Home IV service Ireland

A new community IV service is being developed by the Health Service Executive (HSE Ireland) could end the need for hundreds of older people every year to be relocated to an emergency department when they need rehydration therapy and intravenous antibiotics.

On a visit to St Joseph’s Community Nursing Unit in Longford, HSE chief executive Professor Brendan Drumm said he would like to see the intravenous   therapy services available in all of the HSE’s 143 community nursing units across the country as soon as possible.

Full story here.

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Needlestick prevention award

“The award has been designed to reward and recognize health-care institutions that are committed to providing a safer environment to their patients and staff through the use of safety-engineered devices and programs,” said Kevin Egesborg, manager of healthcare worker safety for BD Canada, the company that presented the award, which also comes with a $500 grant to be used toward further health-care safety education.

From 2006/07 to 2007/08, the number of needle-stick injuries at OSMH dropped from 19 to 10. OSMH is one of 18 hospitals across Canada to win the award in 2008.

Click here for the full news item.

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Alcohol handwash and drink-driving

A New Zealand doctor has been convicted of drink-driving, despite blaming an alcohol handwash he used at work. Ian Denholm, 53, had pleaded not guilty to the charge, saying the surgical handwash put him over the legal limit.

The orthopaedic surgeon has been fined $275 (£180) and had his licence suspended for six months by a Wellington court. The doctor claimed his eczema provided an extraordinary ability to absorb alcohol in the hand wash gel he used to scrub up after operations.

Click here for the full story.

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Maximal sterile barrier precautions

Lee, D.H., Jung, K.Y., Choi, Y.H. (2008) Use of maximal sterile barrier precautions and/or antimicrobial-coated catheters to reduce the risk of central venous catheter-related bloodstream infection. Infection Control & Hospital Epidemiology. 29(10), p.947-50.

Abstract:

Central venous catheter-related bloodstream infection is clinically important because of its high mortality rate. This prospective study shows by multivariate analysis that the use of maximal sterile barrier precautions (odds ratio, 5.205 [95% confidence interval, 0.015-1.136]; P=.023) and the use of antimicrobial-coated catheters (odds ratio, 5.269 [95% confidence interval, 0.073-0.814]; P=.022) are independent factors associated with a lowered risk of acquiring a central venous catheter-related bloodstream infection.

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Vascular access in oncology

Gallieni, M., Pittiruti, M., Biffi, R. (2008) Vascular access in oncology patients. CA: a Cancer Journal for Clinicians. 58(6), p.323-46.

Abstract:

Adequate vascular access is of paramount importance in oncology patients. It is important in the initial phase of surgical treatment or chemotherapy, as well as in the chronic management of advanced cancer and in the palliative care setting. We present an overview of the available vascular access devices and of the most relevant issues regarding insertion and management of vascular access. Particular emphasis is given to the use of ultrasound guidance as the preferred technique of insertion, which has dramatically decreased insertion-related complications. Vascular access management has considerably improved after the publication of effective guidelines for the appropriate nursing of the vascular device, which has reduced the risk of late complications, such as catheter-related bloodstream infection. However, many areas of clinical practice are still lacking an evidence-based background, such as the choice of the most appropriate vascular access device in each clinical situation, as well as prevention and treatment of thrombosis. We suggest an approach to the choice of the most appropriate vascular access device for the oncology patient, based on the literature available to date.

Full text article here.

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Citrate reduces CRBSI

Winnett, G., Nolan, J., Miller, M. and Ashman, N. (2008) Trisodium citrate 46.7% selectively and safely reduces staphylococcal catheter-related bacteraemia. Nephrology Dialysis Transplantation. 23(11), p.3592-8.

Abstract:

Background. Trisodium citrate (TSC) 30% has been shown in a randomized control trial to be an effective antimicrobial catheter locking solution, able to significantly reduce catheter-related bacteraemia (CRB) in haemodialysis patients. Since that report, the formulation in Europe has been changed to 46.7% TSC without confirmatory data on efficacy. We report a 55 915 patient-day at risk experience in tunnelled lines of 46.7% TSC, emphasizing efficacy and changes in microbiology seen.

