Intravenous therapy misconnections

The FDA have issued a special edition of ‘Patient Safety News’, they are repeating a number of reports as Read more

Insulin safety concerns

The FDA have issued a special edition of ‘Patient Safety News’, they are repeating a number of reports as they are some of the most important safety issues that continue to pose a public health concern.

The Institute for Safe Medication Practices (ISMP) recently described an increase in reports about mixups between insulin U-100 and insulin U-500. These errors could result in dangerous hyperglycemia or hypoglycemia. Mistakes have occurred when prescribers accidentally selected U-500 regular insulin from computer screens instead of U-100.

Click here for the full Patient Safety News item.

 

 

Prescribing blood by nurses

The RCN Blood Transfusion Nursing Forum have reported on the prescription of blood by nurses. The report Read more

BBraun sign IV therapy agreement

BBraun has signed a contract with Premier Purchasing Partners. Under the agreement, which will go into effect on February 1, 2009, Premier’s members, a network of approximately 2,000 hospitals and 53,000 healthcare facilities, will have access to BBraun’s portfolio of intravenous therapy products and solutions. This will include large-volume, PCA and syringe pumps and sets, IV tubing and extension sets, drug delivery systems, nutritional products, pre-mixed drugs and safety IV catheters.

Caroll Neubauer, chairman and CEO of B Braun Medical, said: “Through relationships with organizations such as Premier’s as well as automation and expansion of our manufacturing facilities, we’ve proven that we have the capabilities to not only handle a large capacity of orders, but to do so in the most efficient way possible.”

Click here for the full story.

 

Parenteral nutrition study day

Fresenius Kabi have announced the date for the 2008 Parenteral Nutrition Study Day - The Birth of a New Read more

Free HCAI technology events

Smart Solutions are offering free HCAI technology events during September 2008. At the events you will hear from a keynote speaker and have the opportunity to put your questions directly to a member of the Smart Solutions project team.

The Smart Solutions team will also be at the Infection Prevention Society annual conference at Harrogate International Conference Centre from 22-24 September. To arrange a meeting contact the team in advance on 0161 901 2697.

The free HCAI events are:

 

• Wednesday 3 September, 12-2pm - Biopark, Welwyn Garden City - Hosted by Health Enterprise East, contact Maggie Lewis on 01480 364925 for reservations.
• Thursday 4 September, 9.30am-1pm - Brooklands Hotel, j37 off M1, near Barnsley - Hosted by Medilink, contact Nikola Alevizos on 0114 222 6317 for reservations.
• Thursday 18 September, 9.30am-1pm - Liverpool Innovation Park, Edge Lane - Hosted by Medilink NW, contact Hayley Hall on 0161 901 2513 for reservations.

Click here for more information.

Smart solutions for HCAI

Smart Solutions is an NHS programme that aims to find the best products and technologies from across all industry sectors that could be used to fight healthcare associated infections (HCAIs).

Smart Solutions are looking for companies with a product or technology that could help prevent the spread of MRSA or similar infections? Smart Solutions will have your product assessed by a team of experts, with a view to evaluating it in a hospital setting and potentially supplying it across the NHS? They are also looking for hospitals which would like to take part in testing new infection control products?

Click here for the smartsolutionsforhcai.co.uk website.

Needlefree port protection

marketwatch.com reported that the Ivera Medical Corporation today announced an exclusive license agreement with BD, for the worldwide rights to selected BD-issued and pending patents for an intravenous port protector designed to reduce the potential for healthcare-acquired bloodstream infections.

“The licensing agreement between BD and Ivera broadens our existing patent applications and removes potential patent issues so we can move forward with the worldwide marketing and sales of the Curos Port Protector,” Jack Saladow, Ivera Vice President of Marketing and Sales said.

Click here for the full story.

Blood culture time to positivity

Time to blood culture positivity can assist in excluding a catheter-related blood stream infection as the source an infective episode. This article by Ben-Ami et al (2008) examines this issue in relation to Candidemia.

Ben-Ami, R., Weinberger, M., Orni-Wasserlauff, R., Schwartz, D., Itzhaki, A., Lazarovitch. T., Bash, E., Aharoni, Y., Moroz, I. and Giladi, M. (2008) Time to blood culture positivity as a marker for catheter-related candidemia. Journal of Clinical Microbiology. 46(7), p.2222-6.

Abstract: Candida spp. are important causes of nosocomial bloodstream infections. Around 80% of patients with candidemia have an indwelling central venous catheter (CVC). Determining whether the CVC is the source of candidemia has implications for patient management. We assessed whether the time to detection of Candida species in peripheral blood (time to positivity [TTP]) can serve as a marker for catheter-related candidemia. Prospective surveillance of Candida bloodstream infection was conducted in two medical centers. TTP was recorded by the BacT/Alert automated system. Sixty-four candidemia episodes were included. Fifty patients (78%) had an indwelling CVC. Thirteen patients (20.3%) had definite catheter-related candidemia. TTP was shorter for definite catheter-related candidemia (17.3 ± 2 h) than that for candidemia from other sources (38.2 ± 3 h; P < 0.001). A TTP cutoff of 30 h was 100% sensitive and 51.4% specific for catheter-related candidemia (area under the receiver-operator characteristic curve of 0.76). We conclude that TTP in peripheral blood is a sensitive but nonspecific marker for catheter-related candidemia and that a TTP of more than 30 h can help exclude an intravascular catheter as the possible source of candidemia.

Implanted peripheral arm ports

Kawamura et al (2008) suggest that implanted intravenous ports can be placed easily at peripheral sites and can be well maintained with minimal morbidity. They offer a good alternative to implanted chest ports.

