman D., Raas-Rothschild A., Banikazemi M., Waldek S. and Thompson L. (2008) Home-based infusion therapy for patients with Fabry disease. British Journal of Nursing. 17(10), p.53-57.

Abstract:

“Fabry disease is an inherited, progressive, life-threatening disease; therefore, lifelong therapy is needed. By replacing the deficient enzyme, disease progression may be delayed or halted, thereby avoiding serious complications. Hospital-based agalsidase therapy is generally perceived as inconvenient and home-based infusion therapy is greatly appreciated by patients, their families and healthcare professionals. Patients can get familiar with infusion therapy in a hospital setting and, if specific requirements are fulfilled, routine nurse-assisted infusion, or self-care at the patients home can be organized. A stable patient who tolerates the infusion and a suitable home environment are prerequisites for home therapy. The authors’ clinical experiences underscore the safety and practicality of home therapy. In addition to a major positive impact on the patient’s quality of life, home infusion therapy may reduces the constraints of hospital resources. This article reviews the collective experiences with agalsidase beta home infusion therapy and outlines how safe, patient-centred homecare can be organized. Home infusion therapy with Fabrazyme® should not be withheld from patients considered eligible according to the proposed criteria. Similar approaches to other enzyme therapies are also possible” (Cousins et al 2008).

Refeeding syndrome

Mary Ann Yantis and Robyn Velander have recently published an article that examines the issues of refeeding syndrome.

Yantis M.A. and Velander R. (2008) How to recognize and respond to refeeding syndrome. Nursing2008. 38(5), p.34-39.

 

Abstract:

“Severely malnourished patients can experience significant fluid shifts and electrolyte imbalances after aggressive nutritional is initiated. This potentially lethal disorder, known as refeeding syndrome (RFS), is usually associated with PN, but it can occur with enteral nutrition (EN), oral intake or dextrose-containing I.V. fluids.

Although information about RFS is available in nutrition journals, it isn’t widely discussed in general nursing literature. We’ll fill that gap with this article by discussing how to identify this dangerous complication and what to do about it” (Yantis and Velander 2008).

 

Heparin flushes

The use of heparin has suddenly come under the spotlight in the UK. However, the reason for this attention is different to previous concerns in countries such as the US.

“An independent report has recently been published reviewing the circumstances of four patient safety incidents where an anaesthetist mis-selected sodium heparin 25,000 units in 5 ml (Monoparin) instead of sodium heparin 50 units in 5 ml (Hepsal) and administered the more concentrated solution in unlabelled syringes to four children. Thankfully the four children only experienced some temporary bleeding and otherwise are not reported to have suffered longer term harm. However, the potential for serious harm was recognised by the hospital trust” (NPSA 2008).

The NPSA state:

• Organisations should review local policies to minimise the use of heparin flush solutions in all devices, including complex central venous or arterial catheters.  This should take into account the evidence reviewed by UK Medicines Information (UKMi) which confirms that heparin flushes should not normally be used to flush peripheral intravenous catheters.  
• All flush solutions should only be administered following a prescription or patient group direction.
• Local policy and procedures should be reviewed to ensure risk with heparin flush solutions is minimised.
• Healthcare organisations should ensure that all relevant staff are made aware of this guidance and revised policy.

The Rapid Response Report from the NPSA can be viewed here and further support information can be viewed here.

What is a PICC?

It is always helpful to have introductory type materials available that can begin to explain complex vascular access devices.

This particular article is aimed at the Emergency Responder, however anyone looking for a basic introductory description of central venous access devices will benefit from this article. The author, Marc A. Minkler, NREMT-P, CCEMT-P, is a paramedic/firefighter with the Portland (ME) Fire Department.

Marc explains “When confronted with a patient with a central venous access device (CVAD), many providers hesitate before using the device, due to concerns about misuse, infection and dislodgement. The reality is that providers’ familiarity with the various devices and techniques used to access patients can make their ability to provide complete ALS care much easier” (Minkler 2008).

Click here to view the full article.

You may also find our PICC patient information leaflet useful - click here.

Topical local anaesthesia review

Various topical local anaesthetics are commercially available. This randomized double-blind trial reviews two alternative products.

Arendts G., Stevens M. and Fry M. (2008) Topical anaesthesia and intravenous cannulation success in paediatric patients: a randomized double-blind trial. British Journal of Anaesthesia. 100(4), p.521-4.