Methods. On 1 July 2006, inter-dialytic catheter locking solution was changed from 5000 IU/ml heparin to Citra-lockTM (46.7% TSC) in all haemodialysis patients at Barts and the London Renal Unit dialysing through an incident or prevalent tunnelled catheter. Prospectively collected blood culture data for the 6 months prior to the switch and 3 months at the end of the first year of TSC use were analysed. TSC tolerability was excellent with only a single withdrawal for intolerance of the agent. No major adverse events were reported.

Results. A major fall in CRB rates was noticed with a change from heparin (2.13/1000 catheter-days) in 2006 to TSC (0.81/1000 catheter-days) in 2007. This was due to significant reductions in staphylococcal CRB, true for sensitive, methicillin-resistant and coagulase-negative staphylococci. No increase in catheter malfunction was observed.

Conclusions. We found that 46.7% TSC is a safe, convenient and highly effective catheter locking solution, leading to significant reduction in CRB largely by preventing staphylococcal bloodstream infections. Given that Staphylococcus aureus in particular is associated with serious and often disseminated infection, TSC seems to be a powerful tool for dialysis units.

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Infection control surveillance methods

Rosenthal, V.D., Maki, D.G. and Graves, N. (2008) The International Nosocomial Infection Control Consortium (INICC): goals and objectives, description of surveillance methods, and operational activities. American Journal of Infection Control. 36(9), 36(9)(e1-12).

Abstract:

We have shown that intensive care units (ICUs) in countries with limited resources have rates of device-associated health care-associated infection (HAI), including central line–related bloodstream infection (CLAB), ventilator-associated pneumonia (VAP), and catheter-associated urinary tract infection (CAUTI), 3 to 5 times higher than rates reported from North American, Western European, and Australian ICUs. The International Nosocomial Infection Control Consortium (INICC) is an international ongoing collaborative HAI control program with a surveillance system based on that of the US National Healthcare Safety Network. The INICC was founded 10 years ago to promote evidence-based infection control in hospitals in limited-resource countries and in hospitals of developed countries without sufficient experience in HAI surveillance and control, through the analysis and feedback of surveillance data collected voluntarily by the member hospitals. It developed from a handful of South American hospitals in 1998 to a dynamic network of 98 ICUs in 18 countries, and is the only source of aggregate standardized international data on HAI epidemiology. Herein we report the criteria and mechanisms for gaining membership in INICC; the training of personnel in INICC hospitals; the INICC protocol for outcome surveillance of CLABs, VAPs, and CAUTIs in ICUs, microorganism profiles, bacterial resistance, antibiotic use, extra length of stay, extra costs, extra mortality, and risk factor analysis, and for process surveillance, including compliance rates for hand hygiene, vascular catheter care, urinary catheter care, and measures for prevention of VAP; and the use of surveillance data feedback as a powerful weapon for control of HAIs. The INICC will continue to evolve in its quest to find more effective and efficient ways to assess patient risk and improve patient safety in hospitals.

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Nosocomial infection control

Rosenthal, V.D., Maki, D.G., Mehta, A., Alvarez-Moreno, C., Leblebicioglu, H., Higuera, F., Cuellar, L.E., Madani, N., Mitrev, Z., Duenas, L., Navoa-Ng, J.A., Garcell, H.G., Raka, L., Hidalgo, R.F., Medeiros, E.A., Kanj, S.S., Abubakar, S., Nercelles, P. and Pratesi, R.D. (2008) International Nosocomial Infection Control Consortium report, data summary for 2002-2007, issued January 2008. American Journal of Infection Control. 36(9), p.627-37.

Abstract:

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from 2002 through 2007 in 98 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study, using Centers for Disease Control and Prevention (CDC) National Nosocomial Infections Surveillance System (NNIS) definitions for device-associated health care-associated infection, we collected prospective data from 43,114 patients hospitalized in the Consortium’s hospital ICUs for an aggregate of 272,279 days. Although device utilization in the INICC ICUs was remarkably similar to that reported from US ICUs in the CDC’s National Healthcare Safety Network, rates of device-associated nosocomial infection were markedly higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infections (CLABs) in the INICC ICUs, 9.2 per 1000 CL-days, is nearly 3-fold higher than the 2.4–5.3 per 1000 CL-days reported from comparable US ICUs, and the overall rate of ventilator-associated pneumonia was also far higher, 19.5 vs 1.1–3.6 per 1000 ventilator-days, as was the rate of catheter-associated urinary tract infection, 6.5 versus 3.4–5.2 per 1000 catheter-days. Most strikingly, the frequencies of resistance of Staphylococcus aureus isolates to methicillin (MRSA) (80.8% vs 48.1%), Enterobacter species to ceftriaxone (50.8% vs 17.8%), and Pseudomonas aeruginosa to fluoroquinolones (52.4% vs 29.1%) were also far higher in the Consortium’s ICUs, and the crude unadjusted excess mortalities of device-related infections ranged from 14.3% (CLABs) to 27.5% (ventilator-associated pneumonia).