Kawamura, J., Nagayama, N., Nomura, A., Itami, A., Okabe, H., Sato, S., Watanabe, G. and Sakai, Y. (2008) Long-term outcomes of peripheral arm ports implanted in patients with colorectal cancer. International Journal of Clinical Oncology. 13(4), p.349-354.

Abstract:

Background  Venous ports are mandatory for chemotherapy in cancer patients because prolonged infusions are required. The aim of this study was to assess the safety of peripheral arm ports for chemotherapy in patients with colorectal cancer.

Methods  A peripheral venous access port was placed in the upper arm in 113 consecutive patients with metastatic colorectal cancer (MCRC). All patients received modifi ed FOLFOX (5-fl uorouracil [5-FU]/l-leucovorin [LV]/oxaliplatin [L-OHP]) 6 or FOLFIRI (5-FU/LV/irinotecan hydrochloride [CPT-11]) regimens at least once via the venous access port. All patients were followed up at least once every 2 weeks.

Results  Puncture of the basilic veins was successfully completed under real-time sonographic guidance or radiographic guidance in all patients. The median operative time was 30 min. The cumulative follow-up period was 29 886 catheter days (range, 9–560 days; mean, 264 days). No procedural complications, such as pneumothorax, hemothorax, arterial puncture, or cardiovascular problems, occurred in our series. A total of nine patients (8.0%) had complications. Port-site infection occurred in six patients (5.3%; 0.20 infections per 1000 catheter-days). One patient (0.9%) had an episode of ultrasound-documented deep vein thrombosis in the ipsilateral upper extremity (0.03/1000 catheter-days). Dislocation or migration of the catheter tip occurred in two patients (0.07/1000 catheter-days). A second port was placed in six patients (5.3%) after removal of the fi rst port.

Conclusion  Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC.

Free preview - click here.

 

Internal jugular vein cannulation

Fujiki et al (2008) in the Surgery obesity journal examine the issue of right internal jugular vein cannulation in the morbidly obese patient.

Fujiki, M., guta, C.G., Lemmens, H.J. and Brock-Utne, J.G. (2008)  Is it More Difficult to Cannulate the Right Internal Jugular Vein in Morbidly Obese Patients than in Nonobese Patients? Obesity surgery. 18(9), p.1157-9. 

Abstract:

BACKGROUND: The placement of an internal jugular vein (IJV) catheter is considered to be more difficult in morbidly obese patients. The objective of this study was to compare the success of simulated IJV puncture between morbidly obese patients and a nonobese control group. METHODS: Thirty-four morbidly obese patients with body mass index (BMI, kg/m(2)) >/=40 were compared with 36 patients with BMI < 30. Right IJV puncture was simulated using an ultrasound probe directed towards the sternal notch at the midpoint between the sternal notch and the mastoid process. The investigator placing the probe was blinded as to the image being created on the ultrasound machine. Success rate was assessed at three different head rotation angles from midline; 0 degrees , 30 degrees , and 60 degrees . RESULTS: There was no statistically significant difference in successful simulated IJV puncture between two groups for any of the head positions. However, there was a higher incidence of the carotid artery (CA) puncture in the morbidly obese patient group when the head rotation was advanced from neutral position to 60 degrees (p < 0.05). In addition, the ultrasound showed significantly more overlapping of the IJV over the CA in morbidly obese patients at 0 degrees (p < 0.05) and 30 degrees (p < 0.05). Our results show no statistically significant difference in success rate of IJV puncture between morbidly obese patients and nonobese patients. Keeping the head in a neutral position in morbidly obese patients minimizes the overlapping of the IJV over the CA and the risk of CA puncture. CONCLUSION: However, due to the fact that even in the neutral position there is a significant increase in overlap between IJV and CA, we recommend the use of ultrasound guidance for IJV cannulation in obese patients.

 

Skin-tunnelled catheter care

Green (2008) reviews the care and management of patients with skin-tunnelled catheters; the article aims to make healthcare staff and patients aware of potential complications to enable early identification and treatment.

Green, J. (2008) Care and management of patients with skin-tunnelled catheters. Nursing Standard. 22(42), p.41-48.

Abstract:

Central venous access devices (CVADs) are used in secondary and, increasingly, primary care settings to provide access to the central circulation. Skin-tunnelled catheters (STCs) are frequently used as the vascular access device of choice, particularly for patients receiving chemotherapy and for those who require long-term access for repeated transfusions. Despite the increased use of STCs, practice varies between trusts and community teams. This article provides an overview of the care and management of patients with STCs.

CVC tip placement

Bansal et al (2008) highlight the impact of suboptimal central venous access device tip placement on the incidence of early catheter malfunction.

Bansal, A., Binkert, C.A., Robinson, M.K., Shulman, L.N., Pellerin, L. and Davison, B. (2008) Impact of Quality Management Monitoring and Intervention on Central Venous Catheter Dysfunction in the Outpatient Chemotherapy Infusion Setting. Journal of Vascular and Interventional Radiology. 19(8), p.1171-1175.

Abstract:

Purpose: To assess the utility of maintaining and analyzing a quality-management database while investigating a subjectively perceived increase in the incidence of tunneled catheter and port dysfunction in a cohort of oncology outpatients.

Materials and Methods: All 152 patients undergoing lytic therapy (2–4 mg alteplase) of a malfunctioning indwelling central venous catheter (CVC) from January through June 2004 at a single cancer center in the United States were included in a quality-management database. Patients were categorized by time to device failure and the initial method of catheter placement (surgery vs interventional radiology). Data were analyzed after 3 months, and areas of possible improvement were identified and acted upon. Three months of follow-up data were then collected and similarly analyzed.

