Vivitrol injection site reaction

FDA is alerting healthcare professionals about the risk of serious reactions at the injection site among patients treated with Vivitrol (naltrexone). Vivitrol is administered intramuscularly to treat alcohol dependence.

FDA has received nearly 200 reports of injection site reactions, including cellulitis, induration, hematoma, abscess, sterile abscess and necrosis. Some patients needed surgical intervention. The risk may be increased if the drug is injected subcutaneously or accidentally into fatty tissue.

Practitioners using Vivitrol should use only the specially designed needle that comes with the drug, and take care not to inject the material intravenously, subcutaneously, or into fatty tissue. The special needle may not be long enough to reach muscle tissue in patients with significant gluteal fat. Healthcare providers should consider alternative treatment in these cases.

Patients who develop pain, swelling, bruising, itching or redness that does not improve within two weeks should be instructed to report this, and should be referred to a surgeon.

Click here for the FDA report.

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Vascular access training

The NHS Core Learning Unit presented a poster at IPS 2008 in Harrogate, UK. The poster describes the launch of an online vascular access training programme. The programme is available at www.corelearningunit.nhs.uk

Reducing healthcare associated infections (HCAIs) and increasing cleanliness across all care settings is everyone’s responsibility. Commissioned by the NHS Core Learning Unit, Thames Valley University London and Intuition designed and developed the National Infection Control Training program for use by all NHS staff – both clinical and non-clinical. The Programme was created to help all staff understand their role and make their contribution to cleaner, safer care.

The programme is available at www.corelearningunit.nhs.uk

This poster publication presents overview of the online vascular access training programme and was presented at the following conference: IPS 2008.

Thank you to Dr Carol Pellowe for granting permission to publish this poster.

Click here to view the poster.

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Haemodialysis catheter infection reduction

Taylor, C., Cahill, J., Gerrish, M. and Little, J. (2008) A new haemodialysis catheter-locking agent reduces infections in haemodialysis patients. Journal of Renal Care. 34(3), p.116-20).

Abstract:

Background: Intravenous catheters for haemodialysis increase the risk of sepsis. This study investigates the use of a taurolidine/citrate catheter-locking agent for patients receiving hospital-based haemodialysis, auditing the number and cost of infections before and after its introduction.

Methods: The incidence and cost of treatment of catheter sepsis occurring in all patients receiving haemodialysis via a line were investigated over 6-month periods before and after introducing the taurolidine/citrate line-locking agent.

Results: A reduction of 4.62 infections per 1000 catheter days, or 88.5%, was shown after the introduction of the new line-locking agent.

The total costs of line infections in the first 6 months were €52 500, (£41 000); after the introduction of the taurolidine/citrate locks, these reduced to €33 300, (£26 000), a reduction of €19 200 (£15 000).

Conclusions: The use of a taurolidine/citrate haemodialysis catheter-locking agent in our haemodialysis population has significantly reduced the line sepsis rate, with a positive impact on morbidity, mortality and cost.

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Jet injection of lidocaine

Spanos, S., Booth, R., Koenig, H., Sikes, K., Gracely, E. and Kim, I.K. (2008) Jet Injection of 1% buffered lidocaine versus topical ELA-Max for anesthesia before peripheral intravenous catheterization in children: a randomized controlled trial. Pediatric Emergency Care. 24(8), p.511-515.

Abstract:

BACKGROUND: Peripheral intravenous (PIV) catheter insertion is a frequent, painful procedure that is often performed with little or no anesthesia. Current approaches that minimize pain for PIV catheter insertion have several limitations: significant delay for onset of anesthesia, inadequate anesthesia, infectious disease exposure risk from needlestick injuries, and patients’ needle phobia. OBJECTIVE: Comparison of the anesthetic effectiveness of J-Tip needle-free jet injection of 1% buffered lidocaine to the anesthetic effectiveness of topical 4% ELA-Max for PIV catheter insertion. METHODS: A prospective, block-randomized, controlled trial comparing J-Tip jet injection of 1% buffered lidocaine to a 30-minute application of 4% ELA-Max for topical anesthesia in children 8 to 15 years old presenting to a tertiary care pediatric emergency department for PIV catheter insertion. All subjects recorded self-reported visual analog scale (VAS) scores for pain at time of enrollment and pain felt following PIV catheter insertion. Jet injection subjects also recorded pain of jet injection. Subjects were videotaped during jet injection and PIV catheter insertion. Videotapes were reviewed by a single blinded reviewer for observer-reported VAS pain scores for jet injection and PIV catheter insertion. RESULTS: Of the 70 children enrolled, 35 were randomized to the J-Tip jet injection group and 35 to the ELA-Max group. Patient-recorded enrollment VAS scores for pain were similar between groups (P = 0.74). Patient-recorded VAS scores were significantly different between groups immediately after PIV catheter insertion (17.3 for J-Tip jet injection vs 44.6 for ELA-Max, P < 0.001). Blinded reviewer assessed VAS scores for pain after PIV catheter insertion demonstrated a similar trend, but the comparison was not statistically significant (21.7 for J-Tip jet injection vs 31.9 ELA-Max, P = 0.23). CONCLUSION: J-Tip jet injection of 1% buffered lidocaine provided greater anesthesia than a 30-minute application of ELA-Max according to patient self-assessment of pain for children aged 8 to 15 years undergoing PIV catheter insertion.

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Needlestick and insulin pens

Kiss, P., De Meester, M. and Braeckman, L. (2008) IV injuries in Nursing Homes: The Prominent Role of Insulin Pens. Infection Control and Hospital Epidemiology.

Abstract:

Causes and circumstances related to 162 needlestick injuries in nursing homes were analyzed. In addition to nurses, geriatrics helpers were found to be an important occupational group at risk. Insulin pens were the most frequent cause of needlestick injuries among nursing personnel. Insulin pens are a major instrument involved with unsafe needle-handling practices.

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Impact of central line education program

Santana, S.L., Furtado, G.H.C., Wey, S.B. and Medeiros, E.A.S. (2008) Impact of an Education Program on the Incidence of Central Line–Associated Bloodstream Infection in 2 Medical-Surgical Intensive Care Units in Brazil. Infection Control and Hospital Epidemiology.

Abstract:

An intervention study was undertaken to evaluate the impact of an education program on the incidence of central line–associated bloodstream infection (CLABSI) in 2 intensive care units. There was a nonsignificant reduction in the incidence of CLABSI (odds ratio, 0.46 [95% confidence interval, 0.21–1.02];  ) despite a significant increase in knowledge of CLABSI prevention by the staff of both intensive care units after the education program.

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Older blood increases infection risk

A new study by US researchers found that patients given transfusions of blood stored for more than 4 weeks were nearly three times as likely to develop urinary-tract infections, pneumonia and infections associated with intravenous lines, as those getting fresher blood.

US researchers looked at the rate of hospital infections in 422 patients against the age of the blood transfusion they received. The average age of the blood was 26 days, with 70 percent of patients receiving blood older than 21 days, the researchers found. Current federal regulations allow blood to be stored up to 42 days.

Click here for the full story.

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Community infusion stand

A medical innovation born in the West Midlands is poised to play a crucial role in helping to save millions of lives across the world.

Medical Devices Technology International (MDTi), which has been shortlisted for a prestige Lord Stafford Award for Innovation, has signed a deal for its ‘Hoo-kOn’ intravenous community infusion stand to be used by the Worldwide Health Organisation (WHO) and the International Red Cross as they treat people throughout the globe.

The news of this contract comes just a few months after the product was accepted in NHS Trusts, with its unique modular frame providing a solution that is easier to transport, operate and clean – improving infection control and potentially saving the Government hundreds of thousands of pounds each year.

Martin Levermore, Chief Executive Officer of MDTI, said: “The idea for the ‘Hoo-kOn’ was devised by a team of Wolverhampton IV Therapy Nurses within the NHS PCT, who had grown frustrated with conventional stands that are heavy, expensive and difficult to use if you are on your own.

Click here for the full story.

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Chatting on phone while taking blood

A hospital nurse has been suspended for allegedly chatting on her mobile phone while carrying out a blood test. Calista Ukaegbu is said to have used hand signals to tell the woman patient what to do because she was so engrossed in her conversation. When the patient made her displeasure clear she mouthed the word ’sorry’ but carried on with the call, it is claimed. She only stopped the conversation when a colleague walked in and made it clear that she should hang up.

Last night bosses at the Queen Elizabeth Hospital, in Woolwich, South East London, confirmed they had suspended Miss Ukaegbu earlier this month after a complaint was made about her ‘unprofessional’ behaviour.

Click here for the full story.

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Curos port protection

Ivera Medical Corporation, a San Diego (CA) based medical device company today announced that it received FDA 510(k) clearance to begin marketing its Curos™ Port Protector, an innovative medical device that decontaminates needleless intravenous (I.V.) access ports, and helps to prevent touch and airborne contamination.

The Curos Port Protector is designed to reduce patient exposure to the risks of hospital acquired bloodstream infections and help maintain hospital infection control protocols.

“The Curos Port Protector market approval is a significant milestone toward the success of our company,” Bob Rogers, Chief Executive Officer of Ivera Medical said. “It confirms our commitment to assist healthcare providers in their efforts to reduce bloodstream infections caused by touch or airborne contamination of needleless I.V. ports.”

Click here for the full press release.

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Power injectable antibiotic CVC

Cook Medical Brings Power Injection Capability of Contrast Media to Spectrum® Antimicrobial Central Venous Catheter Line.

Responding to industry demand for an antimicrobial impregnated central venous catheter capable of withstanding pressure injection rates required for CT scans, Cook Medical has received U.S. Food and Drug Administration 510(k) clearance for a power injectable indication for sizes 7-10 French of its Spectrum® Antibiotic Central Venous Catheters, the company announced today.