Abstract:

“It is not known whether the choice of topical anaesthetic influences the likelihood of successful i.v. cannulation in the paediatric population. The null hypothesis of this study was that no difference exists in the initial success rate of cannulation between two commonly used topical anaesthetics. A randomized double-blind trial conducted on patients between the age of 12 months and 12 yr presenting to a tertiary hospital emergency department. Patients requiring cannulation were randomized to either 4% amethocaine gel (AnGEL) or 5% lidocaine and prilocaine in a 1:1 emulsion (EMLA). The primary endpoint was success of initial attempt at i.v. cannulation. One hundred and seventy-seven patients were analysed of 203 enrolled. The success rate of AnGEL (73/97, 75%) and EMLA (59/80, 74%) did not significantly differ (chi2(1) 0.05, P=0.82). No difference exists in the cannulation success rates between the two anaesthetics. The choice of topical anaesthetic in paediatric cannulation should be based on other factors such as cost, time to anaesthesia, efficacy of the agent, and adverse effect profile” (Arendts et al 2008).

Distraction ‘v’ pain during cannulation

This small inventive study illustrates the potentional of a novel approach to distraction during cannulation.

Agarwal A., Yadav G., Gupta D., Tandon M., Singh P.K. and Singh U. (2008) The role of a flash of light for attenuation of venous cannulation pain: a prospective, randomized, placebo-controlled study. Anesthesia & Analgesia. 106(3), p.814-6.

Abstract:

“Venous cannulation is often performed without any analgesia, even though pain experienced during this procedure is at times very distressing. Various pharmacological and nonpharmacological measures have been tried with variable results to minimize venous cannulation pain. We designed the present study to evaluate the efficacy of a flash of light on attenuating venous cannulation pain. Ninety adults (15-60 yr), ASA physical status I and II, of either sex, undergoing elective laparoscopic cholecystectomy, were included in this prospective and randomized study. Patients were divided into three groups of 30 each. Group I (control); Group II (distraction): photographed without a flash of light; and Group III (flash): photographed with a flash of light just before venous cannulation of a vein on the dorsum of the nondominant hand. Immediately after the photograph, venous cannulation was performed using an 18-gauge cannula. Two patients from each group could not be cannulated on their first attempt and were therefore dropped from subsequent analysis. The incidence of venous cannulation pain in the flash group was lower, i.e., 50% (14 of 28) when compared to 100% (28 of 28) observed in the other two study groups” (Agarwal et al 2008).

Reducing hemolyzed samples in ED

Hemolyzed samples from the emergency department are common place. This article demonstrates the sampling from IV catheters may increase the incidence of hemolysis.

Lowe G., Stike R., Pollack M., Bosley J., O’Brien P., Hake A., Landis G., Billings N., Gordon P., Manzella S. and Stover T. (2008) Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques. JEN: Journal of Emergency Nursing. 34(1), p.26-32.

Abstract:

“Re-collection of hemolyzed blood specimens delays patient care in overcrowded emergency departments. Our emergency department was unable to meet a benchmark of a 2% hemolysis rate for the collection of blood samples. Our hypothesis was that hemolysis rates of blood specimens differ dependent on the blood collection technique by venipuncture or intravenous catheter draw. A prospective, cross-over study of blood collection techniques in a 64,000 annual visit, community teaching hospital emergency department was conducted. Eleven experienced registered nurses with more than 2 years’ ED experience completed a standardized phlebotomy retraining session. Registered nurses were randomly assigned to collect samples via intravenous catheters or venipuncture. After nurses collected 70 samples, they then collected samples via the other method. A standardized data collection form was completed. Blood samples were processed and assessed for hemolysis using standard procedures by laboratory technicians who were blinded to the collection method. A total of 853 valid samples were collected; 355 samples (41.6%) were drawn via venipuncture and 498 samples (58.4%) were drawn through an intravenous catheter. Of these, 28 intravenous catheter samples (5.6%) were found to be hemolyzed, whereas only 1 venipuncture sample (0.3%) was hemolyzed. This finding was significant (x2 < 0.001). Experienced ED nurses can reduce the number of hemolyzed specimens by collecting via venipuncture instead of through intravenous catheters. This practice should be considered as standard of care in the ED setting” (Lowe et al 2008).

 

Medication safety and job satisfaction

Medication safety, nursing, job satisfaction and management go hand-in-hand.

Bowcutt M., Rosenkoetter M.M., Chernecky C.C., Wall J., Wynn D. and Serrano C (2008) Implementation of an intravenous medication infusion pump system: implications for nursing. Journal of Nursing Management. 16(20, p.188-97.