Results: In a 6-month period, 152 patients treated for catheter malfunction received a total of 276 doses of lytic therapy. A 3-month interim analysis revealed a disproportionately high rate (34%) of early catheter malfunction (ECM; <30 days from placement). Postplacement radiographs demonstrated suboptimal catheter positioning in 67% of these patients, all of whom had surgical catheter placement. There was a 50% absolute decrease in the number of patients presenting with catheter malfunction in the period from April through June (P < .001). Evaluation of postplacement radiographs in these patients demonstrated a 50% decrease in the incidence of suboptimal positioning (P < .05).

Conclusions: Suboptimal positioning was likely responsible for some, but not all, cases of ECM. Maintenance of a quality-management database is a relatively simple intervention that can have a clear and important impact on the quality and cost of patient care.

Tunneled CVC insertion site care

Kerr et al (2008) suggest that a purse-string suture at the CVC tunnel exit site may reduce bleeding at the insertion site.

Kerr, A., Pathalapati, R., Qiuhu, S. and Baumstein, D. (2008) Purse-string Suture to Prevent Bleeding after Tunneled Dialysis Catheter Insertion. Journal of Vascular and Interventional Radiology. 19(8), p.1176-1179.

Abstract:

Purpose: To determine whether placing a purse-string suture at the tunnel exit site at the time of tunneled dialysis catheter (TDC) insertion will decrease postprocedural bleeding.

Materials and Methods: In a retrospective single-center, single-operator study, 51 patients in the control group had TDCs inserted without purse-string sutures at the tunnel exit site and 50 patients in the experimental group had TDCs inserted with purse-string sutures at the tunnel exit site. The patients’ charts were evaluated for postprocedural progress notes describing bleeding, plasma hemoglobin levels before and after catheter insertion, and transfusion of packed red blood cells in the first 5 days after catheter insertion.

Results: Thirteen patients in the control group (25.4%) and three patients in the experimental group (6%) had postprocedural chart notes describing bleeding. The difference between the two groups was highly significant (P = .0124). Six percent of patients in the control group and none of the patients in the experimental group required prolonged compression or compression dressing placement after catheter insertion. There was a significant mean hemoglobin decrease of 0.3 g/dL after catheter insertion in the control group and an insignificant mean hemoglobin decrease of 0.1 g/dL in the experimental group. The difference in hemoglobin decrease between the two groups was not significant. The difference in the number of patients requiring transfusion in the 5 days after catheter insertion (eight of 51 vs nine of 50) was not significant.

Conclusions: Venous bleeding after TDC insertion is a complication that merits attention. Routine purse-string suture placement at the tunnel exit site is a minor change in standard technique that can nearly eliminate this problem, as reflected in postprocedural chart notes.

Catheter exchange and air embolism

Kolbeck et al (2008) examine the issue of wire catheter exchange and the potential for air embolism, part of the process included clamping the catheter with the wire in place. We emphasize that clamping the catheter when a wire is inside the central venous access device may result in a wire embolism. However, the article adds to the body of literature that concerns the risk of air embolism.

Kolbeck, K.J., Stavropoulos, S.W. and Trerotola, S.O. (2008) Over-the-Wire Catheter Exchanges: Reduction of the Risk of Air Emboli. Journal of Vascular and Interventional Radiology. 19(8), p.1222-1226.

Abstract:

Purpose: This study evaluated the aerostatic properties of the catheter clamp during over-the-wire catheter exchanges and determined if protective devices reduce volumes of air emboli (AE).

Materials and Methods: A cuffed catheter was placed in an AE model in physiologic conditions and the volume of AE was recorded during 60 seconds (n = 10). Similarly, the volume of AE entering the model during 30 seconds was recorded with the catheter clamp open (n = 10) or closed over the wire (n = 10), and with the sliding clamp in the open position (n = 10). The volume of AE during 60 seconds was recorded with the sliding clamp closed over the wire (n = 10) and with the aerostatic valve with (n = 10) and without (n = 10) a wire in place.

Results: Without a wire, no AE occurred with the catheter clamp closed (60 seconds, n = 10). There was no statistically significant difference between the volumes of AE with the catheter clamp open or closed over the wire during 30 seconds (43 mL ± 4 and 32 mL ± 11, respectively). With the protective devices in place and the wire unchanged in position, no AE occurred during 60 seconds. A positive control (sliding clamp and catheter clamp open, n = 10) yielded AE volumes of 44 mL ± 5 in 30 seconds.

Conclusions: AE can occur with the catheter clamp closed over a wire. Protective devices reduce the volume of AE under simulated physiologic conditions and are recommended with over-the-wire catheter exchanges.

 

IV specialist team combat MRSA

The introduction of a specialist intravenous team at a UK hospital is cited one of the new measures introduced to reduce MRSA infections.
Tina Lloyd, The East Sussex Hospitals NHS Trust’s lead infection control nurse, said “Infection control and patient safety is a priority for this trust”.
Read the full story here.

IO compartment syndrome

Mohen and Sarwark (2008) present a case study that describes compartment syndrome following intraosseous infusion.

Mohen, T.C. and Sarwark, J.F. (2008) Compartment syndrome following intraossseous infusion. Orthopedics. 31, p.815.

Absract:
“Initially described by Drinker et al in 1922, intraosseous infusion is a valuable technique in the resuscitation of critically I’ll pediatric patients in whom vascular access has proved otherwise impossible… This article presents a case of compartment syndrome as a result of intraosseous infusion in 6-year-old girl”.
Full article can be found here.

CVAD air embolism death

The California Department of public health have fined 18 hospitals for state health code violations, including causing the death of one patient by improperly inserting a jugular central venous access device.
Full story at here.

BARD PICC includes Maxplus

Medegen Inc. announced today a co-marketing agreement between CR Bard and Medegen Inc. This will result in the Maxplus Clear needleless access device being included in Bards Peripherally Inserted Central Catheter (PICC) kits.