“Spectrum already represents the most effective device available to help prevent catheter-related bloodstream infections, one of the most widespread and potentially lethal hospital-acquired infections,” reported Bruce Gingles, vice president and global leader of Cook Medical’s critical care strategic business unit. “Customers have asked Cook for a power injection version of this catheter to avoid the need to insert a second line for contrast.”

The FDA clearance includes power injection indications for the distal lumen of adult Spectrum catheters in 7 French, 8 French, 9 French and 10 French diameters. The FDA clearance does not include power injection indications for Spectrum catheters in pediatric sizes.

Central venous catheters (CVCs) such as Spectrum are typically used in approximately half the patients undergoing treatment in a hospital’s intensive care unit. In the United States alone, more than 5 million CVCs are used annually, with more than 80,000 patients developing a catheter-related bloodstream infection (CRBSI). Costs associated with treating these preventable infections average approximately $30,000 each, and about 20,000 patients a year die from these systemic infections. Numerous peer-reviewed publications, including a landmark study published in the New England Journal of Medicine, have demonstrated both the safety and superior efficacy of Spectrum Central Venous Catheters in preventing catheter-related bloodstream infections.

On October 1, 2008, Medicare eliminated reimbursement to hospitals for treating CRBSIs and other hospital-acquired infections. Cook Spectrum Antimicrobial Central Venous Catheters are a scientifically proven tool hospitals and clinicians can use to eliminate preventable CRBSI and avoid the risk of Medicare nonpayment.

The Cook Spectrum Antimicrobial Central Venous Catheter is available for immediate delivery in the United States. For more information on Spectrum technology and how it can help reduce infectious disease rates and control health care costs, visit www.cookcriticalcare.com.

 

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Syringes reused during endoscopy

Public health officials in Alberta are looking for 2,700 former patients of a small hospital in the western Canadian province, after staff there reused syringes to administer medication through intravenous lines.

The Alberta government said on Monday that staff at a health complex in High Prairie, a small town about 300 km (186 miles) northwest of the provincial capital of Edmonton, were using syringes to inject medication into plastic intravenous lines of multiple patients.

Click here for the story on Reuters.

Click here for the story on CTV.

Update 29th October 2008 – The nurses who reused syringes in a northern Alberta hospital should bear some responsibility for their actions and possibly face sanctions, says a local nursing professor.

Click here for the full update.

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Needlestick fine

Allcare Dental and Dentures, has agreed to pay $44,550 in fines to the federal Occupational Safety and Health Administration after an employee was accidentally stuck with a used needle. Allcare Dental and Dentures admitted no wrongdoing in settling the allegations of safety violations.

Click here for the full story.

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Routine IV replacement challenged

Fujita, T. and Namiki, N. (2008) Replacement of peripheral intravenous catheters. Journal of Clinical Nursing. 17(18), p.0962-1067

Abstract:

Research in Brief series. Observational research in Japan recording peripheral intravenous catheterisation activities over a 3 month period, including frequency of, and reasons for, catheter replacement and incidence of catheter-related complications. Guidelines from the US Centers for Disease Control and Prevention recommending changing catheters at least every 96 hours are challenged. 4 refs.

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PICC versus peripheral IV catheter

Periard, D., Monney, P., Waeber, G., Zurkinden, C., Mazzolai, L., Hayoz, D., Doenz, F., Zanetti, G., Wasserfallen, J.B. and  Denys, A. (2008) Randomized controlled trial of peripherally inserted central catheters vs. peripheral catheters for middle duration in-hospital intravenous therapy. Journal of Thrombosis & Haemostasis. 6(8), p.1538-7836.

Abstract:

Summary.  Introduction: Intravenous (i.v.) therapy may be associated with important catheter-related morbidity and discomfort. The safety, efficacy, comfort, and cost-effectiveness of peripherally inserted central catheters (PICCs) were compared to peripheral catheters (PCs) in a randomized controlled trial. Methods: Hospitalized patients requiring i.v. therapy ≥ five days were randomized 1:1 to PICC or PC. Outcomes were incidence of major complications, minor complications, efficacy of catheters, patient satisfaction, and cost-effectiveness. Results: 60 patients were included. Major complications were observed in 22.6% of patients in the PICC group [six deep venous thrombosis (DVT), one insertion-site infection] and 3.4% of patients in the PC group [one DVT; risk ratio (RR) 6.6; P = 0.03]. Superficial venous thrombosis (SVT) occurred in 29.0% of patients in the PICC group and 37.9% of patients in the PC group (RR 0.60; P = 0.20). Patients in the PICC group required 1.16 catheters on average during the study period, compared with 1.97 in the PC group (P < 0.04). The mean number of venipunctures (catheter insertion and blood sampling) was 1.36 in the PICC group vs. 8.25 in the PC group (P < 0.001). Intravenous drug administration was considered very or quite satisfying by 96.8% of the patients in the PICC group, and 79.3% in the PC group. Insertion and maintenance mean cost was 690 US$ for PICC and 237 US$ for PC. Discussion: PICC is efficient and satisfying for hospitalized patients requiring i.v. therapy ≥ five days. However, the risk of DVT, mostly asymptomatic, appears higher than previously reported, and should be considered before using a PICC.

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Implantable port devices in pediatrics

Hooda, B., Lalani, G., Fadoo, Z. and Billoo, G.  (2008) Implantable Port Devices Are Catheters of Choice for Administration of Chemotherapy in Pediatric Oncology Patients—A Clinical Experience in Pakistan. Annals of the New York Academy of Sciences. 1138(1), p.43-46.

Abstract:

Phlebitis and cellulitis are commonly encountered problems in oncology patients receiving chemotherapy through peripherally inserted intravenous catheters. Use of central venous access devices (CVAD) is desirable. We have seen a steady increase in the use of CVADs in our oncology service with frequent use of indwelling ports, particularly during the last 2 years. In this study we have attempted to elucidate advantages of CVAD and compared them to peripheral catheters. This is a retrospective study with chart review of all oncology patients admitted in our oncology service at the Aga Khan University Hospital from March 2003 to March 2005. A survey was also conducted from a randomly selected sample of parents of children with cancer to elicit parental views regarding their choice of a particular catheter. Catheter-related infections were quite common (over 50%) in patients with peripheral lines, resulting in increased costs and prolonged hospitalization. Externalized CVADs were found difficult to care for, carried a risk of being accidentally pulled out or punctured, and were deemed undesirable for older female patients for cosmetic reasons. We found that the internalized CVADs (portacath) were superior to the externalized or peripheral lines and resulted in better patient and family satisfaction. Use of peripheral lines must be gradually phased out of pediatric oncology practice in Pakistan. Indwelling CVADs have become the standard of care internationally and should be considered for most patients in developing countries whenever resources are available.

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Fracture of a Broviac catheter

Puvabanditsin, S., Garrow, E., Weerasethsiri, R., Patel, N., Davis, S.E. and Azuma, M. (2008) Fracture of a Broviac catheter in a low-birth-weight infant. Hong Kong Medical Journal. 14(5), p.411-3.

Abstract:

Central venous catheters are widely used in children, particularly in very-low-birth-weight infants in whom long-term access to the venous system is required. This may be achieved by using peripherally inserted central catheters or tunnelled central venous lines (eg Broviac or Hickman lines). Previous case reports of fractured central catheters in premature neonates have involved peripherally inserted silastic catheters. Fractures and embolisation of Broviac central venous fragments have not been previously reported in preterm neonates. We describe a premature neonate with this rare complication along with the retrieval technique used.

Click here for the full case study.

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Preventing peripheral intravenous infection

Morris, W. and Tay, M.H. (2008) Strategies for preventing peripheral intravenous cannula infection. British Journal of Nursing (IV therapy supplement). 17(19), p.S15-21.

Abstract:

Peripheral intravenous (IV) cannulation is a procedure that involves breaching the integrity of the skin, exposing patients to the risk of infection. Acquisition of infection has associated costs both for patients and the NHS. The high number of peripheral IV cannulae (PICs) inserted annually has resulted in serious infection and significant morbidity (O’Grady et al, 2002). Risks associated with PIC infection must be addressed to reduce patient morbidity and increased cost of prolonged hospital admission and treatment. This article discusses the sourses and routes of infection associated with peripheral IV cannulation, and examines healthcare management strategies for preventing infection when performing peripheral cannulation. These comprise: the Peripheral Venous Cannulation Policy, which empowers practitioners to challenge poor cannulation practices and standardize practice; education, which provides learning opportunities within programmes such as Infection Control Core Competencies Study Days, designed to promote infection prevention strategies directly related to cannula care at aimed at all levels of Trust staff; and the Peripheral Cannula Care Plan, which ensures accurate documentation of cannulation procedures. This last strategy example to use and provides a route for improving cannula-related documentation.

Intravenous therapy safety assessment

Scroggs, S. (2008) Improving patient safety using clinical needs assessments in IV therapy. British Journal of Nursing (IV therapy supplement). 17(19), p.S22-28.

Abstract:

A clinical needs assessment (CNA) consulting programme was initiated with the NHS Healthcare Purchasing Consortium to improve safety and reduce risk in intravenous (IV) therapy through standardization, best practice guideline adherence and ensuring adequate training. The results of CNAs conducted at two acute NHS Trusts (A and B) are summarized. Fifteen-minute ‘pump needs assessment’ and ‘clinical practice review’ interviews were conducted with junior and senior staff members, and recommendations were made to a multidisciplinary Trust-steering committee. Post-assessment recommendations included: standardizing to one pump type with active medication error reduction software, purchasing optimal numbers of IV pumps, implementing best practice guidelines and protocols to minimize unnecessary IV set tear-down (removing and replacing IV set), the use of standardized accessories and ensuring adequate training. Both assessments showed that streamlining, best practice adherence and training could result in pronounced cost savings and improve patient safety. Importantly, the cost savings could facilitate implementation of CNA recommendations. The Trusts have since prioritized standardizing IV pumps and accessories and future implementation of medication error software. The CNA is a valuable tool for Trusts that positively impacts on patient safety.