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Central line insertion bundles

Bonello, R.S., Fletcher, C.E., Becker, W.K., Clutter, K.L., Arjes, S.L., Cook, J.J. and Petzel, R.A. (2008) Joint Commission Journal on Quality & Patient Safety. 34(11), p.639-45.

Abstract:

Background: Measured adherence to evidence-based best practice in the intensive care unit (ICU) setting, as in all of health care, remains unacceptably low. In 2005 to 2006, the VA Midwest Health Care Network used a quality improvement collaborative (QIC) model to improve adherence with ICU best practices in widely varying ICU and hospital settings in nine Department of Veterans Affairs (VA) hospitals.

Methods: Interdisciplinary performance improvement teams at each of the participating sites implemented evidence-based ventilator and central line insertion bundles, interdisciplinary team rounds, and use of a daily patient ICU bedside checklist.

Results: Adherence with all five elements of the ventilator bundle improved from 50% in the first three months to 82% in the final three months of the intervention. Mean ventilator-associated pneumonia (VAP) rates decreased by 41% over the same time frame. Use of a central line insertion checklist to monitor adherence with the central line bundle increased from 58% in the first three months to 74% in the final three months of the intervention. Mean catheter-related bloodstream infection (CRBSI) rates decreased by 48% over the same time frame. Following completion of the collaborative, eight of the nine sites continued to report on adherence with the ventilator and central line bundles, the practice of interdisciplinary team rounds, and the use of an ICU patient checklist. The incidence of VAP and CRBSI in these eight sites declined in the 12-month period following the collaborative’s completion, compared with the previous 12-month period.

Discussion: Implementing the ventilator and central line bundles was associated with a reduction in rates of VAPs and CRBSIs.

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Needle anxiety

Royle, J. and Wright, L. (2008) Needle anxiety in the clinic: a needs assessment. British Journal of Nursing. 17(20), p.1274-1279.

Abstract:

Background: A needs assessment for needle anxiety was carried out across people with either spinal cord injury (SCI) or spina bifida (SB). Aims: to identify the numbers of people reporting anxiety when having blood taken and being given injections; to explore individual beliefs; and to identify appropriate action. Method: A self-report questionnaire was developed for clinical use, piloted and administered across a 6-month period. Two-hundred and thirty-one questionnaires were returned (188 SCI group and 43 SB group). Data were analysed using SPSS. Results: There was a significant report of anxiety for both areas in both groups: 10–12% for SCI and 16–19% for SB. Eleven per cent of the SCI group and 19% of the SB group believed it was a problem for them; however, only 4% of each group identified they would want help. Conclusion: There is a clinical responsibility to address the level of need identified by this project. Six proposals are made to highlight awareness of this issue and provide guidance on strategies and interventions for patients and staff.

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Eye of the needle report

Research by the Health Protection Agency found more than three quarters of staff who have been put at risk of contracting hepatitis C had not been properly followed up.

Professor Mike Catchpole, Director of the Health Protection Agency’s Centre for Infections, said: “Although the numbers of reported healthcare workers infected with hepatitis C following their injury were few, these cases should never have occurred”.

” We all need to do everything we can to prevent occupational exposure injuries occurring. It is important for healthcare workers to report incidents of occupational exposure”.

“Testing and follow up checks are vital as infections can remain undetected for many years. However, our main aim should be doing everything we can to prevent occupational exposure injuries occurring in the first place”.

“Many incidents of occupational exposure can be prevented if there is proper adherence to standard precautions for the safe handling and disposal of clinical waste”.

No health professionals have contracted HIV through a needlestick injury since 1999.

The Eye of the Needle report is available at www.hpa.org.uk/needle

News report from the Telegraph.