Press release here.

Synthetic heparin

Scientists reported that a fully synthetic version of heparin is closer to final development.

Described at the ACS’s 236th national meeting, this non-animal version could improve patient safety.

Click here for more information.

Blood transfusion and HIV

It was reported in Argentina that two intensive-care patients contracted HIV after receiving blood transfusions at public hospitals in the Argentine province of Cordoba.

An unidentified donor gave blood at a Cordoba city hospital in December, testing negative for HIV, when the donor returned in May to give blood again, tests came back positive for the virus – but the blood had already been transfused.

Click here for the full story.

Intravenous fluid administration error

A Californian medical center is being investigated by the state Department of Public Health after a July 31 incident involving a patient and intravenous fluid administration.

The error involved a medication that was administered at a rate greater than what was ordered, the hospital says. The patient who had too much intravenous fluid is in stable condition, the hospital says.

Click here for the full story.

Acuset flow control award

Auckland entrepreneur Ray Avery won a Bayer Innovators Award for the Acuset flow controller, which administers intravenous fluids and medicines. Ray won the research and development category of the Bayer Innovators Awards, one of six categories encompassing a wide range of industries and sectors.

The Acuset flow controller was recognised by the judge as simple and cheap – and a breakthrough in health equipment that has implications for clinical treatment around the world.

Click here for the full story.

Click here for more information on the Acuset device.

 

Medical errors in Japan

Mainichi Daily News reports that the number of annual near misses in healthcare reached 200,000 for the first time in 2007, with more than 3,000 of them having been capable of turning fatal.

The survey, which was announced by the Japan Council for Quality Health Care, also found that more than one fourth of the cases concerned prescriptions and other pharmaceutical mistakes.

Among the incidents, 27 percent involved prescriptions and preparations of drugs; 17 percent had to do with the use and management of medical equipment; and 9 percent concerned caretaking in medical treatment.

Those who were primarily involved in the near misses were nurses, comprising 73 percent. The causes of medicine-related cases included mistakes in identifying the names or the amount of drugs to be administered to patients, as well as errors in setting the rates for intravenous drips.

More IV news at IVTEAM

IV specialist job losses

HeraldTribune.com report that Sarasota Memorial Hospital will lay off 31 employees “Among the hardest-hit units is the hospital’s team of nurses that specialize in inserting intravenous lines. Eight of the 13 nurses were laid off.

Sarasota Memorial will keep a smaller IV nurse team, and give all nurses a refresher course in starting IVs, officials said. The hospital will retain its overall nurse-to-patient ratio of 1 to 5, Chief Nursing Officer Jan Mauck said.

Most layoffs take effect this week, and employees will get severance pay and assistance in finding new jobs, officials said”.

Click here for the full story.

Vincristine NPSA alert

The NPSA in the UK have reported on “…reports of serious incidents in hospitals outside of the UK in which doses of vinca alkaloids intended for intravenous administration have been administered by the intrathecal (spinal) route in error, updated advice has been issued to the NHS. The incidents include three cases where doses of vincristine had been diluted to 10ml and 20ml in syringes”.

IVTEAM has reported on one of these cases here.

The NPSA continue with “Previous guidance to the NHS in England and Wales was to dilute doses of vinca alkaloids to 10ml or greater in a syringe in order to reduce the risk of wrong route errors. This guidance needs to be updated following the learning from these incidents in other countries.

When vinca alkaloids are prescribed, dispensed or administered in adult and adolescent units: 

• Doses in syringes should no longer be used. 

• The prescribed dose should be supplied from the hospital pharmacy ready to administer in a 50ml minibag of sodium chloride 0.9% (for some brands of vinorelbine glucose 5% solution for injection may be used instead of sodium chloride 0.9%). 

• The following warning should be prominently displayed on the label of ALL vinca alkaloid doses ‘For Intravenous Use Only – Fatal If Administered by Other Routes’.  

• There should be judicious use of colour and design on the label, outer packaging and delivery bags to further differentiate minibags containing vinca alkaloids from other minibag infusions. 

• The vinca minibag should be infused intravenously over 5 - 10 minutes and the patient closely monitored for signs of extravasation. Incidents of extravasation should be reported and shared via the National Extravasation Information Service (www.extravasation.org.uk). 

• Chemotherapy policies and procedures should be amended to reflect these requirements.  

• Staff should be alerted and trained to follow the new practice. 

• Practice should be audited to ensure compliance with the revised safety procedure”. 

Patient dies after IV drug error

BBC News have reported that an inquest has heard that a woman died after accidentally being given the wrong drug.

Joan Nicholls, 77, was admitted to Stafford General Hospital in September 2006 with suspected kidney failure. She was given a drip with an anaesthetic, instead of other drugs intended to restore her blood pressure. The BBC report “… that hours after being admitted to the hospital’s emergency assessment unit, her condition began to deteriorate. Mrs Nicholls’ blood pressure dropped and medical staff initially administered the drug Gelfusine through an intravenous drip to try to rehydrate the patient. However, it was later mistakenly replaced with the drug Lignocaine, commonly used for local anaesthetics. The hearing was told Mrs Nicholls, of Pye Green, South Staffordshire, was given an “enormous dose” of the drug. Senior staff nurse Nikki Bacon, who was on duty at the time, said there was a “shocked silence” when doctors realised what had happened”.

Click here for the full story.

Wireless MRI infusion pump

The U.S. Food and Drug Administration has approved a wireless version of the Madrad Inc. Continuum infusion pump, used for medication delivery during an MRI.

The original Continuum system was introduced in 2002 and allows patients to remain connected to their intravenous medications while undergoing scans, instead of waiting until they were stable enough to remove the IVs or otherwise staying connected to pumps by as much as 30 feet of connection tubing.