Abstract:

“To assess perceptions of nurses regarding the implementation of intravenous medication infusion system technology and its impact on nursing care, reporting of medication errors and job satisfaction. Medication errors are placing patients at high risk and creating an economic burden for hospitals and health care providers. Infusion pumps are available to decrease errors and promote safety. Survey of 1056 nurses in a tertiary care Magnet hospital, using the Infusion System Perception Scale. Response rate was 65.43%. Nurses perceived the system would enhance their ability to provide quality nursing care, reduce medication errors. Job satisfaction was related to higher ratings of the management team and nursing staff. Perceptions verified the pump was designed to promote safe nursing practices. It is important to consider relationships with job satisfaction, safe nursing practice and the importance of ratings of nursing staff and management teams when implementing infusion technology. Infusion pumps are perceived by nurses to enhance safe nursing practice. Results stress the importance of management teams in sociotechnological transformations and their impact on job satisfaction among nurses” (Bowcutt et al 2008).

 

Neonatal vascular access

Articles that report on neonatal vascular access are not commonplace. Therefore, we are pleased to draw your attention to this recent article.

Ramasethu J. (2008) Complications of vascular catheters in the neonatal intensive care unit. Clinics in Perinatology. 35(1), p.199-222.

Abstract:

“Insertion of an intravascular catheter is the most common invasive procedure in the neonatal ICU. With every passing decade, technological innovations in catheter materials and sizes have allowed vascular access in infants who are smaller and sicker for purposes of blood pressure monitoring, blood sampling, and infusion of intravenous fluids and medications. There is, however, growing recognition of potential risks to life and limb associated with the use of intravascular catheters. This article reviews complications of venous and arterial catheters in the neonatal ICU and discusses treatment approaches and methods to prevent such complications, based on current evidence” (Ramasethu 2008).

Impressive fall in needlestick injuries

These authors have demonstrated  an impressive fall in needlestick injuries with minimal cost outlay.

Whitby M., McLaws M.L. and Slater K (2008) Needlestick injuries in a major teaching hospital: the worthwhile effect of hospital-wide replacement of conventional hollow-bore needles. American Journal of Infection Control. 36(3), p.180-6.

Abstract:

“Needlestick injury (NSI) with hollow-bore needles remains a significant risk of bloodborne virus acquisition in health care workers. The impact on NSI rates after substantial replacement of conventional hollow-bore needles with the simultaneous introduction of safety-engineered devices (SEDs) including retractable syringes, needle-free intravenous (IV) systems, and safety winged butterfly needles was examined in an 800-bed Australian university hospital. NSIs were prospectively monitored for 2 years (2005-2006) after the introduction of SEDs and compared with prospectively collected preintervention NSI data (2000-2004). Preintervention hollow-bore NSI rates over 10 years persisted at a constant rate between 3.01 and 3.77 per 100 full-time equivalent employees (FTE) (P = .31). Rates for 2005 (1.93; 95% CI: 1.48-2.47 per 100 FTE) and 2006 (1.50; 95% CI: 1.11-1.97 per 100 FTE) were significantly lower than the average rate for the preintervention years (3.39; 95% CI: 2.7-4.24 per 100 FTE, P = .00004). This represents a fall of 49% (43.1%-55.7%) in hollow-bore NSI, contributed to by the virtual elimination of NSI related to accessing IV lines. More importantly, high-risk injuries were also reduced 57% by retractable syringe use with an overall budgetary increase of approximately US $90,000 per annum. Introduction of SEDs results in an impressive fall in NSI with minimal cost outlay” (Whitby et al 2008).

Vacancy - IV Therapy Practitioner

I have just read that Royal Manchester Children’s Hospital is advertising for a Band 6 (22.5 hours) IV Therapy Practitioner.

“Our team comprises of dedicated paediatric nurses working collaboratively within a friendly, dynamic department to deliver family-centered care that meets the individual needs of every child. And you will take their skills to the next level alongside RSCN or RN Child qualifications, you should bring a proven track record at Band 5 level and demonstrable ability to deliver teaching programmes to staff groups and families”.

For an informal chat please contact Anne Stanton, Tel: 0161 918 5525 or anne.stanton@cmmc.nhs.uk

HepC contamination - CDC full report

The Morbitity and Mortality Weekly Report (MMWR) from the CDC into “Acute Hepatitis C Virus Infections Attributed to Unsafe Injection Practices at an Endoscopy Clinic, Nevada, 2007″ has been published. The report is very thorough, it describes the investigation and highlights how the contamination may have occurred. Click here for the full report.