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Alcohol hand gel adoption

Moody, L., Saint, S., Kaufman, S.R., Kowalski, C. and Krein, S.L. (2008) Adoption of Alcohol-Based Handrub by United States Hospitals: A National Survey. Infection Control & Hospital Epidemiology. 29(12), p.1177–1180.

Abstract:

The extent to which the use of alcohol-based handrub for hand hygiene has been adopted by US hospitals is unknown. A survey of infection control coordinators (response rate, 516 [72%] of 719) revealed that most hospitals (436 [84%] of 516) have adopted alcohol-based handrub. Leadership support and staff receptivity play a significant role in its adoption.

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Sharp injury in OR

Myers, D.J., Epling, C., Dement, J. and Hunt, D. (2008) Risk of Sharp Device–Related Blood and Body Fluid Exposure in Operating Rooms. Infection Control & Hospital Epidemiology. 29(12), p.1139–1148.

Abstract:

Objective.  The risk of percutaneous blood and body fluid (BBF) exposures in operating rooms was analyzed with regard to various properties of surgical procedures.

Design.  Retrospective cohort study.

Setting.  A single university hospital.

Methods.  All surgical procedures performed during the period 2001–2002 ( ) were included in the analysis. Administrative data were linked to allow examination of 389 BBF exposures. Stratified exposure rates were calculated; Poisson regression was used to analyze risk factors. Risk of percutaneous BBF exposure was examined separately for events involving suture needles and events involving other device types.

Results.  Operating room personnel reported 6.4 BBF exposures per 1,000 surgical procedures (2.6 exposures per 1,000 surgical hours). Exposure rates increased with an increase in estimated blood loss (17.5 exposures per 1,000 procedures with 501–1,000 cc blood loss and 22.5 exposures per 1,000 procedures with >1,000 cc blood loss), increased number of personnel ever working in the surgical field (20.5 exposures per 1,000 procedures with 15 or more personnel ever in the field), and increased surgical procedure duration (13.7 exposures per 1,000 procedures that lasted 4–6 hours, 24.0 exposures per 1,000 procedures that lasted 6 hours or more). Associations were generally stronger for suture needle–related exposures.

Conclusions.  Our results support the need for prevention programs that are targeted to mitigate the risks for BBF exposure posed by high blood loss during surgery (eg, use of blunt suture needles and a neutral zone for passing surgical equipment) and prolonged duration of surgery (eg, double gloving to defend against the risk of glove perforation associated with long surgery). Further investigation is needed to understand the risks posed by lengthy surgical procedures.

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Needlefree blood test

Doctors in New Zealand will soon have the option to test a patient’s haemoglobin level without taking a Read more

Venepuncture training

Shoeman, S., O’Connor, E.F., Harrison, R., Muirhead-Smith, A., Shah, M.A. and Ware, N. (2008) Venepuncture technique training vs practice: a survey of foundation year 1 doctors. British Journal of Hospital Medicine. 69(9), p.524-8.

This survey investigated potential disparity between foundation year 1 doctors’ formal undergraduate venepuncture training and their actual clinical practice. Is there still a high prevalence of needle and syringe use?

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Peripheral intravenous cannulation video

Ortega, R., Sekhar, P., Song, M., Hansen, C.J. and Peterson L. (2008) Peripheral Intravenous Cannulation. The New England Journal of Medicine. 359(21).

Since this article has no abstract, below are the first 100 words from the narration of this Video in Clinical Medicine and its chapter headings.

Peripheral Intravenous Cannulation Introduction: The ability to obtain peripheral intravenous access is an essential skill for all physicians. Although considered one of the simplest invasive procedures, mastering this potentially lifesaving intervention requires refined skills and experience. Cannulating a vein, particularly a small one, can be challenging. The purpose of this video is to demonstrate how to access peripheral veins using an intravenous catheter. Indications Peripheral intravenous catheterization is required in a broad range of clinical applications, including intravenous drug administration, for intravenous hydration, transfusions of blood or blood components, during surgery, during emergency care, and in other situations in which . . . 

• Introduction
• Indications
• Contraindications
• Anatomy
• Site Selection
• Equipment
• Preparation
• Procedure
• Troubleshooting
• Complications
• Summary

Click here for the video link - subscription to The New England Journal of Medicine may be required.