Intravenous therapy guide

Scales, K. (2008) Intravenous therapy: a guide to good practice. British Journal of Nursing (IV therapy supplement). 17(19), p.S4-12.

Abstract:

This article provides an overview of the principles of good practice that underpin intravenous (IV) therapy. The indications for choosing the IV route and selecting an appropriate vascular access device (VAD) are explained. Common inserion sites for VAD placement and the care and management of VADs are reviewed. Infection control aspects of IV therapy are highlighted, including the management of IV equipment and the importance of the nurse’s role in the prevention of infection associated with IV therapy. Common complications of IV therapy are explained and strategies suggested for their prevention. The article addresses the issues associated with general IV therapy, it does not address specialist subjects such as parenteral nutrition, chemotherapy or blood transfusion.

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Seat belt associated central line fracture

Ghayyda, S.N., Roland, D. and Cade, A. (2008) Seat belt associated central line fracture-A previously unreported complication in cystic fibrosis. Journal of cystic fibrosis. 7(5), p.448-9.

Totally implantable venous access devices (TIVAD) are used widely in the management of cystic fibrosis (CF). They have been shown to be safe and advantageous in the long term administration of intravenous antibiotics. However, TIVADs are not without short and long term complications including infections, thrombosis and mechanical failure. Patients should be counselled prior to TIVAD insertion regarding the risks and instructed on post-operative care of the device to minimise the risks. However it is not routine practice to advise on seating position within the car in relationship to the seatbelt placement over the anterior chest wall. Line failure due to direct pressure from a seatbelt worn to prevent injury in the sudden deceleration involved during a motor vehicle accident (MVA) has not been described previously in the CF literature We report the case of an 8 year old child who fractured her Vascuport(R) line secondary to seatbelt trauma following a road traffic accident (RTA). Children and adults with CF should be advised to sit in the car on the side that places the shoulder strap of the seatbelt on the opposite side to the TIVAD line.

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Community IV therapy

Kayley, J. (2008) Effective practice in community IV therapy. British Journal of Community Nursing. 13(7), p.323-4, 326-8.

The government has policies for care in the community, reducing acute admissions and length of hospital stays and greater patient choice (Department of Health (DH) 2002; DH, 2006) but the NHS has no overall strategy for community intravenous (IV) therapy. Despite this, community IV therapy is expanding to cover a wider range of medication and therapies. While this enables community nurses to extend their skills it can also present many challenges. Carrying out this form of treatment in the community requires comprehensive organization and multidisciplinary working. This article aims to cover the key aspects that need to be in place to ensure that community IV therapy is safe, appropriate and manageable and that infection control is maintained.

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Vein Entry Indicator Device – VEID

Simhi, E., Kachko, L, Bruckheimer, E. and Katz, J. (2008) A Vein Entry Indicator Device for Facilitating Peripheral Intravenous Cannulation in Children: A Prospective, Randomized, Controlled Trial. Anesthesia and Analgesia. 107(5), p.1531-1535.

BACKGROUND: Vascular access is often technically difficult in children because of the small caliber and impalpability of the veins. In this study, we sought to determine if use of the Vein Entry Indicator Device (VEID) in children facilitates peripheral venous access.

METHODS: Two-hundred-two healthy (ASA grade I and II) children scheduled for same-day surgery at a major tertiary hospital in Israel were randomly allocated to undergo VEID-assisted or standard peripheral venous cannulation. All cases involved the insertion of a 22-gauge cannula into an upper limb vein. Primary outcome measures were number of attempts to successful cannulation, rate of success at first attempt, and time required for insertion. The data were presented as mean (sd). Analyses of variance and Pearson 2 test or Fisher’s exact test were used to compare the groups; forward stepwise logistic regression was used to identify the three variables (age, vein assessment category, use of the VEID) significantly associated with a successful first attempt. A P value of 0.05 was considered significant.

RESULTS: Successful cannulation was achieved at the first attempt in the majority of patients in both groups. Two attempts were needed in 8% of the VEID group and 28% of the control group, and 3 attempts were needed in 1% and 3%, respectively (P < 0.01). Analysis by vein assessment category yielded a similar rate of successful first-attempt cannulations in the two groups for easy veins. However, for the difficult and intermediate categories, the rate was 89.7% in the VEID group compared to 23.3% in the control group (P < 0.001). The fewer number of attempts in the study group was associated with a shorter time from the start of the search for an appropriate vein to successful cannulation (9.1 s versus 22.5 s in the control group).

CONCLUSIONS: The VEID facilitates the insertion of peripheral venous cannulas in healthy children with intermediate/difficult veins undergoing same-day surgery, reducing the number of attempts and the overall time required.

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Catheter-related sepsis

Tzortzis, S., Apostolakis, S., Xenakis, K., Spiropoulos, G. and Lazaridis, K. (2008) Catheter-related septic thrombophlebitis of the superior vena cava involving the atrial septum: a case report. Cases Journal. 1:272.

Background

Intravascular catheters provide necessary vascular access, for intravenous therapy, blood sampling and pressure monitoring. However, their use is often associated with serious local and systemic complications including local site infection, intravascular catheter-related bloodstream infections, septic thrombophlebitis, and endocarditis.

Case presentation

We present a case of a 72 year old postoperative patient presented with persistent fever. Transthoracic and transesophageal echocardiograms demonstrated a lesion in the superior vena cava, protruding into the right atrium and infiltrating the atrial septum. Candida albicans grew in blood cultures as well as in the subclavian catheter tip culture. Anti-fungal and antithrombotic therapy was initiated. After 2 weeks treatment the lesion was diminished. Conclusions: Transthoracic and transesophageal echocardiography has been proved efficient and cost-effective in guiding therapy in cases of catheter related infections. In the presented case the lesions in vena cava and the involvement of the endocardium were early identified by echocardiography. Moreover, a follow-up echocardiogram confirmed the efficiency of the therapeutic approach.

Click here for the provisional pdf.

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Leaking central line

A UK hospital have apologised to the family of a man who died following ”shortcomings” in the care he received. The 64-year-old, known only as “Mr C,” died of a heart attack at the Western General Hospital in 2006. He had been admitted four days earlier when his condition worsened following bowel surgery. 

After a complaint to the Scottish Public Service Ombudsman, a number of issues were probed at the hospital’s high dependency ward. The ombudsman’s report noted that records had not been properly kept in the run-up to Mr C’s death, making it difficult for nurses to keep track of medication. It also highlighted a leaking insulin tube, which was designed for treating the man’s diabetes but was, in fact, only succeeding in making his gown wet. 

The ombudsman’s report concluded: “The advisers were clear that one could not say whether Mr C’s death was avoidable. For example, one could not say that the issues with the leaking central line led to his death”.

Click here for the full story.

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Peripheral catheter infection

Daily Nation report how an infection following a peripheral catheter has resulted in the amputation of a babies arm.

Ms Wanjiru initially took her daughter to Kenyatta “around August 18” for pneumonia treatment. As part of the treatment in ward 3A, Lesley was put on an intravenous drip. The drip was placed on her left hand, but when it started swelling, the needle was moved to her right one. Three weeks later, by the time Lesley was supposed to be discharged, it was clear that something was wrong.

“Her hand looked strange… it was losing colour,” Ms Wanjiru recalls. Nurses told her that a blood clot was causing an infection, and that surgery was necessary.

Click here for the full story.

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Patient safety congress 2009

Health Service Journal and the Nursing Times are delighted to announce the launch of the Patient Safety Congress 2009. Following the immense success of the inaugural event last May, which saw 800 delegates and over 100 speakers, we are pleased to bring you early information about next year’s event. We have again teamed up with the National Patient Safety Agency, the NHS Institute for Innovation and Improvement and the Health Foundation, and this year the Department of Heath HCAI and Cleanliness Division and NHS Connecting for Health have also joined our partnership.

Click here for more information.

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Bare below the elbows

Martin Kiernan reports on the policy statement published last week from the Royal College of Surgeons of England. The key sentence was as follows.

“Intuitive interventions that have no evidence base and whose implementation does not harm patient safety or outcomes should be accommodated where practically possible, though priority should be given to evidence-based best practice. For example, surgeons should adhere to the ‘bare below the elbows’ policy contained within the 2008 hygiene code when in direct contact with patients.”

Click here for the full story.

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Safety needle launched at MEDICA

The world’s first manually retractable hypodermic safety needle, designed to significantly reduce the incidence of needlestick injuries, will be launched at MEDICA 2008, Messe Düsseldorf, Germany. Unveiled at the largest healthcare technologies trade fair in the world, the revolutionary needle is just one of the infection fighting devices being showcased by UK based company InterVene Ltd.

The organisation’s philosophy ‘Because safety doesn’t happen by accident’ is the inspiration behind the new range of products, which have  been designed to reduce Hospital Associated Healthcare Infections (HCAIs).

Matthew Root, Managing Director of InterVene, said: “All the products we are bringing to market have been designed with safety in mind, both for the healthcare professional and the patient. Safety is no accident and that is why we believe so strongly in a range of products that encourages best practice and stops the spread of infections in healthcare environments.

Click here for the full press release.

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Symposium includes needlestick

The National Institute for Occupational Safety and Health (NIOSH), through the Division of Safety Research, has a broad research program focused on preventing traumatic occupational injuries. As part of this effort, NIOSH is hosting the fourth National Occupational Injury Research Symposium (NOIRS) on October 21–23, 2008, at the Sheraton Station Square in Pittsburgh, Pennsylvania. NOIRS is the only national forum for presenting research methods, data, and findings focused exclusively on the prevention of occupational injuries. Abstracts from the oral and poster session presentations will be posted to the NIOSH website after the symposium.