The CDC write “On January 2, 2008, the Nevada State Health Division (NSHD) contacted CDC concerning surveillance reports received by the Southern Nevada Health District (SNHD) regarding two persons recently diagnosed with acute hepatitis C. A third person with acute hepatitis C was reported the following day. This raised concerns about an outbreak because SNHD typically confirms four or fewer cases of acute hepatitis C per year. Initial inquiries found that all three persons with acute hepatitis C underwent procedures at the same endoscopy clinic (clinic A) within 35–90 days of illness onset. A joint investigation by SNHD, NSHD, and CDC was initiated on January 9, 2008. The epidemiologic and laboratory investigation revealed that hepatitis C virus (HCV) transmission likely resulted from reuse of syringes on individual patients and use of single-use medication vials on multiple patients at the clinic. Health officials advised clinic A to stop unsafe injection practices immediately, and approximately 40,000 patients of the clinic were notified about their potential risk for exposure to HCV and other bloodborne pathogens. This report focuses on the six cases of acute hepatitis C identified during the initial investigation, which is ongoing; additional cases of acute hepatitis C associated with exposures at clinic A might be identified. Comprehensive measures involving viral hepatitis surveillance, health-care provider education, public awareness, professional oversight, licensing, and improvements in medical devices can help detect and prevent transmission of HCV and other bloodborne pathogens in health-care settings”.

Click here for the full report.

Last chance - free study day

Last chance to attend the Epic2 & Saving Lives Implementation Study Day.

London 2nd June SOLD OUT

Bristol 3rd June Few free tickets remain

Birmingham 4th June SOLD OUT

Manchester 5th June SOLD OUT

A free study day aimed at helping your Trust implement national guidelines in preventing infections and to help save even more patients’ lives.

This national programme in June has been jointly developed by the Infection Prevention Society (IPS) and the EPIC2 authors/Thames Valley University.  A faculty of experts in their field has been assembled to lead the delivery of each study day.  It is free to all healthcare workers.

To register free visit www.fitwisereg.com or complete the application form.

Spaces are limited to 150 per venue.

 

Photosensitivity with Cipro

Medscape has recently reported that “The US Food and Drug Administration (FDA) has approved safety labeling revisions to advise of the risks for photosensitivity and phototoxicity in patients receiving treatment with quinolone antibiotics such as ciprofloxacin, updated information regarding the risk for cardiomyopathy in patients receiving trastuzumab therapy, and the potential for developing Clostridium difficile–associated diarrhea more than 2 months after completion of antimicrobial therapy”.

CME credits are available for this subject through the Medscape website.

CDC report on hepatitis cases

The New York times reports that “Health care workers at a Las Vegas endoscopy clinic linked to more than 80 cases of hepatitis C routinely mishandled injection equipment and medication vials and often failed to perform basic hand hygiene, according to a report from the Centers for Disease Control and Prevention released Friday”.

The article also explains the cause of the contamination “Officials noted that IV stoppers were sometimes not properly wiped, that syringes and vials were reused and disinfectant cleaning baths for equipment were used for two endoscopic procedures rather than one as recommended. Health officials believe the hepatitis was spread by the clinic’s reuse of anesthesia syringes among patients”.

Postoperative pain in children

NEW YORK (Reuters Health) write - Postoperative pain in children with cancer can be safely managed with simultaneous epidural and intravenous opioids, according to researchers at St. Jude Children’s Research Hospital in Memphis, Tennessee.

Anghelescu D.L., Ross C.E., Oakes L.L. and Burgoyne L.L. (2008) The Safety of Concurrent Administration of Opioids via Epidural and Intravenous Routes for Postoperative Pain in Pediatric Oncology Patients. Journal of pain and symptom management. 35(4), p.412-419.

Abstract

“Supplementation of epidural opioid analgesia with intravenous opioids is usually avoided because of concern about respiratory depression. However, the choice of adjunct analgesic agents for pediatric oncology patients is limited. Antipyretic drugs may mask fever in neutropenic patients, and nonsteroidal anti-inflammatory agents may exert antiplatelet effects and interact with chemotherapeutic agents. We examined the safety of concurrent use of epidural and intravenous opioids in a consecutive series of 117 epidural infusions in pediatric patients and compared our findings to those reported by other investigators. We observed a 0.85% rate of clinically significant respiratory complications. The single adverse event was associated with an error in dosage. In our experience, the supplementation of epidural opioid analgesia with intravenous opioids has been a safe method of postoperative pain control for pediatric patients with cancer” (Anghelescu et al 2008).