The Continuum MR Infusion System now offers a wireless remote option to give patient care workers the ability to control infusion from inside or outside the scan room.

Click here for a Medgadget update on this story.

 

Arterial line alert

The NPSA have reported “Arterial lines are routinely used in critical care areas for sampling arterial blood to measure blood gases, glucose and electrolytes.

 Patients may be harmed if the wrong infusion is given to keep the line open or when poor sampling leads to delayed or inappropriate treatment.

 The NPSA is aware of two deaths and 82 other incidents up to June 2008 where the wrong infusion fluid was attached to the arterial line. A further 76 incidents, including one case of serious harm, related to faulty sampling technique”.

 Visit the NPSA for the full details.

Peripheral IV safety catheter

This article aims to illustrate that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by needlestick injuries and that political influence is growing to provide safer devices.

Strauss, K.W. and Van Zundert, A.A.J. (2008) Peripheral intravenous catheter use in Europe: towards the use of safety devices. Acta Anaesthesiologica Scandinavica. 52(6), p.798-804.

Abstract:

Background: Peripheral intravenous catheters are among the most widely used medical devices in the world. European patients are increasingly aware of the risk of health care associated infections and the role catheters play in their facilitation.

Aims: We intend to show that European health care providers are increasingly aware of the occupational risks of bloodborne infections such as HIV and hepatitis which can be transmitted by the needles from catheters and that the political will is building to take action to ensure safer devices are provided.

Methods: We review the wide variety of peripheral intravenous catheters which are specially engineered to reduce these risks.

Results: Available safety devices include spring-loaded retractable needles, guards that shield the dangerous tips and closed, needle-free access valves for intravenous sets.

Conlusions: It is no longer necessary for patients and professionals to take risks to health and life when solutions which minimize these risks are at hand.

Venous access ports

Jordan et al (2008) in a recently published article describe the typical complications associated with venous access ports, which include venous thrombosis, port infection, extravasation, pinch off syndrome, dislocation, occlusion and catheter leakages. The also include management strategies to reduce these complications.

Jordan. K., Behlendorf, T., Surov, A., Kegel, T., Maher, G. and Wolf, H.H. (2008) Venous access ports: frequency and management of complications in oncology patients. Onkologie. 31(7), p.404-10.

Abstract:

Totally implantable venous access ports have been in use now for over 20 years. They are valuable instruments for long-term intravenous treatment of patients with cancer. Apart from perioperative difficulties, the typical complications associated with venous access ports are venous thrombosis, port infection, extravasation, pinch off syndrome, dislocation, occlusion and catheter leakages. The vast majority of these complications are avoidable, or at least the complication rate can be reduced with health care personnel training and education of patients. This review will give a broad overview on the frequency and possible complications related to port devices. Furthermore, this review suggests strategies for management including proposals to avoid such complications.

 

IV panda

This is not exactly recent news, but we could not resist sharing it! Reuters, October 25, 2007 reported on 9-year-old male panda Shishi, who was suffering from a high fever and required an intravenous drip at Longhu park in Huainan, east China’s Anhui province. Apparently, the panda became sick because it heard the roars of nearby lions and tigers, according to the local veterinarians.

Investing in infusion nurse specialists

With a push toward outpatient services and changes in medical coverage, demand for outpatient infusion therapy nurses is expected to rise.

On the LSJ.com website Nancy Trick, past president of the Great Lakes chapter of the Infusion Nurses Society, said she thinks hospitals will begin investing in infusion therapy specialists, even though the number of infusion therapy nurses has remained relatively steady the past several years.

There are two factors that could lead to an increase, Trick said.

A recent Centers for Disease Control and Prevention study that found intravenous therapy patients do better with specialized teams. And the federal Medicare and Medicaid programs in October are expected to stop paying for preventable infections such as those that could occur because of intravenous catheters.

“Hospitals have to get ready for this, and my belief is that they will bring back not a full-blown IV team. But they may bring back specialists that work on policies and procedures related to infusion therapy,” Trick said. “Prevention is always more cost effective than treatment.”

Click here for the full story.

 

Chemotherapy assistant

A chemotherapy assistant from the Royal Hampshire County Hospital has been invited to present a poster detailing her role at a leading conference in Southampton.

She is one of the first chemotherapy assistants in the south, a medical assistant specially trained in cannulation, taking blood and monitoring central lines and dressings.

Click here for the full story.

IV catheter - nerve damage

The Saratogian reports on great news about the recipient of a donar liver and his living donar. However, the Read more

Patients paying for IV flush

The Bath Chronicle, UK has reported on a story of a Bath shopkeeper with a vascular access device for chemotherapy who pays for her prescriptions to have it flushed twice weekly.

The patient, Mrs Vaughan said: “At present, I am undergoing chemotherapy and thought all my treatment would be free. ”But I have to pay for the medication I have to take in conjunction with it, such as anti-sickness, antacid and steroid tablets.” She has stated ”Twice a week my wonderful district nurses come in to flush the line and the ampoules used for this I have to pay for.”

Click here for the full story.

This lady is supporting the Macmillan Cancer Support campaign against unfair prescription charges in England - click for more information.

13th August 2008 - UPDATE from Cancer Research UK.

IV therapy course in Jamestown

Jamestown Community College’s Warren Center has been approved by the Pennsylvania State Board of Nursing to conduct an intravenous therapy course.

The non-credit 20-hour course, designed primarily for licensed practical nurses, will be conducted on Saturdays, Sept. 20 through Oct. 4 at the Warren/Forest Higher Education Council complex. Course enrollment is open to health care professionals able to administer IV therapy within their scope of practice.