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Saline error child dies

Two year old Emily Jerry died at Rainbow Babies & Children’s Hospital after a pharmaceutical technician prepared her intravenous treatment with a 23 percent saline solution instead of a typical mix of less than 1 percent, according to the Ohio State Board of Pharmacy.

Eric Cropp is the Rainbow pharmacist whose task it was to oversee the unidentified technician that mixed the chemotherapy solution. Cropp faces a hearing before the pharmacy board over the incident. If found negligent, he could be fined or lose his license. Cropp, of Bay Village, no longer works for the hospital and could not be reached for comment.

The technician, who no longer works at the hospital, faces no action because Ohio is one of 17 states that does not regulate pharmaceutical technicians.

Click here for the full story.

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Needlestick in a general hospital

Zhang, M., Wang, H., Miao, J., Du, X., Li, T. and Wu, Z. (2008) Occupational exposure to blood and body fluids among health care workers in a general hospital, China. American Journal of Industrial Medicine. 10.1002/ajim.20645

Abstract:

Objectives: To understand current status of occupational exposure to blood and body fluids (BBF), and awareness of knowledge about occupational bloodborne pathogen exposures and universal precaution among hospital-based health care workers (HCWs).

Methods: A cross-sectional study was conducted during April to May 2004 to study incidence of occupational exposure to BBF among 1,144 hospital-based HCWs.

Results: The total incidence and the average number of episodes exposure to BBF was 66.3/100 HCWs per year and 7.5 per person per year in the past year, respectively. The incidence (per 100/HCWs per year) and the average number of episodes (per HCW per year) of percutaneous injury (PCI), mucous-membrane exposure (MME), and exposure to BBF by damaged skin was 50.3 and 1.8; 34.4 and 1.7; and 37.9 and 4.0, respectively. The leading incidence and the average number of episodes of PCI occurred in delivery room (82.6 and 1.8). The highest percentage of PCI’s that occurred during the previous 2 weeks occurred during a surgical operation (22.8%). Of all sharp instruments, the suture needle contributed the highest percentage of PCI’s (24.7%) among HCWs in the last 2 weeks. Over two-thirds (68.3%) of respondents were immunized with Hepatitis B vaccine; less than one-half (47%) of HCWs wore gloves while doing procedures on patients. The respondents demonstrated a lack of knowledge regarding transmission of bloodborne diseases and universal precautions.

Conclusions: Risk for potential exposure to BBF appears high in HCWs, and almost all of episodes are not reported. It is urgent to establish the Guideline for Prevention and Control of Occupational Exposure to Bloodborne Pathogens among HCWs. 

American Journal of Industrial Medicine.

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Occupational blood exposure

Leiss, J.K., Lyden, J.T., Mathews, R., Sitzman, K.L., Vanderpuije, A. Mav, D., Kendra, M.A., Klein, C. and Humphrey, C.J. (2008) Blood exposure incidence rates from the North Carolina study of home care and hospice nurses. American Journal of Industrial Medicine. 10.1002/ajim.20646

Abstract:

Background: Home care/hospice nurses may be at elevated risk of blood exposure because of the nature of their work and work environment. However, little is known about the incidence of blood exposure in this population.

Methods: A mail survey (n = 1,473) was conducted among home care/hospice nurses in North Carolina in 2006.

Results: The adjusted response rate was 69%. Nine percent of nurses had at least one exposure/year. Overall incidence was 27.4 (95% confidence interval: 20.2, 34.6)/100,000 visits. Nurses who had worked in home care 5 years had higher exposure rates than other nurses - seven times higher for needlesticks and 3.5 times higher for non-intact skin exposures. Nurses who worked part time/contract had higher exposure rates than nurses who worked full time - seven times higher for needlesticks and 1.5 times higher for non-intact skin exposures. The rates for part-time/contract nurses with 5 years experience were extremely high. Sensitivity analysis showed that it is unlikely that response bias had an important impact on these results.

Conclusions: Approximately 150 North Carolina home care/hospice nurses are exposed to blood annually. If these results are representative of other states, then approximately 12,000 home care/hospice nurses are exposed each year nationwide. Improved prevention efforts are needed to reduce blood exposure in home care/hospice nurses.

American Journal of Industrial Medicine.