 

Journal of Infusion Nursing

The May 2008 edition of the The Journal of Infusion Nursing has been published. The content of this edition includes:

Hall G. and Esser E. (2008) Challenges of care for the patient with acute kidney injury. Journal of Infusion Nursing. 31(3), p.150-156.

Abstract

“Acute kidney injury (AKI) can be a devastating problem for hospitalized patients. Whether it is acute or chronic renal failure, or a result of prerenal, postrenal, or intrarenal causes, AKI greatly increases mortality as well as inpatient cost. This article provides an overview of AKI, along with specific information to arm the infusion nurse to optimise patient care for the long term” (Hall and Esser 2008).

 

Hertzog D.R. and Waybill P.N. (2008) Complications and controversies associated with PICCs. Journal of Infusion Nursing. 31(3), p.159-163.

Abstract

“The placement of peripherally inserted central catheters has grown into one of the most common forms of intravenous access. Although complications associated with peripherally inserted central catheters are low, most healthcare providors will encounter them on a frequent basis. Awareness of these complications will help the clinician manage these issues appropriately” (Hertzog and Waybill 2008).

 

Nichols I. and Humphrey J.P. (2008) Effiency of upper arm placement of PICCs using bedside ultrasound and microintroducer technique. Journal of Infusion Nursing. 31(3), p.165-176.

Abstract

“In one hospital in southern Georgia, the review and analysis of 500 peripherally inserted central catheter procedural attempts by designated, speciality nurses using microintroducer technique and ultrasound guidance revealed an overall catheter placement success rate of 94.6%. this research analysis also provided information on the disposition of those 6-French dual-lumen and triple-lumen, power injectable peripherally inserted central catheters actually placed in situ on subjects who remained hospitalized or within the hospital’s rehabilitation facility. Of the 422 catheters removed, none exhibited signs or symptoms of mechanical phlebitis, and one tested positive per laboratory analysis for organisms confirming infection” (Nichols and Humphrey 2008).

 

Tripathi S., Kaushik V. and Singh V. (2008) Peripheral IVs: Factors affecting complications and patency – a randomized controlled trial. Journal of Infusion Nursing. 31(3), p.182-188.

Abstract

“Peripheral intravenous access is a common but stressful pediatric procedure. Though in use for some decades now, there is no consensus on factors affecting the duration of patency and complications. The present study is a randomized controlled trial covering all aspects associated with vascular access. This prospective interventional study was conducted over a period of 6 months in a general pediatric ward of Lady Hardinge Medical College and Associated Kalawati Saran Children’s Hospital. This sample was composed of 88 patients, from neonates to 12-year-olds who were admitted to the pediatric ward, on whom a total 377 catheters were started. Intravenous cannulations were randomized for heparin flushes (1:100 dilution) and splints. Prospective data were collected regarding duration of patency and complications. Both univariate and multivariate analysis were done. There was a statistically significant increase in the duration of patency with the use of heparin flushes. Shorter patency duration and increased complications were associated with younger age, wrist and scalp insertions, and 24-gauge catheters.

 

Improving patient safety

Simon Keady and Meera Thacker offer an insight into the rationale and steps being taken in response to recent NPSA alerts.

Reference

Keady S. and Thacker M. (2008) National Patient Safety Agency: Improving patient safety across all critical care areas. Intensive and Critical Care Nursing. 24, p.137-140.

“The National Patient Safety Agency (NPSA) reviews patient safety incidents throughout the National Health Service (NHS) in the United Kingdom and aims to initiate preventative measures. Recent alerts include injectable medication, oral syringes for enteral administration, preventing hyponatraemia in children and anticoagulation. This article gives an insight into the rationale and steps currently being undertaken to respond to these recommendations” (Keady and Thacker 2008).

Arterial blood gas analysis

Jacqueline Coggon a clinical educator at King’s Mill Hospital, UK has published an article on understanding ABG reports.

Reference

Coggon J.M. (2008) Arterial blood gas analysis 1: Understanding ABG reports. Nursing Times. 104(18), p.28-29.