”Currently, health care professionals leave the county for this training,” said Terrie Ericson, JCC Warren Center director. ”This opportunity will provide a more cost effective and convenient alternative for busy working professionals to get the training they need.”

Click here for the full story.

IV therapy: extravasation-infiltration

Lisa Dougherty, Nurse Consultant Intravenous Therapy at the Royal Marsden NHS Foundation Trust writes this excellent article. Lisa not only describes the differences between infiltration and extravasation, she also demonstrates that it is not only cytotoxic drugs that pose a risk.

Dougherty, L. (2008) IV therapy: recognizing the differences between infiltration and extravasation. British Journal of Nursing. 17(14), p.896-901.

Abstract:

“Infiltration and extravasation are complications that can occur during intravenous therapy administered via either peripheral or central venous access devices. Both can result in problems with the siting of future venous access devices, nerve damage, infection and tissue necrosis. The nurse is the key to reducing the risk of infiltration and extravasation, through her knowledge and skill in cannulation and the intravenous administration of drugs (by bolus injection or infusion). The nurse must also be able to recognize the early signs and symptoms of infiltration and extravasation and act promptly and effectively to limit tissue damage. The first sign of possible leakage of drugs into the tissues is pain and discomfort, so patients must be informed of what symptoms to look out for and be asked to report any change in sensation as soon as they are aware of it. Finally, accurate documentation of the event is vital to facilitate patient care and in case of litigation”.

Medication error prevention

Karen Cox describes in the British Journal of Nursing explores the relationship between rational choice theory and the systematic approach to error management in nursing.

Cox, K. (2008) The application of crime science to the prevention of medication errors. British Journal of Nursing. 17(14), p 924-927.

Abstract:

“It is now accepted that human error in healthcare is inevitable and that a punitive response does not facilitate patient safety. Reason’s (2000) system approach acknowledges that adverse events, such as medication errors, rarely have a single explanation and advocates the review of systemic factors, such as organizational culture, management and strategy. Rational choice theory has much in common with the system approach but the emphasis is on understanding the decision-making process of those who make errors. It could therefore be used in conjunction with the system approach to enhance the ability of healthcare providers to learn from medication errors and other adverse events. The aim of this article is to explore the relationship between rational choice theory and the system approach to error management in nursing”.

 

Intravenous iron

In an article published in the Nursing Standard George Peebles and Sean Fenwick describe the administration of intravenous iron in a short-stay hospital setting.

Peebles, G. and Fenwick, S. (2008) Intravenous iron administration in a short-stay hospital setting. Nursing Standard. 22(48), p.35-41.

Abstract:

“Anaemia and iron deficiency are prevalent in the Western and developing world. They have implications for the quality of life, prognosis and survival in a number of clinical settings. These range from the implications of anaemic status and associated outcomes in pregnancy, reduced blood transfusion requirements following surgery to lethargy and tiredness in older people if left unrecognised and untreated. Renal medicine is at the forefront of diagnosing and treating anaemia associated with chronic renal disease. In this arena the role of intravenous (IV) iron is well established. This article describes how IV iron may be given in total doses in a short-stay hospital setting”.

Antimicrobial copper

ASTM International Committee B05 on Copper and Copper Alloys has created a new task group, TG9018, focused on antimicrobial applications of copper and copper alloys. The group’s formation follows an announcement by the U.S. Environmental Protection Agency it will register copper alloys as antimicrobial materials with specific health claims.

The EPA registration notes copper, brass and bronze are capable of killing harmful, potentially deadly bacteria. The registration is based on independent laboratory testing under EPA-prescribed protocols demonstrating the metals’ ability to kill specific disease-causing bacteria, including Methicillin-resistant Staphylococcus aureus, or MRSA. The registration has implications for the use of copper and copper alloys in hospital equipment, such as intravenous stands, dispensers, faucets, sinks and work stations.

Click here for the full story.

 

IPS announce IV forum

The Infection Prevention Society exists to promote the advancement of education in infection prevention and control for the benefit of the community as a whole, in particular by the provision of training courses, accreditation schemes, education materials, meetings and conferences.

Following on from the mandatory surveillance of MRSA bacteraemia, there is now a recognition of the risk of infection to patients to whom IV therapy is administered. As a result of this, many healthcare providers have taken the option of setting up specialist IV teams, often within the remit of Infection Prevention and Control Teams.

IPS recognise that a need exists for a national independent IV forum to provide and shape guidance and standards relating to the education and practice requirements of IV therapy. The Infection Prevention Society are proud to announce the launch of such a forum. Membership of the IPS IV Forum will facilitate shared expertise throughout the UK.

The Infection Prevention Society incorporating the ICNA has announced that the inaugural meeting of the ‘IPS IV Forum’ will take place alongside the Infection Prevention 2008 Conference to be held at the Harrogate International Conference Centre, UK. The meeting will be on the 24th September 2008 from 1pm to 4pm.

The aim of the forum includes:

• The group will serve as a network for practitioners working in IV Therapy
• Develop competencies in line with those produced for Infection Control Nurses (ICNA 2004)
• Agree a standardised role specification
• Review current education and training opportunities currently available for such post holders within the UK
• Explore and subsequently seek to support and inform the development of suitable academic modules
• To consider career pathways for staff working in IV Therapy
• To consider best practice in relation to IV Therapy and share practical experiences
• Representation on IV Therapy issues within the IPS and externally as required
• Develop an IV Conference to run in parallel with the IPS National Conference
• Respond and comment on national guidance on behalf of the IPS

Click here to read the full press release.

Register your interest to become a member of the IPS IV Forum by emailing info@fitwise.co.uk

Infection prevention and procurement

Connected, the NHS Supply Chain journal has published an article that investigates the impact of procurement specialists on infection prevention.