Leading researchers in occupational injury prevention will present findings about many major categories of injury, including needlestick. Those unable to attend the conference can participate electronically by posting comments, research, and real-world examples on the NIOSH Science Blog.

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Infusion stolen from patients

A registered nurse under suspension infiltrated some of Melbourne’s leading public and private hospitals to remove intravenous pain-relief drugs from patients – including a dying woman – to support her heroin addiction.

The nurse engaged Glenda Saultry, a terminally ill patient, in conversation and, after checking her medical chart, removed her infusion pump, which was connected to her by an extension line, lock and a needle in her arm. She unscrewed the lock and left the hospital with the entire pump and contents that contained an estimated four milligrams of pain relief medication.

Later that same day, posing as a student nurse, she entered Cabrini Hospital in Malvern where she helped bathe a patient recovering from major abdominal surgery. The prosecutor, Ms Swadesir said that the nurse removed the line connected to the man’s analgesic pump, which delivered morphine, and a pain relief line to remove a syringe of morphine.

Click here for the full story.

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Intravenous history

The British Columbia Medical Association Medical Museum has placed its collection of medical devices online. The example shown in the photograph is a syringe set from 1900-1914.

The museum describe the set as: ”Rectangular hinged lidded case with lift-out rack holding 5 graduated frosted glass syringe barrels [20cc, 10cc, 5cc, 2cc and 1cc for insulin] with fixed tapered tips and removable collars and plungers [thumb rest on top of plunger stem]. 18 needles and canulae in fixed rack on inside of lid, room for 20 needles total. ‘ORIGINAL-RECORD/”DREI FACKELRING”-MARKE’ with ringed staff design in centre stamped into top centre of case”.

Click here to view the full collection.

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Vene-K disposable tourniquet

Vygon have just launched the VENE-K a single use, quick release tourniquet. The company suggest that the practice of ”Venepuncture & cannulation are the two most invasive procedures performed in everyday practice within the NHS. Current statistics reveal that there are over 40 million procedures a year that involve the use of a tourniquet”. In addition tourniquets may harbour pathogenic organisms, and potentially put patients at risk of cross-contamination.

As this is a new product and the topic has met with such interest on the IVTEAM discussion list we have provided this update. The commercial contact at Vygon for further information is Caroline Redmond caroline.redmond@vygon.co.uk

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Drug calculations for nurses

Nurses’ poor maths is putting patients’ lives at risk, a Government report has revealed. A new study carried out in Lothian hospitals reveals “widespread confusion” in the nursing sector over how to calculate correct dosage of powerful intravenous drugs.

Tutors observed 40 nurses in voluntary remedial numeracy workshops at Edinburgh’s Western General and Royal Infirmary and at St John’s Hospital in Livingston. They found they had difficulty converting doses from larger to smaller units, adapting doses using fractions or multiplication, calculating flow rates, and applying patients’ weight to adjust dosages.

Click here for the full story.

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Hand gel ‘pedometer’

A study abstract by Dartmouth-Hitchcock Medical Center presented at the annual American Society of Anesthesiologists conference reveals a promising new approach to healthcare hand hygiene and hospital infection rate reductions using new personal sanitizer dispensers with electronic measures.

Tracking before-and-after infection rates in a 26-bed intensive care unit (ICU), researchers found that by introducing the use of personal sanitizer dispensers by healthcare providers, significant improvements in hand hygiene adherence corresponded to reductions in healthcare acquired infections (HAIs). 

The study documented improvements in both catheter related blood stream infections (CRBSI) and ventilator-associated pneumonia (VAP). “During the before study period CRBSI rates were 4.6/1000 line days compared with 1.7/1000 line days in the after group, a 63% reduction. 

The personal dispensers include the ability to record time stamp records every time the dispenser is used. The results are downloaded using a USB cable that connects a computer to the dispensers. The system uses the electronic performance data to empower frontline healthcare providers to improve their hand hygiene.

Click here for the full story.

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Peel-off labels reduce drug errors

A study presented at the 2008 Annual Meeting of the American Society of Anesthesiologists proposes that the relatively simple act of universalizing the look of medication labels can significantly decrease the occurrence of medication errors ― errors that cause patients unnecessary harm and cost the health care industry an estimated $3.5 billion each year.

According to Elizabeth H. Sinz, M.D., Donald E. Martin, M.D., and their group from the Department of Anesthesiology at Penn State Hershey, medication errors are all too common.

“An average hospital patient may experience one medication error per day, contributing to 1.5 million preventable adverse drug reactions each year,” said Dr. Sinz.

Around one-third of these events are the result of errors during the process of administration of intravenous medications ― but there currently are no regulations on color usage in the labeling of pharmaceutical products. The Penn State study points to some fairly simple solutions.

“We propose that general use of the international color coding of drug classes used in anesthesia by the pharmaceutical industry for labeling and medication packaging might reduce the number of errors which result from human factors,” said Dr. Martin.

In the study’s simulated operating room environment, volunteer anesthesiologists, residents and nurses drew up medications with different colored labels at an ever-increasing speed to mimic an emergency. The research group then counted mistakes and near-mistakes and found that although the number of actual mistakes was too low to detect a difference, when the color of the label on the syringe matched the color of the label on the bottle, fewer near-mistakes occurred compared to when the colors didn’t match.

And when peel-off labels that are taken off the bottle and placed on the syringe were used, errors were reduced and fewer commands were skipped.

Click here for the full story.

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Needlestick injury in prison

A prisoner who was injured by a syringe hidden in his cell mattress has been awarded damages. Mr Kevin D’Arcy, counsel for Jonathan Coyle, told the Circuit Civil Court his client’s hand was pierced when he accidentally grabbed the needle of a hypodermic syringe while tucking bedding under the mattress. The syringe had been hidden in a tear in the mattress.

Awarding Coyle €7,500 damages, Judge Deery said evidence had revealed the cell had not been locked at all times and that the prison governor’s directions in regard to search procedures had not been fully complied with.

Click here for the full story.

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Virtual IV station

With two patient rooms, an operating room and an administrative station, LTC’s new Patient Simulation Center has the antiseptic look and feel of a hospital, right down to the shiny tile floor. It has been designed to incorporate the latest in high-tech equipment and clinical skills instruction in preparing students for health-care careers.

A tour of the center this past week revealed a cutting-edge approach that exposes students to real-life situations but without any of the risks. There is even a “virtual IV” station, where they learn by computer to successfully start an intravenous injection.

Click here for the full story.

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Chlorhexidine IV dressing

Eyberg, C.I. and Pyrek, J. (2008) A Controlled Randomized Prospective Comparative Pilot Study to Evaluate the Ease of Use of a Transparent Chlorhexidine Gluconate Gel Dressing Versus A Chlorhexidine Gluconate Disk in Healthy Volunteers. Journal of the Association for Vascular Access. 13(3), p.112-117.

Abstract:

Products and technologies that aid health care professionals in vascular access practice save staff time, and while promoting patient safety and prevention of infection can provide excellent opportunities for evaluations to support evidence-based practice. This was an industry sponsored, prospective, single site, controlled, randomized clinical evaluation pilot study of two catheter dressings, 3M™ Tegaderm™ Chlorhexidine Gluconate (CHG) IV Securement Dressing (CHG gel dressing) (3M Health Care, St. Paul, MN) and BIOPATCH® Antimicrobial Dressing with Chlorhexidine Gluconate (BIOPATCH® Protective Disk with CHG, Johnson & Johnson, Somerville, NJ). Twelve intravascular (IV) therapy health care professionals (Clinicians) were asked for their professional evaluations of the catheter dressings: the ease of application and performance factors featured in specific questions. Catheters were secured on 12 healthy volunteers to simulate inserted jugular catheters (IJ) and peripherally inserted central catheters (PICC) using StatLock® PICC Plus and 3M™ Steri-Strip™. Each clinician applied and removed one CHG gel dressing and one CHG disk on one simulated PICC and one simulated IJ site, according to the manufacturers’ instructions.

The clinicians concluded, based upon a 1 to 5 rating scale, that the CHG gel dressing is better in regard to ease of application, ease of applying correctly, ease of removal, ability to visualize the insertion site, ease of training another clinician to apply the dressing, and more intuitive application. Twelve out of 12 clinicians favored the CHG gel dressing over the CHG disk in overall performance.

More dressing information.

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IV site monitoring by videoconference

Astapova, E.V., Stachura, M.E., Chernecky, C. and Rosenkoetter, M.M.(2008) Low-End Videoconferencing for Vascular Access Device Site Assessment in Homecare. Journal of the Association for Vascular Access. 13(3), p.135-138.

Abstract:

Vascular access devices (VAD) represent high technology and are used frequently in infant, pediatric, adult, and geriatric populations for vascular infusion of chemotherapy, immunotherapy, blood products, biologic response modifiers, nutrition support, analgesics, ionotropics, antibiotics, and other medications, as well as for extraction of pleural fluid from patients with chronic effusions and for treatment with dialysis. Increasingly, these devices are migrating to the home setting as they are used in chronic care and as insurance requirements reduce access to prolonged hospital stays.

Surveillance of infections in high risk patients such as those with cancer, cardiac conditions, or post-trauma convalescence is essential to avoid adverse events and to offer early treatment. VAD site and blood stream infections are common VAD complications, occurring in up to 50% of home care patients, usually during days 4-25 after hospital discharge. Our literature search for reports of remote home monitoring for support of VAD patients and their caregivers found none.