“This is the first of a two-part unit on arterial blood gas (ABG) analysis, and focusses on background information and basic interpretation of ABGs where no evident compensation is taking place. It discusses the various components on a ABG report, the normal ranges and the significance of abnormal readings. A detailed step-by-step guide to ABG interpretation is available in the Portfolio Pages for this unit at nursingtimes.net, as well as practice examples” (Coggon 2008).

Umbilical cord blood

Collection of cord blood at birth will be regulated for the first time in the UK under new rules announced by the Human Tissue Authority (HTA) to ensure safety and traceability.

The trend of collecting cord blood in public or private banks for potential medical applications, including the treatment of leukaemia, has grown more popular in recent years. The new rules, announced today, will mean that from 5 July 2008 cord blood can only be collected by people with specialist training and on premises that meet essential standards.

All maternity units that collect cord blood will need to act under a Human Tissue Authority (HTA) licence that will ensure:

• Staff have training in collecting cord blood, raising standards and making sure that best possible quality of sample is taken.
• Procedures which will help prevent any medical attention being drawn away from mother or child during collection.
• A system is in place to make sure that the cord blood cells are traceable from collection to their use in treatments.

Award for training simulator

Dr David Kessel and team from Leeds, UK have come second in its category at the NHS National Technology awards in London. “The simulator uses virtual reality technology to train people in the skill of ultrasound-guided needle insertion”. Click here for the full story.

JVAD spring 2008

The spring edition of the The Journal of the Association of Vascular Access has been published. The content of this edition includes:

Dawson R.B. (2008) Nursing Beyond the “Process”: Collegiality and Consultation Improves Outcomes by Protecting the ftissue Integrity of PICC Insertions Sites. The Journal of the Association of Vascular Access. 13(1), p.8.

Abstract

“On a daily basis vascular access nurses are presented with complex patient care issues involving intravenous therapy. The nursing process as an instrument to organize nursing care is valuable; however, is it enough to positively affect patient outcomes? Nursing beyond the fundamental process requires the intent to advocate and protect the patient from unnecessary risk or harm. A patient with impaired tissue integrity from epidermolysis bullosa required a nurse specialist whose practice included advocacy, collegiality and consultation in order to protect a PICC insertion site and prevent complications. The intervention included the use of a soft silicone contact layer (Mepitel) and a transparent semi-permiable membrane dressing (Tegaderm). A new clinical process was born from the collaboration of two nursing professionals and it positively impacted patient outcomes. This is a professional approach to nursing care that is under utilized” (Dawson 2008).

 

Olson C. and Heilman J.M. (2008) Clincal Performance of a New Transparent Chlorhexidine Gluconate Central Venous Catheter Dressing. The Journal of the Association of Vascular Access. 13(1), p.13.

Absract

“As the sciences of vascular access and infection prevention rapidly advance healthcare professionals are often faced with new technologies designed to help, but which are often so complicated to use that they cause unforeseen problems. As a vascular access team at a major mid-western hospital, we evaluated the ease-of-use and the performance characteristics of a new transparent catheter dressing, 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) containing the antimicrobial chlorhexidine gluconate (CHG), with a variety of central venous catheters insertion sites in comparison to a standard non-antimicrobial dressing Tegaderm (3M Health Care, St. Paul, MN). Following IRB approval, sixty-three consenting patients were enrolled and randomized; 33 in the CHG antimicrobial dressing group and 30 in the standard dressing group. Thirty six patients had peripherally inserted central catheters (PICCs), 20 had intrajugular insertions (IJ), and 7 had subclavian insertions. The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was evaluated for its ability to permit visualization of the insertion site, ease of use, ease of using correctly, ability to secure the catheter and absorb exudates and remain transparent.

The new 3M Tegaderm CHG IV Securement Dressing (3M Health Care, St. Paul, MN) was found to be as easy to use in central venous catheter care clinical practice as the standard of care non-antimicrobial transparent adhesive dressing. No additional training or education was needed to properly use it. This dressing was applied and removed like standard transparent adhesive dressings, but offered many advantages over standard dressings. Advantages include that it is antimicrobial, handles moderate bleeding, remains transparent and appears to offer greater catheter securement than the Tegaderm (3M Health Care, St. Paul, MN) standard dressing. The CHG gel pad also conformed well to the catheter” (Olsen and Heilman 2008).

 

Daniels L.S. and Gouvas M.O. (2008) Effects of INR Levels on Bleeding Occurrances During the First 24-hours of Ultrasound Guided PICC Line Insertions. The Journal of the Association of Vascular Access. 13(1), p.22.