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Needlestick injury report

The Royal College of Nursing said simple shielded needles could stop most accidents and protect nurses from infections such as HIV and hepatitis. But the poll of nearly 2,000 nurses in the UK suggests that nearly half do not have access to safer needle devices.

The RCN write “The RCN has called on the Government and employers in the NHS to introduce needle policies and invest in safer alternatives to traditional needles to prevent needlestick injuries occurring. The College’s comments follow the publication of an RCN report which found that nearly half of all nurses (48%) have been injured by a needle that had previously been used on a patient.

The report, entitled Needlestick Injury in 2008 highlighted the danger which nurses faced whilst carrying out their work, despite the fact that the majority of employer had a needlestick policy in place:

• 34% of respondents felt at risk of contracting diseases such as HIV and Hepatitis C following injuries.
• In 90% of cases, the injury drew blood.
• 28% of respondents did not receive any employer advice about the risk of blood-borne diseases after reporting an incident to their employer.
• Only 55% received any form of training from their employer on safer needle use.

Dr Peter Carter, Chief Executive & General Secretary of the Royal College of Nursing said:

“Government and employers in the NHS need to start taking this issue seriously by introducing needle policies and investing in safer alternatives to traditional needles, so that these accidents don’t happen in the first place. Nurses should also receive full support from their employers when they sustain an injury because no one wants to feel isolated and alone when going through such trauma”.

4,407 nurses responded to the RCN Needlestick Injury in 2008 survey published in the RCN’s fortnightly Bulletin magazine and a further 320 nurses completed an online survey. The RCN says it is now looking forward to working with the Government, regulators and employers to address the issue. The report was launched to MPs, peers and stakeholders at the House of Commons yesterday (18 November 2008).

Read the RCN needlestick injury 2008 report.

More on the BBC news channel.

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A day with Annette Jeanes at UCLH

Alice Miles in the Timesonline reports on “Spending a day with the woman charged with keeping back the tide of infection at University College London Hospital”.

She writes “Most people’s daily briefings are mundane: some sales figures perhaps, a bit of staff news, an IT change. For Annette Jeanes, it is about life and death: the death of a person, the life of a bug. Her daily meeting with the hospital’s microbiologists sounds like a list of everything you or I would hope never to meet. You may not understand the words, but you know they are bad”.

Later she continues with a comment from Dr Vanya Gant, a consultant in microbiology and infection “Completely supportive of Jeanes, he said other staff regard her as a “rock-eating bitch”. (“That’s true,” she replied. “I don’t mind.”) “We have people with world-class skills,” said Dr Gant. “These people are world leaders, very often they are unique and to a certain degree they spin around their own axis with justification. So when we come along and say, ‘great surgery, mate, wash your hands’ - you get the point.”

Click here for the full news story.

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IV errors result in misconduct hearing

A nurse allegedly made a series of clinical mistakes, a Nursing and Midwifery Council (NMC) misconduct hearing was told yesterday.

Anitha Kuttappan, 52, is said to have failed to administer an intravenous infusion, used a 2ml syringe instead of a 10ml syringe to administer intravenous drugs. Elizabeth Forbes, for the NMC, said that Kuttappan also “had forgotten to bring with her a bung to close the exposed implanted port. She left the port exposed for approximately 10 minutes.”

The hearing continues.

Click here for the full news story.

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Peripheral IV pain management

Leahy, S., Kennedy, R.M., Hesselgrave, J., Gurwitch, K., Barkey, M. and Millar T.F. (2008) On the front lines: lessons learned in implementing multidisciplinary peripheral venous access pain-management programs in pediatric hospitals. Pediatrics. 122, Supplement 3, p.S161-70.

Abstract:

Venipuncture and intravenous cannulation are among the most common and widespread medical procedures performed on children today. Therefore, effective treatment of venous access pain can benefit from an integrated systems approach that enlists multiple players in the health care system. By using case studies that analyze this issue from the perspective of the nurse, the physician, the pharmacist, and the child life specialist, this article illustrates how multidisciplinary programs designed to manage needle pain have been developed successfully in several institutions. Common themes that arise from these case studies include the importance of a multidisciplinary evidence-based approach to advocate change; a system-wide protocol for the administration of local anesthetics; convenient access to topical local anesthetics; department and hospital-wide support for educational efforts, including training in nonpharmacologic techniques used by child life specialists; and ongoing quantification of the overall success of any program. Implementation of these strategies can result in significant improvements in the pediatric venous access experience.