The use of videoconferencing technology to assess VAD sites in the post-discharge environment would significantly enhance patient safety, facilitate continuity of care, and meet the Communicable Disease Center’s stated need for the development of surveillance systems to monitor infections in home care settings. Low-cost Internet- or telephone-based videoconferencing technology that could be deployed easily and used during risk periods would be highly beneficial to patients and increase the cost-effective use of homecare nursing personnel.

We report criteria-based protocols for remote assessment of VAD status, for monitoring VAD care procedures employed in the home, and for conducting VAD-care teaching of patients and their caregivers. In addition, we report an initial evaluation of the ability to assess VAD status using low-end videoconferencing technologies.

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Ultrasound guided PICC insertion

Krstenic, W.J., Brealey, S., Gaikwad, S. and Maraveyas, A. (2008) The Effectiveness of Nurse Led 2-D Ultrasound Guided Insertion of Peripherally Inserted Central Catheters in Adult Patients: A Systematic Review. Journal of the Association for Vascular Access. 13(3), p.120-125.

Abstract:

To conduct a systematic review that compares the effectiveness of nurses using 2-D ultrasound guided insertion of peripherally inserted central catheters (PICCs) with the landmark method in adult patients. Nine electronic databases were searched, the reference lists of studies were screened, the Internet was searched, and contact was made with experts. A quality assessment checklist was used to assess study validity. Dichotomous outcome data on the failure rate to insert PICCs were calculated as relative risk (RR) with 95% confidence intervals. Data were pooled using the Mantel-Haenszel fixed effects model. From 156 studies, four eligible non-randomised studies were identified. Three studies originated from the United States and RR of failure to insert PICCs was significantly lower in the ultrasound group: 0.26 (0.10 to 0.64), 0.47 (0.38 to 0.59) and 0.28 (0.20 to 0.41). One study from the United Kingdom did not find a statistically significant difference in failure to insert PICCs between landmark and ultrasound groups: single centre RR was 0.60 (0.23 to 1.57) and multi centre RR was 0.42 (0.16 to 1.09). The pooled RR for all studies was 0.40 (0.33 to 0.48) showing that ultrasound significantly reduces failure rates by 60%. The presence of bias is evident in all studies. There is evidence to support the use of 2-D ultrasound by nurses to insert PICC lines. Further more rigorous research is required, such as a multi-centre randomised controlled trial with economic evaluation, before the widespread uptake of this technology can be recommended.

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PICC placement outcomes

van Boxtel, A.J.H., Fliedner, M.C., Borst, D.M. and Teunissen, S.C.C.M. (2008) Peripherally Inserted Central Venous Catheters: First Results after the Introduction in a Dutch University Medical Center. Journal of the Association for Vascular Access. 13(3), p.128-133.

Abstract:

Purpose: To analyze patient outcomes and processes of insertion after the introduction of the peripherally inserted central catheter (PICC) in the University Medical Center Utrecht (UMC Utrecht) in the Netherlands.

Patients and method: A prospective analysis of PICC inserted in the UMC Utrecht looking at patient characteristics, dwell time and infections.

Results: A total number of 510 PICCs in 439 patients with 17655 catheter days were analyzed using ultrasound (US) and modified Seldinger technique (MST). Overall there were 2.35 catheter-related bloodstream infections (CRBSI) per 100 devices and 0.68 infections per 1000 catheter days. When used specifically for home infusion, the CRBSI rates were 1.09 per 100 devices and 0.23 per 1000 catheter days. One advanced nurse practitioner (ANP) inserted all PICCs. Although a full sterile barrier (no hat and gown) was not used during insertion, the infection rate in our study was lower compared to the 1.1 infection per 1000 catheter days reported in a meta-analyses on CRBSI (Maki, Kluger, & Crnich, 2006).

Conclusion: Through the use of modern techniques like US and MST and upper arm insertion of PICCs, the complication rate is lower compared to older techniques as shown in most prospective studies. Extended dwell time, as a positive outcome of using PICCs made more doctors decide to choose a PICC. Age of the patient did not influence dwell time or complications. Further research, preferably a randomized controlled trial, is needed to compare the subclavian catheter with the PICC as well as exploration of the effects of anticipatory choice for PICCs, specifically in immune compromised patients.

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ANTT training resource

The University of Nottingham has produced an online ANTT resource. The programme consists of short animated clips, a video demonstration and an assessment module.

Click here to view the programme.

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Vascular access device training online

The NHS Core Learning Unit have launched an online vascular access training programme. The programme is available at www.corelearningunit.nhs.uk

Reducing healthcare associated infections (HCAIs) and increasing cleanliness across all care settings is everyone’s responsibility. Commissioned by the NHS Core Learning Unit, Thames Valley University London and Intuition designed and developed the National Infection Control Training program for use by all NHS staff – both clinical and non-clinical. The Programme was created to help all staff understand their role and make their contribution to cleaner, safer care.

The programme is available at www.corelearningunit.nhs.uk

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Cannulation training

A successful service improvement project at Portsmouth Hospitals NHS Trust demonstrated that educational initiatives about peripheral lines decreased MRSA rates. The South Central Strategic Health Authority (SC SHA) advocated the design of a pilot project to improve peripheral cannulation in all its acute NHS Trusts; the Peripheral Line Training Project.

This poster publication presents the results of this initiative and was presented at the following conferences: IPS 2008, ANTT 2008.

Thank you to Dr Eleanor Guegan for granting permission to publish this poster.

Click here to view the poster.

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HAI conference

The Lancet have announced the healthcare-associated infections conference at the QEII conference centre, London, UK, December 11-12, 2008.

Healthcare-associated infections will combine state-of-the-art lectures with the opportunity for delegates to discuss management of HAIs with key opinion leaders. We anticipate that participants will benefit from:

• A greater understanding of the impact of mandatory surveillance and public reporting.
• Enhanced knowledge of the best approaches for achieving a sustainable reduction in HAIs.
• An update on the WHO multimodal strategy to improve hand hygiene.
• An opportunity to discuss perspectives and exchange ideas for the future of infection control.
• An insight into fundamental strategies to bring about change within their organisations.

Click here for further information.

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Intravenous supplies in Africa

The Washington Post highlights the perils of poor access to emergency obstetric care and limited health-care resources to the lives of women and children.

Focusing on the African nation of Sierra Leone, the Post published highlights the death of women during childbirth and how this was directly related to the environment. Perhaps most strikingly, the article reports that at dilapidated city hospitals in Freetown, patients are expected to provide their own medical supplies such as: intravenous fluids and bags, catheters, and rubber gloves.

Warning: the following link contains graphic images and interviews of woman and infants some of whom die during childbirth. 

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Anaphylactic reaction

Terry Parsons died 44 minutes after being treated for a skin infection at Gisborne Hospital in April this year. He suffered an anaphylactic reaction to the antibiotic drug, despite repeatedly telling medical staff of his allergy to penicillin.

In the coroner’s findings, Mr Devonport said staff at Gisborne Hospital had not exercised enough caution when administering Flucloxacillin, after warnings of Mr Parsons’ allergy were made by his general practitioner.

Despite speaking to his GP, to Mr Parsons and his wife Judith about his allergies, the house surgeon on duty decided to proceed with the penicillin-based drug. Within six seconds of administering the drug Mr Parsons complained that he felt “itchy”. The nurse immediately withdrew the syringe and began administering oxygen. He soon became restless and very red in his face, chest and shoulders. As the nurse was calling for assistance Mr Parsons collapsed on the floor and an official “crash call” was put out.

Mr Devonport said the house surgeon treating Mr Parsons was aware of his previous reactions to penicillin as adrenaline and antihistamine were drawn up as a precaution.

Click here for the full story.

Home IV growth

Growing numbers of patients needing intravenous medications are getting their treatments at home. But a gap in Medicare coverage is making it harder for older and sicker patients to swap hospital stays for home care.

Hundreds of new intravenous drugs and biologic products have come on the market in recent years to treat maladies such as infections, cancer and chronic diseases. Administering these medications at home generally costs $150 to $200 a day, far below the $1,500-to-$2,500-a-day cost of a typical inpatient hospital stay. Home-infusion therapy also eliminates the risk that patients will be exposed to infections caused by hospital bacteria that can invade through IV lines and catheters.

Eyeing the potential for savings, many private insurers provide full coverage for home-infusion therapy. But Medicare, under its two-year-old Part D program, covers only the drugs administered intravenously — not the pharmacy and nursing services, supplies and equipment that make up roughly half the cost of home-infusion therapy.

Click here for the full story in The Wall Street Journal.

MRSA screening

Publicservice.co.uk the information portal for the public sector report on the universal screening for MRSA.

They write “With a quarter of NHS bodies failing to meet basic standards of infection control, the chief inspector of infection control, Professor Brian Duerden, inspector of microbiology and infection control at the Department of Health, outlines the challenges of introducing universal screening for all patients and the benefits that will come from it”.

Professor Duerden writes “The three year programme on prevention and control of Methicillin-resistant Staphylococcus aureus (MRSA) infection has had a major impact on healthcare associated infections (HCAI) in the NHS. The very challenging target to halve the number of MRSA bacteraemias (bloodstream infections) by April-June 2008, which many thought to be impossible, was achieved, with the figures published in September showing a 57% reduction. However, we must not rest on this achievement; it is clear that MRSA infections can be reduced further and the pressure must be kept up for continued improvement”.

Click here for the full item on publicservice.co.uk

Intravenous record keeping

Arslan, S. and Karadag, A. (2008) The determination of record-keeping behavior of nurses regarding intravenous fluid treatment: The case of Turkey. Journal of Infusion Nursing. 31(5), p.287-294.