Abstract

“A sample of 127 patients with an International Normalized Ratio (INR) of 1.5 or greater, undergoing a Peripherally Inserted Central Catheter (PICC) insertion, were observed for bleeding at the time of insertion and for 24 hours post insertion. Over 60% of patients experienced no or mild bleeding at insertion. For an INR less than 3.0, fewer than 10% of the sample experienced moderate bleeding within the first 24 hours. No PICCs were discontinued due to bleeding. Results suggest that INR levels below 3.0 did not appear to have an impact on amount of bleeding during PICC insertion. After 24 hours, INR levels of 3.0 and above did appear to have an impact on the amount of bleeding” (Daniels and Gouvas 2008).

 

A. Scocca A., Gioia A. and Poli P. (2008) Initial Experience of a Nurse-Implemented Peripherally Inserted Central Catheter Program in Italy. Journal of the Association of Vascular Access. 13(1), p.27.

Abstract

“In Italy prior to 2006 central venous catheters were inserted only by anaesthesiologists. Nurses were excluded based on professional profile. In 2005 the nursing staff of the Pain Therapy and Palliative Care Unit (PTPCU) at Santa Chiara Hospital in Pisa, proposed that nurses be permitted to insert Peripherally Inserted Central Catheters (PICCs). The recommendation was submitted to the Italian National Board of Nurses with a request to implement a training program. The Board approved the proposal in January 2006. Initially the PTPCU nursing staff had PICC training programs through the St. Chiara Hospital Vocational Training Office. The program was initially implemented by a nurse volunteer who had critical care training, intravenous therapy experience and who demonstrated competence with PICC placement based on training by PTPCU interventional anaesthesiologists. To date, nearly 250 successful PICC placements have been performed using the Modified Seldinger TEchnique (MST) in conjunction with ultrasound guidance. Physicians and nurses identified potential candidates and the patients were assessed by the PICC nurse. The combination of PICC/MST was found to facilitate placement in patients with impalpable vessels and above the antecubital fossa as well as improve freedom of movement and reduce the likelihood of patients accidently dislodging the device. The primary reasons for PICC placement included antibiotic or antiviral therapy (26%), total parenteral nutrition administration (35%) and chemotherapy (39%). There were 211 catheters exclusively for inpatients and 39 catheters exclusively for outpatients. The PICC program resulted in an excellent safety profile, a high success rate, and few post-procedural complications. It was a less costly option compared to centrally inserted, tunnelled, or implanted central vascular access devices; it improved the quality of the nursing care and decreased patients’ waiting time for vascular access placement” (Scocca et al 2008).

 

Verhey P.T., Gosselin M.V., Primack S.L., Blackburn P.L. and Kraemer A.C. (2008) The Right Mediastinal Border and Central Venous Anatomy of Frontal Chest Radiograph - Direct CT Correlation. Journal of the Association of Vascular Access. 13(1), p.32.

Abstract

“We describe a direct and accurate method for defining chest radiographic anatomy and use this method to delineate the anatomic composition of the right mediastinal border in an adult population. Intravenous contrast-enhanced computed tomographic scans of the chest and accompanying scout tomograms from 99 adults without previously known or detected cardiopulmonary disease that could potentially distort mediastinal, cardiac, or pulmonary anatomy were retrospectively evaluated. Transverse CT images through the mediastinum were directly referenced to the respective acquisition location on the scout tomogram via the acquisition reference line. The anatomic composition of the right mediastinal border on the scout tomogram was determined by drawing a vertical line tangential to the most lateral right mediastinal structure in each transverse CT image. The lengths and relationships of these structures were tabulated. These results will help to create a consensus among radiologists and other clinicians regarding radiographic anatomy, allowing improved localization of mediastinal pathology and enabling more optimal positioning of vascular and cardiac support services” (Verhey et al 2008).

Infection control survey

The RCN are seeking views on infection control. The RCN are developing a robust strategy for infection prevention and control. When you complete the online survey remember to add www.ivteam.com to your response for question 17

Click here to complete the online survey from the RCN.

Prescription only cannulae

It has been reported by an NHS hospital that enforcing stricter requests for cannulation has dramatically reduced the incidence of MRSA bacteraemias. The Winchester and Eastleigh Healthcare NHS Trust have started to have cannula insertions ‘prescribed’, in addition they ensure cannula sites are checked at least daily using a scorecard system.