“The rise in Healthcare Associated Infections (HCAIs) in recent years is a key concern for the NHS. HCAIs not only jeopardise the provision of effective healthcare, but they also place a significant financial burden on trust funds. In fact, it is estimated that HCAIs cost the NHS in the region of £1 billion every year, with infections contributing to around 15,000 hospital deaths annually. Malcolm Bowen, Clinical Purchasing Specialist at Bristol and Weston Purchasing Consortium, shares his views on how clinical procurement can help NHS trusts to face the challenges of reducing HCAIs in the future”.

Click here for the full story.

$1 million settlement following IV

A family has accepted a $1 million settlement for the 2005 death of one of their premature twin sons at Central DuPage Hospital.

Benjamin Abderhalden was born Oct. 3, 2005, a premature 33-week-old twin, weighing 4 pounds and 11 ½ ounces, with an excellent prognosis for survival, according to a news release from the Chicago-based firm Corboy & Demetrio, which represented the family.

The day after his birth, Fontanilla ordered a percutaneous central venous catheter for the newborn to provide him with nutrients and intravenous therapy. On Oct. 9, Benjamin developed respiratory distress with fluid in his chest cavity, according to the release. The tip of the line had eroded the vein, allowing fluid to spill out. He died a day later.

Click here to view the full story.

MRSA and peripheral IV

It has been reported that two patients at Macclesfield Hospital, UK have allegedly contracted MRSA because of poor cannulation technique and refresher training has been carried out.

The Macclesfield Express reports that John Wilbraham, chief executive of the East Cheshire NHS trust, which runs the hospital, said: “MRSA is often linked to cleanliness but this is about technique. Infection can occur when cannulae are not inserted properly.

“What has been identified is an issue with some of the ward staff’s methods of doing a cannula.”

Click here for the full story.

Intravenous Conference New Zealand

IVNNZ Inc have announced the 11th Intravenous Nursing New Zealand Conference  is taking place 10-12th September 2008, Crowne Plaza Hotel, Auckland, New Zealand.

This years keynote speaker will be Elizabeth Krzywda, Nurse Cliniician, USA.

Click here for the conference flyer.

Click here for an application form.

Scottish IV Access Conference

The Scottish Intravenous Access Network has announced its 4th Annual conference. The conference will be held at Beardmore Conference Hotel, Clydebank and is scheduled for the 23rd October 2008.

The cost of this conference is a remarkable £45 per delegate (includes lunch).

Contact Linda Kelly for an application form linda.kelly3@ggc.scot.nhs.uk

The conference is aimed at all healthcare professionals involved in the insertion, care and maintenance of all types of intravenous access devices. The day is divided into lectures and workshops, topics covered in the day include:

• Development of a competency framework for staff working with CVAD
• Teaching patients to care for CVAD’s in the home
• Developing care bundles for CVAD’s
• Dealing with complications of CVAD insertion.
• CVAD’s through a patients eyes.
• Setting up a PICC insertion service.
• The latest developments in catheter maintenance.
• Patient information.

Hand washing and hand gel

Manoj Jain, an infectious disease physician in Memphis and a medical director of Medicare’s quality improvement organization in Tennessee writes in the Washington Post about hand washing. I particularly like the section about how much time should be taken up every shift with hand washing.

Manoj states “For one thing, rigorous hand washing is time-consuming. Guidelines advise that we first rinse, then soap for 20 seconds, then rinse again for 30 seconds; after this, we paper-dry our hands and turn the faucet off using the paper towel. For health-care workers, the procedure is supposed to be followed before and after every patient encounter. That means two minutes per patient visit, which adds up to an hour for a doctor who sees an average 30 patients a day, and 2 1/2 hours per shift for an ICU nurse. I have yet to find a doctor or a nurse who is so diligent… In the past few years, the hand-washing exercise has gotten simpler, with the increased acceptance of alcohol-based gels”.

Click here to read more about hand washing.

Navilyst PASV intravenous catheter

Navilyst Medical, formerly Boston Scientific’s Fluid Management and Vascular Access businesses, today announced its new company name following the February 2008 acquisition by Avista Capital Partners, a private equity firm focused on growth-oriented healthcare, energy and media companies.

Navilyst Medical’s vascular access products include the PASV(R) Technology, designed to automatically close after infusion, disconnection or aspiration, reducing the risk of complications including catheter-related bloodstream infections.

“Navilyst Medical combines the best attributes of an established medical device company–market-leading technology, superior clinical data, experienced leadership and proven worldwide sales and distribution capabilities. We maintain the singular focus of a small, eager organization striving to improve patient care while collaborating with clinicians in the global marketplace,” said President Dave McClellan.

Click here for the full story.

UPDATE: 5th August 2008 Click here

Intravenous catheter embolism

Thomas Sharon, Legal Nurse Consultant reminds us that we have a duty of care to ensure that the correct insertion procedure is followed when placing a peripheral intravenous catheter.

Thomas writes… “When it comes to foreign body emboli, it seems that few nurses and doctors remain aware of this risk because so many violate the prime directive in the standards of care: Once you pull the needle out of the catheter never reinsert it… The proper technique is to insert, pull the needle back and check for flash back… What happens all too often is when the workers realize that they missed the vein because there is no flash back, or the catheter seemed to have slipped out of the vein during the threading process, they reinsert the needle in order to access the vein without having to withdraw and start again. However, this is completely contrary to the standard of care because if the catheter tube is kinked upon reinsertion of the needle the needle could sever a portion of the catheter and it then becomes a foreign body”.

Click here to read his full report.

Tegaderm CHG IV dressing

The Journal of Infusion Nursing, (2008), 31(4) describes the recently launched 3M Tegaderm chlorhexidine gluconate (CHG) IV securement dressing.