Abstract:

Record-keeping is one of the legal and professional responsibilities of nurses. This study aims to determine the record-keeping behavior of nurses regarding intravenous fluid treatment (IVFT). The study was conducted with 150 nurses working in adult clinics of a 936-bed university hospital. The most frequently fulfilled record-keeping behaviors were solution type, total solution amount, and date of treatment. The least frequent fulfilled behaviors were the diagnosis of patients and the time of passage of medication added to the solution. The nurses never recorded type of IV fluid treatment, complications, and discontinuation of therapy. According to findings of the study, the record-keeping behavior of nurses regarding IVFT is not at the desired level.

Neonatal PICC placement

Mickler, P. (2008) Neonatal and Pediatric Perspectives in PICC Placement. Journal of Infusion Nursing. 31(5), p.282-285.

Abstract: 

The nurse providing care to the acute or critically ill child is all too familiar with the issues surrounding vascular access. Establishing and maintaining the correct access device is an ongoing problem. There are several types of vascular access devices available to the patient. Before placing any device, a thorough assessment of the patient is necessary. Choosing the wrong device can delay or interrupt the application of therapy. A peripherally inserted central catheter is one example of a vascular access device, and it is defined as a catheter inserted via a peripheral vein with the tip residing in the superior or inferior vena cava. This type of central catheter is commonly used in pediatric patients because it can offer reliable and stable vascular access. When appropriate, children with peripherally inserted central catheters can be discharged to the outpatient setting.

Typhilitis

Haut, C. (2008) Typhilitis in the Pediatric Patient. Journal of Infusion Nursing. 31(5), p.270-277.

Abstract:

Cancer statistics in children are promising as mortality rates consistently decrease, reflecting newer chemotherapeutic agents and the evolution of hematopoietic stem cell transplant. Typhilitis or neutropenic enterocolitis is a potentially life-threatening complication of cancer treatment often found in immunocompromised children receiving vigorous chemotherapeutic regimens and noted in children post-stem-cell transplant. Recent literature suggests a relationship between typhilitis and other types of cancers and immunocompromised illness occurring in both children and adults. The pathogenesis of typhilitis is poorly understood, with limited evidence regarding incidence. Nursing care and assessment of children receiving oncologic treatment requires vigilance and immediate response to prevent and manage complications, especially gastrointestinally related typhilitis.

Colony stimulating factors

Throm, M.J. (2008) A Review of the Pharmacology and Pharmacotherapy of Colony-Stimulating Factors. Journal of Infusion Nursing. 31(5), p.295-306.

Abstract: 

Colony-stimulating factors (CSFs) have an established role in oncology. This article reviews the advances in the pharmacology, pharmacotherapy, and expanded indications of CSFs outside oncology and the role of the infusion nurse. New pharmacologic formulations of CSFs allow for less frequent dosing, less nursing administration time, and increased adherence. Expanded uses in human immunodeficiency virus/acquired immunodeficiency syndrome, Crohn’s disease, mucositis, wound healing, chronic kidney disease, Jehovah’s Witnesses, illegal use in sports, and non-drug-induced thrombocytopenia are reviewed. The role of the infusion nurse in the minimization of CSF prescribing errors, administration, monitoring, and patient education are summarized.

Needlestick legislation in Canada

A new proposal from the Ontario government will see the mandatory use of safety-engineered needles extended to home care, family medicine and ambulance services by 2010.

The announcement comes a month after safety-engineered needles became mandatory in hospitals across the province, following the August, 2007 passing of Ontario Regulation 474/07 under the Occupational Health and Safety Act. The regulation called for their use in hospitals by September 1, 2008, and in laboratories, specimen collection centres, psychiatric facilities and long-term care facilities by April 1, 2009.

Click here for the full story.

Baxa launch flush in UK

IV therapy update (IVTEAM): It is reported today that Baxa Ltd have announced the launch of a new line of pre-filled saline IV syringes in the UK. Baxa ZR sterile, pre-filled saline IV syringes provide a safe and effective alternative to flushes drawn from multi-dose vials or manual filled.

Terry Aston, managing director of Baxa Ltd comments, “The time is right for pre-fills in the UK. Research and industry best practice widely acknowledges that the greater the number of procedures in preparation of medication, the greater the risk of cross-contamination. ZR pre-filled syringes reduce risk and are far more convenient to use.”

Click here for the full story.

 

Accelerated seldinger technique poster

The Accelerated Seldinger Technique reduces the danger of air embolism while providing fail-safe needlestick protection and faster access. Those were among the conclusions of research presented at the annual conference of the Association for Vascular Access (AVA).

The poster presentation describes the results of a study led by Bonnie Smith, R.N., manager of the IV therapy department at a Florida medical center.  Smith’s research compared the Accelerated Seldinger Technique (AST) to the Modified Seldinger Technique (MST), a widespread, though sometimes problematic approach to placing central catheters. This poster was presented at the following conference: AVA 2008.

Click here to view the poster.

 

Peripheral vascular catheter care plan

Insertion of peripheral vascular catheters (PVC) is a common invasive procedure that forms part of the management of many in-patients. However, this type of device has associated risk of bacteraemia. 

Root Cause Analysis (RCA) of MRSA BSIs within Southport and Ormskirk NHS Trust for the time period 2006-07, identified a number of infections relating to PVCs. Issues included sub-optimal documentation resulting in prolonged dwell times and lack of personal accountability in PVC management. 

This poster publication presents how a policy for review, routine replacement at or before 72hrs and enhanced documentation and audit has reduced the incidence of bacteraemia associated with PVCs, this poster was presented at the following conference: IPS 2008.

Thank you to Martin Kiernan for granting permission to publish this poster.

Click here to view the poster.

Hospira acquires insulin software

IV therapy update (IVTEAM): Hospira Inc. has acquired MD Scientific’s EndoTool business. The EndoTool software calculates the amount of insulin a patient needs to control glucose levels in critical situations. It adapts to patient responses to intravenous insulin. EndoTool also prompts caregivers when a blood-sugar reading is needed.

Click here for more information.

IV forum launched by IPS

The Infection Prevention Society (IPS), the largest infection prevention and control organisation in the UK and Ireland has recently launched the IPS IV Forum. The forum will bring together like-minded intravenous (IV) and infection and control practitioners to facilitate shared expertise, which in turn will shape and develop IV guidance, education and practice in the UK.

The IPS IV Forum was developed in recognition of the risk of infection to patients to whom IV therapy is administered. MRSA Bacteraemia numbers have been falling in England and other parts of the UK and this has largely been as a result of increased focus on IV therapy as a risk factor in these cases.

The IPS also announced that Andrew Jackson, IV Nurse Consultant at The Rotherham NHS Foundation Trust, UK will lead the IPS IV Forum. Andrew is very enthusiastic about the forum, saying “The forum will draw together IV expertise from throughout the UK and Ireland, this will allow us to rapidly develop educational tools and clinical guides that will reflect the needs of patient, practitioner and organisation”. Andrew continues, “Part of my vision for the IPS IV Forum is that staff will be able to access people and tools that will assist with the implementation of national IV priorities at a local level. The IPS IV Forum is a groundbreaking development for intravenous care in the UK”. Welcoming the formation of the Forum, Martin Kiernan IPS President said “IV Therapy is now recognised as a vital therapeutic intervention for patients and there is now a recogintion of this route as an important portal of entry by which patients can acquire infection. The Forum will provide an important communication medium for those commited to patient safety”.

The IPS IV forum is open to any practitioner with an interest in networking and taking forward standards in IV care. The Forum will meet at least three times a year, provide an online networking facility and will hold an annual conference running alongside the IPS Conference in addition to publishing supplements of the British Journal of Infection Control, which becomes the Journal of Infection Prevention in January 2009. For an information pack email info@fitwise.co.uk For any additional information about the IPS IV Forum contact Andrew Jackson at andrew.jackson@ivteam.com

About IPS:

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.

Website www.ips.uk.net

Outpatient IV for heart failure

A team-based approach to treating heart failure adopted at St Vincent’s Hospital in Dublin could avoid 4,000 hospitalisations a year if used nationally, according to those running the service.

The Heart Failure Unit at St Vincent’s Hospital in Dublin adopts a team-based approach involving doctors, nurses and allied healthcare professionals, according to the director of the unit, Prof Ken McDonald.

The unit yesterday celebrated its 10th anniversary with an official visit by Health Minister Mary Harney. Dr McDonald said the unit’s focus is that instead of keeping patients in overnight or longer in hospital, healthcare professionals work towards avoiding a hospital stay in 80% of patients being treated at the unit. Strategies used to keep people out of hospital include outpatient administration of intravenous therapies, which allows staff to stabilise the majority of patients without the need for A&E care or hospitalisation.

Click here for the full story.

Vascular access team review

Over the past decade or so an eager enterprise of vascular access activity has developed which has offered nurses as the main alternative to the traditional doctor focussed service. This poster aims to review nurse led vascular access team activity in a medium sized General Hospital in the UK and ensure local standards are achievable.

This poster publication presents a review of the vascular access team and was presented at the following conference: Oxford IV conference 2007.

Thank you to Andrew Jackson for granting permission to publish this poster.

Education improves intravenous cannulation

A poor cannulation technique and inadequate continuing care of peripheral lines are causative factors in the development of bacteraemia. The provision of effective educational initiatives about peripheral lines to healthcare staff are essential to promote patient safety and enhance patient outcome through service improvement.

Portsmouth Hospitals NHS Trust had a poor MRSA record, with 73 cases recorded in 2005. The Trust identified that there was a need to develop Trust-wide educational initiatives to attempt to decrease the MRSA rate.

This poster publication presents the results of this initiative and was presented at the following conferences: IPS 2008, ANTT 2008.

Thank you to Dr Eleanor Guegan for granting permission to publish this poster.

Click here to view the poster.