“Winchester and Eastleigh Healthcare NHS Trust has reduced its rates of MRSA bacteraemia infection to zero after introducing a simple prescription technique which could have dramatic effects on infection rates if introduced across the NHS” statement from Louise Halfpenny. Click here for the full story.

Techniques for declotting VAD’s

On the third day of the 35th INS conference in Phoenix, Arizona, Jennifer Estela-Stollwerk, BSN, CRNI provided us with an extensive overview of techniques used for the declotting of venous devices. Jennifer described how 42% of catheter occlusions may be attributed to non-thrombotic events such as lipid deposits. The remaining 58% are described as thrombotic.

Jennifer described the use of ethanol, hydrochloric acid and sodium bicarbonate in the treatment of a variety of non-thrombolytic occlusions.

For the treatment of thrombolytic occlusions, Jennifer describes both treatment with medication and mechanical methods of declotting.

We would like to thank Smith & Nephew Healthcare Ltd for their support which has allowed IVTEAM to attend this grand event.

CathRite at INS

During our time at the 35th INS conference in Phoenix, Arizona we have viewed many products at the industrial exhibition. However, one product stood out from the rest. This product was innovative, easy to use and appears to have been designed with both patient and clinician needs in mind.

As we know, ensuring accurate PICC tip location is an essential element of safe PICC placement. Too short and the patient is at a greater risk of thrombus formation. Too long, issues such as arrhythmia’s may develop. Also, during placement, the PICC may not ‘travel’ along the route that you expect. This may result in PICC tip locations that are unsuitable, such as jugular or azygous vein tip location.

In the past, we have relied upon radiographic type imaging to determine tip location, either during or after PICC placement… excerpts from the Micronix website illustrate the benefits of this device… the frontal and lateral views in the demonstration appeared to be particularly useful!

“This real-time schematic representation of the placement procedure provides a continuous display of the passage and position of the tip of the catheter in relation to anatomical landmarks. The ‘live tracking’ display shows frontal and lateral views simultaneously, enabling medical practitioners to make real-time adjustments of catheter tip positions during placement, and eliminating the need for X-rays. The Technology improves patient care by enabling prompt delivery of vital medication. The Technology is simple, intuitive and inexpensive.”

“Every CVC placement performed using CathRite™ uses a disposable kit, consisting of a catheter, a guiding insert and other low value ancillary items. The RU (placed on the patient’s chest) receives the low-energy electromagnetic signal that is generated by the guiding insert. The MU processes the EMF signal and displays (in real-time) the movement of the catheter as placement occurs. The record of placement is printed out for inclusion into the patient’s case notes. When the placement is completed, the guiding insert is removed from the catheter and discarded”

We look forward to seeing this product in clinical use.

 

Marcia Ryder on biofilm

Marcia Ryder PhD, MS, RN began her session at the 35th INS conference in Phoenix, Arizona with a stark reminder. She told the assemble audience that during her one hour presentation something in the region of 30 people will die in the US of a healthcare associated infection (HCAI)!

The audience are then informed of another stark reality associated with IV’s and the treatment of infection. Bacteria organise themselves into a cooperative community. This bacterial community is held together with biofilm.

Marcia held the attention of her audience for the full hour. The presentation included many informative messages, the two messages that I would like to share is that ‘…all HCAI’s are are a biofilm disease’ and ‘…health care professionals need to re-think the basic things that we do’. Finally, Marcia reminded us that 100 trillion bacteria reside on our skin!

To read more about Marcia’s work on biofilm we recommend that you read the following article… Ryder M.A. (2005) Catheter-related infections: It’s all about biofilm. Topics in Advanced Practice Nursing eJournal. 5(3), posted 18/08/2005.

We would like to thank Smith & Nephew Healthcare Ltd for their support which has allowed IVTEAM to attend this grand event.

 

INS 2008 kicks off in style

The 35th INS conference in Phoenix, Arizona commenced in style this morning at 8am with a keynote address from Tom Hayes who left the audience with tears in their eyes. Tom brought humour to the proceedings whilst delivering his message of live, love, laugh and learn.

This was followed by the first general session ‘models of care for vascular access teams’. 

The exhibition is supported by approximately one hundred companies, covering every aspect of IV therapy. products debuting at the conference include the new Chlorhexidine impregnated dressing from 3M and Baxter’s ‘V link silver impregnated IV connector’

We would like to thank Smith & Nephew Healthcare Ltd for their support which has allowed IVTEAM to attend this grand event.