“The new dressing combines the powerful antimicrobial protection of CHG with the simplicity of Tegaderm film dressings… Becasue the Tegaderm dressing and its integrated  CHG gel pad are transparent, it allows continuous catheter site visualization, letting healthcare professionals detect any signs of inflammation or infection around the intravascular device”.

Click here for more information. Look out for the interactive application guide.

Power injection

Covidien, announced the U.S. commercial availability of Covidien Imaging Solutions’ contrast delivery system with radio-frequency identification (RFID) technology. The components integrate RFID technology to create a system that is designed to aid in patient safety by helping to reduce the risk of medical errors in radiology departments.

Covidien’s contrast delivery system combines its unit-dose RFID-enabled Ultraject(TM) prefilled contrast media syringes with its RFID-enabled Optivantage(TM) DH power injector to provide the only contrast delivery solution of its type available in North America. RFID is an automatic identification technology that captures, stores and transmits data between the RFID-enabled Ultraject prefilled syringe and the RFID-enabled Optivantage DH power injector using devices called RFID transponders, or tags.

“Covidien’s new, innovative system has the potential to help reduce medical errors and increase efficiency in CT imaging,” said Steve Hanley, President, Imaging Solutions, Covidien. “We expect this technology to be the platform for future innovation.”

Click here for the full story.

 

Central catheter thrombosis

Nicholas Yacopetti writes about Central Venous Catheter-Related Thrombosis and makes recommendations for the treatment and prevention of this complication are explored.

Yacopetti, N. (2008) Central Venous Catheter-Related Thrombosis: A Systematic Review.  Journal of Infusion Nursing. 31(4). p.241-248.

Abstract: 

“Thrombosis related to central venous catheters is often underappreciated and misdiagnosed, despite its incidence and impact on patient morbidity and mortality. The purpose of this article is to offer a review of the literature, investigate the pathophysiology of the condition, and summarize the key points. Recommendations for the treatment and prevention of this complication are explored to help guide clinical practice’.

 

HIV review

This article describes epidemiologic trends in HIV and reviews HIV transmission, testing, and treatment. It also discusses the risk of HIV transmission to healthcare workers from occupational exposures

Petroll, A.E., Hare, C.B. and Pinkerton, S.D. (2008) The Essentials of HIV: A Review for Nurses. Journal of Infusion Nursing. 31(4), p.228-235.

Abstract: 

“The US HIV epidemic began in 1981. The number of HIV-infected individuals in the United States and throughout the world is increasing each year. Given the increasing number of HIV-infected individuals, knowledge of the basic pathogenesis of HIV disease and the principles of antiretroviral therapy is important for all healthcare professionals. This article describes epidemiologic trends in HIV and reviews HIV transmission, testing, and treatment. It also discusses the risk of HIV transmission to healthcare workers from occupational exposures and reviews the principles of postexposure prophylaxis used to reduce the likelihood of HIV transmission in appropriate circumstances”.

Lyme disease update

Virginia Savely offers this update on Lymes disease and the role of the home infusion nurse in the management of the patient in reciept of IV antibiotics at home.

Saverly, V.R. (2008) Update on Lyme Disease: The Hidden Epidemic. Journal of Infusion Nursing. 31(4), p.236-240.

Abstract:

“Lyme disease is the most common vector-borne disease in the United States. Diagnosis is problematic for many reasons, including unsatisfactory laboratory tests and confusion about test interpretation. When Lyme disease is diagnosed early, treatment is usually successful with oral antibiotics. Unfortunately, the diagnosis is often missed, allowing the infection to disseminate and affect every body system. When Lyme disease affects the central nervous system, it is often treated with intravenous antibiotics in the home setting. Infusion nurses who are experienced with the myriad symptoms and treatment challenges of these complex patients will be a reassuring asset to patients and physicians alike”.

Update: Lancaster hotspot for Lyme disease - click here.

External jugular catheter

The Infusion Nurse Society has published a position statement on the role of a qualified licensed registered nurse, who is proficient in infusion therapy, during the insertion, care and removal of external jugular catheters.

INS (2008) The Role of the Registered Nurse in the Insertion of External Jugular Peripherally Inserted Central Catheters and External Jugular Peripheral Intravenous Catheters. Journal of Infusion Nursing. 31(4), p.226-227.

Abstract: 

‘As a leader in infusion therapy, the Infusion Nurses Society convened a national task force of experts to examine the practice of registered nurses placing catheters in external jugular veins. It is the position of the Infusion Nurses Society that a qualified licensed registered nurse, who is proficient in infusion therapy, may insert, care for, maintain, and remove external jugular peripherally inserted central catheters and external jugular peripheral intravenous catheters’.

 

Medicare rule-1553-P update

Dr. Charles McIntosh, Vice President and Chief Medical Science and Technology Officer at Cook Group in Bloomington, Indiana has wriiten an interesting overview of the CMS Rule-1553-P.

“As part of Centers for Medicare and Medicaid (CMS) Rule-1553-P, effective October 1, 2008, Medicare will no longer pay for eight conditions that can be acquired by patients during hospital stays that could have been reasonably prevented by following evidence based guidelines. The initial eight conditions identified in CMS Rule-1553-P are: bed sores; objects left in a patient during surgery; in-hospital falls; blood incompatibility; air embolism; mediastinitis, which is an infection of the area between the lungs after heart bypass surgery; catheter-associated urinary tract infections; and central venous catheter-related bloodstream infections. 

Additionally, on April 14, 2008 CMS proposed to supplement this list with an additional nine conditions, including surgical site infections following certain elective procedures; deep vein thrombosis or pulmonary embolism; Staphylococcus aureus septicemia or bloodstream infection; and, Clostridium difficile associated disease”.

Click here for the full review.