IVTEAM launch poster page

IVTEAM are pleased to announce a new section on our website. We have just launched the ‘Poster’ page. We hope to fill it will our readers poster publications so that it can shared across our International IV community. We are happy to publish posters that have been presented at conferebnces. To submit a poster simply send the poster via email to enquiries@ivteam.com

Click here to visit the poster page.

Umbilical Vascular Catheterization

Anderson et al (2008) in The New England Journal of Medicine have published a video describing the umbilical vascular catheterization (NEJM subscription required).

“The placement of umbilical catheters is an essential technique for the treatment of many newborns in unstable condition. This video will demonstrate the placement of catheters in the umbilical vein and the umbilical artery. Careful preparation, sterile technique, and attention to detail are instrumental in successful catheter placement. We will demonstrate the regional anatomy of the umbilicus, indications and contraindications for the insertion of an umbilical catheter, the recommended technique for catheter placement in both the umbilical artery and vein, selected complications associated with the procedure and suggestions for how to avoid them, and appropriate aftercare of the catheter” (Anderson et al 2008).

Click here for the NEJM page.

 

INS conference 2009

The INS 2009 Annual Meeting and Industrial Exhibition is fast approaching, and INS is seeking Abstracts and Posters for presentation at the meeting in Nashville. Abstracts and Educational Posters present research or clinical innovations related to the specialty of infusion nursing that include, but are not limited to: administration, clinical practice, cost-effectiveness, patient or staff education, or professional issues. The deadline for submission is January 15, 2009. This year’s meeting is being held May 16-21 at the Gaylord Opryland® Resort and Convention Center in Nashville, Tennessee.

Click here for more information.

Potassium error caused death

A coroner has delivered a damning verdict after a series of medical blunders at Whiston Hospital left a grandmother dead. Mrs Alker, of Mountfield Court, Orrell, died at Whiston Hospital on September 26, 2003. She had been given a lethal dose of potassium chloride by student nurse Rebecca Riley, which resulted in her going into cardiac arrest. Riley had misunderstood the instructions of her supervisor, Sister Karen Edwardson, and had tried to deliver 20ml in five minutes instead of two hours.

She started to administer the drugs in Mrs Alker’s neck and was only stopped by another doctor after she had injected 15ml – which proved fatal.

Coroner, Mr Sumner slammed the training facilities at LJMU, expressing his concern that students were only given one lecture on intravenous drug administration and said that this was ‘hardly a good foundation’. The court heard that Rebecca Riley, who was only one week from qualifying, did not know that such a large dose of potassium chloride was potentially fatal.

Click here for the full story.

Ethanol reduces CRBSI

A research nurse specialist completing her Masters in Health Sciences at the University of Otago, Christchurch, NZ has shown that using ethanol as a ‘disinfectant’ in intravenous catheters reduces blood stream infection rates in immune-suppressed patients.

Joanne Sanders has demonstrated for the first time that by using diluted ethanol, catheter-related bloodstream infection rates (CRBSI) in patients having chemotherapy are four times lower compared to conventional methods.

Click here for the full story.

Needlestick from HIV patient

Jeffrey Parks MD, Board Certified General Surgeon on East Side of Cleveland, Ohio describes the moment he sustained a needlestick injury from a HIV positive patient.

“I wasn’t paying close attention, my eyes off the operative field when I felt a sharp prick on my index finger. Looking down, my heart sank; the creamy white of the glove was rapidly staining red from the inside. I ripped the glove off and blood was pouring from a deep wound. It hurt like hell. I felt it to the bone. I started dumping betadine on it, then wrapped it in gauze. The attending sent me down to employee health.

When you sustain a needle stick injury, you get plugged into the “system”. You get your blood drawn. You meet with the nurse practitioner. An incident report is filed. You basically spend three hours in employee health. Then I met with the ID specialist. This was the same guy, coincidentally, who took care of my patient. He shook his head, reading the chart. Of all the people to get stuck by, he said”.

click here for the full story.

 

AVA conference dates announced

The Association for Vascular Access announce the dates and venue for the 23rd Annual Scientific Meeting. The venue will be Las Vagas and the dates for your diary are September 14-17, 2009. Registration and housing fees will be posted on the AVA website December 1, 2008.

Click here for more information on the AVA website.

 

TRALI following IVIG

Transfusion-related acute lung injury (TRALI) is a clinical syndrome that presents as acute hypoxemia and noncardiogenic pulmonary edema during or within 6 hours after blood transfusion.

Health Canada received a report of a 38-year-old man who had received Gamunex for the treatment of streptococcal thoracic cellulitis, which had also required débridement. Two hours and 50 minutes into the infusion, after receiving 57.5 g of Gamunex, the patient experienced hypotension and dyspnea. The infusion was stopped. The results of a chest radiograph were compatible with a diagnosis of TRALI. The patient was transferred to the intensive care unit, where he required intubation. The result of an anti-human leukocyte antigen test was pending at the time of reporting.

Click here for the full Canadian Adverse Reaction Newsletter.

 

Reporting CRBSI

Beginning in early 2009, Indiana plans to add a new reportable error to the surgical error reporting system. Hospital infections, in particular those which developed in a patient’s intravenous or central line, will be reported in both hospital and non-hospital environments.

Click here for the full story on injuryboard.com

 

IV catheter prescription update

There have been no new cases of hospital-acquired MRSA bloodstream infections at the Royal Hampshire County Hospital in the past nine months.

MRSA infections have reduced since Dr Chris Gordon consultant physician and Sister Rachel Wright introduced a new system for inserting intravenous cannulae. Since November 2007, the use of cannulae has to be prescribed by a doctor to ensure they are only used when absolutely necessary.

Click here for more on this story.

Intravenous cannulation pain

This economic study compares a variety of local anaesthesia methods for cannulation in the emergency department.

Pershad, J., Steinberg, S.C. and Waters, T.M. (2008) Cost-effectiveness analysis of anesthetic agents during peripheral intravenous cannulation in the pediatric emergency department. Archives of Pediatric and Adolescent Medicine. 162(10), p.952-961.

Abstract:
Objective To conduct a cost-effectiveness analysis of anesthetic agents to reduce the pain of peripheral intravenous cannulation in an emergency department (ED) setting.

Design Cost-effectiveness analysis in which costs were measured as the cost of the agent plus costs associated with time in the ED using data from our hospital cost accounting system. Outcomes were measured as improvements in the self-reported visual analog scale (VAS) pain scores. Variables considered unique to the various agents were cost of the agent, time to peak onset, success rates of cannulation, and mean reduction in VAS scores.

Setting Decision model.

Patients A cohort of patients aged 3 through 18 years enrolled in randomized controlled trials that compared analgesic modalities to facilitate peripheral intravenous cannulation was identified through medical databases searched from their inception (earliest year, 1966) through June 2007.

Main Outcome Measures The main outcome measure was the incremental cost-effectiveness ratio, which represented the additional cost that must be incurred by the hospital to obtain a reduction of 1 additional unit (10 mm or 1 cm) in the VAS score compared with a baseline option of no anesthetic.

Results Our results suggest that the needle-free jet injection of lidocaine device had the lowest incremental cost-effectiveness ratio, followed by intradermal injection of buffered lidocaine; lidocaine iontophoresis; nitrous oxide inhalation analgesia; a heated lidocaine and tetracaine patch; sonophoresis with lidocaine cream, 4%; lidocaine cream alone, 4%; and use of a eutectic mixture of lidocaine and prilocaine cream.

Conclusion Currently, the needle-free jet injection of lidocaine device and injection of buffered lidocaine appear to provide the most cost-effective alternatives to pediatric ED physicians.

Pediatric modified Seldinger

Wald et al (2008) describe the utilization of peripheral catheters in the placement of peripherally inserted  central catheters in children.

Wald, M., Happel, C.M., Kirchner, L., Jeitler, V., Sasse, M. and Wessel, A. (2008) A new modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters. European Journal of Pediatrics. 167(11), p.1327-9.

Abstract:

This study describes a modified Seldinger technique for 2- and 3-French peripherally inserted central venous catheters: A device similar to that used in heart catherisation with a standard micro-introducer serving as sheath and an arterial catheter serving as inner dilator was pushed forward over a wire guide that had before been inserted via a peripheral venous catheter. With this method 2-and 3-French catheters could be safely inserted into peripheral veins of 14 paediatric patients. In conclusion successful insertion of a small peripheral venous catheter offers in most cases a possibility for the placement of a central venous line.

Central venous access techniques

It is very interesting how terminology and the type of practitioners that are ‘allowed’ to be involved in central venous access device placement vary according to geographical location.

Marcy, P.Y. (2008) Central venous access: techniques and indications in oncology. European Radiology. 18(10), p.2333-44.

Abstract:

Long lines can be inserted centrally or peripherally through patent veins into the central venous system down to the atrial caval junction. Traditionally surgeons, anesthetists, cardiologists and more recently interventional radiologists have been placing them using vein cutdown or percutaneous needle puncture techniques. Typical candidates for implanted venous catheters are cancer patients undergoing long-term chemotherapy. The most important issues, in addition to the patency of central veins and the history of previous indwelling catheters, pacewires or venous thrombosis, are the patient’s performance status, body mass index, medical history and respiratory status, and the relevant technique. The present article will give an overview of the radiological and surgical implantation techniques and will highlight the impact of imaging means on the technical feasibility, assessment and treatment of device-related complications.

Safety syringe label

Schreiner MediPharm, a Germany-based global provider of specialty pharmaceutical labeling solutions for over 50 years, recently introduced the Needle-Trap system to help protect healthcare providers from accidental needlestick injuries that can occur with disposable syringes.

The Needle-Trap system features an integrated safety mechanism that is a component of the self-adhesive syringe label. This simple, economical design allows the needle to be safely and easily secured after it has been used and enables healthcare providers to use the same injection technique and disposal process as before. This functional label innovation has received FDA 510(k) clearance for marketing in the U.S. and has won an award from FINAT, the international label manufacturers’ and converters’ association.

Click here for more information on ICT.

Click here for the company product page.

 

Sharp safety device evaluation

This article describes issues that hospitals should consider when making decisions about the introduction of sharp safety devices.

Ford, J. (2008) How to evaluate sharp safety-engineered devices. Nursing Times. 104(36), p.42–45.

Abstract:

With increasing concerns of occupational exposure to bloodborne viruses in healthcare settings, NHS trusts are under pressure to consider opting for safer sharps devices that are designed to protect users from needlestick injuries. However, with an ever-increasing range of ’sharp safety’ devices on the market, deciding what to purchase is a complex issue. In addition, evidence shows that purchasing safety devices alone will not eliminate the problem of needlestick injuries. This article discusses the criteria that should be taken into account when trusts consider introducing sharp safety devices into their workplace. 

 

Venous access for oncology

Sara Wells has written two articles that discuss oncology and haematology patient vascular access needs. The first reviews literature that underpins vascular access device assessment. The second article describes vascular access assessment tools.

 

Wells, S. (2008) Venous access in oncology and haematology patients: part one. Nursing Standard. 22(52), p.39-46.

Abstract:

Reliable and sustained venous access is imperative for the successful treatment of patients with malignant disease. Its institution is achieved by the proactive assessment of patients’ venous access needs. Assessment tools may facilitate this process. This article presents a review of the literature on the three factors fundamental to assessment of patients’ venous access needs: patient characteristics, treatment characteristics and available devices. This literature review contributed to the development of two venous access assessment tools that can be used by nurses: the adult Venous Assessment Tool (VAT) and the algorithm Deciding on IntraVenous Access (DIVA). They are presented in part two of this article, which will be published next week.

 

 

Wells, S. (2008) Venous access in oncology and haematology patients: part two. Nursing Standard. 23(1), p.35-43.

Abstract:

 

AIM: To assess the validity and inter-rater reliability of two tools, Venous Assessment Tool (VAT) and Deciding on IntraVenous Access (DIVA), using thematic analysis of feedback from nurses who used the tools, METHOD: Analysis methods used in grounded theory were employed to investigate the written feedback provided by nurses. Inter-rater reliability was tested statistically using percentage agreement and the kappa (K) statistic. FINDINGS: Thematic analysis of the nurses’ feedback generated themes concerning the role of clinical judgement, how theory translates to practice and the role of patient preference when using VAT and DIVA. Exploring these themes confirmed the validity of the tools and highlighted the importance of these considerations when evaluating the usefulness of assessment tools in the clinical environment. When VAT was used by a group of nurses to assess patients, the strength of agreement statistically was ‘moderate’. When using DIVA, the tool demonstrated ‘very good’ agreement statistically. CONCLUSION: When used with oncology and haematology patients, VAT and DIVA have been shown to generate agreement among the nurses who used them beyond that which would be expected by chance. As the only tools of this kind with evidence of inter-rater reliability, they provide clinicians with a useful resource which can be used in practice or research. However, the use of assessment tools cannot replace clinical judgement or override the preferences of patients.

 

 

Medical device forum

In January 2008, Gill Brook – Medical Device Nurse Practitioner for Wrightington Wigan and Leigh NHS Trust and Rose Parker – Medical Device co-ordinator for St Helens and Knowsley NHS Trust launched our Best Practice forum for Medical Devices.

For several years the two had tried hard to make contact with other like-minded persons across the northwest undertaking the same/similar role. The idea behind this was to enable staff to share best practice, ideas and other issues related to medical devices and training.

Gill states “We made a decision early on to invite corporate people onto the forum this again was for the networking and to enable us to have people who could take our ideas back to companies we who were actually providing us with our medical devices. Over the last several months we have gone from strength to strength and membership has increased. But, we now feel that we are at a point were we would like to extend an invitation to any other people who feel they would benefit from the forum in particular representatives from the PCT to join us. If you are interested or just want to ask any questions please feel free to contact gill.brook@wwl.nhs.uk or rose.parker@sthk.nhs.uk“

Infusion pump malfunction

FDA informed healthcare professionals of the possibility that x-rays used during CT examinations may cause some implanted and external electronic medical devices to malfunction. Most patients with electronic medical devices undergo CT scans without any adverse consequences. However, the Agency has received a small number of reports of adverse events in which CT scans may have interfered with electronic medical devices, including pacemakers, defibrillators, neurostimulators, and implanted or externally worn drug infusion pumps.

Click here for the full FAD announcement.

3 million to reduce HAI’s

The Agency for Healthcare Research and Quality (AHRQ) today announced a three-year, $3 million national effort to reduce patients’ risk of hospital-associated infections in intensive care units (ICUs).

This first-of-its-kind project is modeled after the pioneering efforts of the Michigan Health & Hospital Association’s (MHA) Keystone Center for Patient Safety & Quality and Johns Hopkins University (JHU) Quality and Safety Research Group that have achieved significant and measurable improvements in reducing Central-Line Associated Bloodstream Infections (CLABSI) in Michigan hospital ICUs.

In 2003, the MHA Keystone Center launched its first patient safety improvement program – MHA Keystone: ICU – in more than 100 Michigan hospital ICUs. Through a series of back-to-basic patient safety interventions, this collaborative has since resulted in more than 1,700 lives saved, more than 127,000 excess hospital days avoided and more than $246 million in health care costs saved.

Click here for the full story on Marketwatch.

Prevention of line sepsis

Today representatives from the roundtable summit, “A Leadership Strategy for the Prevention of Line Sepsis,” released a policy statement outlining strategies for patients and healthcare professionals to reduce the incidence of line sepsis, a potentially fatal hospital-acquired infection that affects approximately 250,000 patients each year in the U.S. alone, according to the Centers for Disease Control and Prevention (CDC).

The summit engaged healthcare providers across disciplines, government agencies and constituency groups. The recommendations were announced by representatives from Association for Professionals in Infection Control and Epidemiology, Inc. (APIC), University HealthSystem Consortium and West Penn Allegheny Health System.

The recommendations developed independently by panel members call for patients, healthcare associations, government agencies and healthcare professionals to work collaboratively to drastically reduce line infection and include:

1. Standardized measurement and implementation of best practices

2. Expand patient education to foster greater involvement in their own healthcare

3. Cross-disciplinary team development and continuing education on best practices

4. Organizational leadership to support a culture of patient safety

5. Greater incentives for compliance and data transparency

Click here for the full story on Marketwatch.

Community IV specialist

Oxford Primary Care Trust are advertising for a Band 6 Community IV Therapy Specialist Liaison Nurse. The closing date for applications is October 24th 2008.

Applications are being accepted via www.jobs.nhs.uk reference 574-AN031DM

Needlefree injection

National Geographic News report that a Japanese inventor has developed Needle-free syringes that use air pressure or gases to deliver drugs, the inventor says he’s gone even further to cut costs and improve efficiency.

 

 

 

 

 

 

 

Infection control must improve

The risk of contracting infections at MountainView Hospital has been so great that it is in jeopardy of being dropped as a Medicare and Medicaid participant, according to a recent report by state health inspectors.

Inspectors reported multiple infection control violations at MountainView, including blood on the floor of a lab, a physician assistant contaminating equipment with bloody gloves and no system in place to track whether patients had picked up an infection after undergoing an outpatient endoscopy or cardiac catheterization procedure.

 

Other violations include:

• Leaking bags of intravenous fluids and a failure to dispose of old intravenous fluid bags.
• A phlebotomist drew blood from a patient and kept on her gloves while typing on a keyboard, effectively contaminating it. The woman then removed her gloves and sanitized her hands, but then typed on the same keyboard, contaminating her hands. She then put on a new pair of gloves and proceeded to draw blood from the next patient.

Click here for the full story.

 

Pediatric CRBSI reduction

Alliance for Pediatric Quality Promotes Four Proven Quality Improvement Initiatives. The goal of the Alliance is to bring about immediate, measurable change in the quality of care provided to children. The Alliance is a partnership of the American Academy of Pediatrics (AAP), the American Board of Pediatrics (ABP), Child Health Corporation of America (CHCA) and the National association of Children’s Hospitals and Related Institutions (NACHRI). 

The Alliance advocates the spread of these successful QI initiatives by leveraging the relationships, expertise and resources of the Alliance partners with the aim to improve care for as many children as possible, as quickly as possible. One of the the four QI initiatives is:  

• NACHRI Catheter-Associated Blood Stream Infections Initiative. In its first 15 months, this children’s hospital collaborative reduced PICU infections by 45 percent, prevented 275 infections, saved $9.3 million, and saved over 30 lives in 29 pediatric intensive care units. In April 2008, participating hospitals reached a 70 percent reduction in PICU infections.   

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Accelerated Seldinger at AVA

The Accelerated Seldinger Technique reduces the danger of air embolism while providing fail-safe needlestick protection and faster access. Those were among the conclusions of research presented at the annual conference of the Association for Vascular Access (AVA).

A talk by Steve Bierman, M.D., described the results of a study led by Bonnie Smith, R.N., manager of the IV therapy department at a Florida medical center. Smith’s research compared the Accelerated Seldinger Technique (AST) to the Modified Seldinger Technique (MST), a widespread, though sometimes problematic approach to placing central catheters.

The research, which compared the device to MST under simulated conditions, produced three results:

• Substantially fewer “open-to-air” events. There were 50% fewer “open-to-air” events with AST than with MST, indicating a reduced risk of air embolism.
• Needlestick safety. The WAND’s needlestick safety feature appeared to be failure-proof.
• Much faster speed of access. The time to complete AST — 11.3 seconds — was more than three times faster than the time to complete MST (38.8 seconds).

Click here for the full story on Marketwatch.