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Needlestick pain

Kennedy, R.M., Luhmann, J. and Zempsky, W.T. (2008) Clinical implications of unmanaged needle-insertion pain and distress in children. Pediatrics. 122, Supplement 3, p.S130-3.

Abstract:

Increasing evidence has demonstrated that pain from venipuncture and intravenous cannulation is an important source of pediatric pain and has a lasting impact. Ascending sensory neural pain pathways are functioning in preterm and term infants, yet descending inhibitory pathways seem to mature postnatally. Consequently, infants may experience pain from the same stimulus more intensely than older children. In addition, painful perinatal procedures such as heel lancing or circumcision have been found to correlate with stronger negative responses to venipuncture and intramuscular vaccinations weeks to months later. Similarly, older children have reported greater pain during follow-up cancer-related procedures if the pain of the initial procedure was poorly controlled, despite improved analgesia during the subsequent procedures. Fortunately, both pharmacologic and nonpharmacologic techniques have been found to reduce children’s acute pain and distress and subsequent negative behaviors during venipuncture and intravenous catheter insertion. This review summarizes the evidence for the importance of managing pediatric procedural pain and methods for reducing venous access pain.

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Venipuncture pain reduction

Zempsky, W.T., Robbins, B. and McKay, K. (2008) Reduction of Topical Anesthetic Onset Time Using Ultrasound: A Randomized Controlled Trial Prior to Venipuncture in Young Children. Pain Medicine. 9(7), p.795-802.

Abstract:

Background. Ultrasound treatment prior to topical anesthetic application has been shown to speed anesthesia onset by enhancing anesthetic penetration into the skin.

Objective. To evaluate a low-frequency ultrasound device to facilitate absorption of topical anesthetic in young children who require venipuncture.

Methods. This was a prospective controlled comparison of analgesic effect of a 5-minute application of liposomal lidocaine cream after ultrasound treatment, with a 30-minute application of liposomal lidocaine cream, in children aged 3 to 7 years undergoing venipuncture. Children rated the pain of the venipuncture using the Wong-Baker FACES Pain Rating Scale (FACES) (0 = no pain, 10 = maximal pain), and parents rated their child’s pain using a 100-mm (0 = no pain, 100 = maximal pain) visual analogue scale (VAS). Venipuncture skin sites were evaluated for effect immediately posttreatment, and at 24 to 72 hours post phlebotomy.

Results. Seventy subjects were enrolled: the first 10 patients comprised a pilot series, receiving the ultrasonic treatment and liposomal lidocaine cream; the next 60 subjects were randomized, including 29 allocated to the ultrasound treatment group, and 31 randomized to the 30-minute control treatment with liposomal lidocaine cream. Demographics were similar between the two groups. Mean child’s FACES scale results were similar: Ultrasound group 4.78 (95% CI; 3.06, 6.52), Control group 4.32 (95% CI; 2.82, 5.82) (P = 0.72); and mean parent VAS scores were also the same: Ultrasound: 19.1 (95% CI; 10.3, 27.8), Control: 23.2 (95% CI; 14.7, 31.7) (P = 0.87). Skin effects immediately after ultrasound were limited to minor redness in 9/39 children and significant redness in 2/29 patients.

Conclusion. Ultrasound treatment speeds time of onset of liposomal lidocaine cream anesthesia in young children undergoing venipuncture. Side effects were mild in our population.

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Central venous catheter-related infection guidelines

Wolf, H.H., Leithauser, M., Maschmeyer, G., Salwender, H., Klein, U., Chaberny, I., Weissinger, F., Buchheidt, D., Ruhnke, M., Egerer, G., Cornely, O., Fatkenheuer, G. and Mousset, S. (2008) Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Annals of Hematology. 87(11), p.863-76.

Abstract:

Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.

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Ultrasound basilic vein cannulation

Rose, J.S. and Norbutas, C.M. (2008) A randomized controlled trial comparing one-operator versus two-operator technique in ultrasound-guided basilic vein cannulation. Journal of Emergency Medicine. 35(4), p.431-5.

Abstract:

The basilic vein offers an alternative site for peripheral intravenous access for emergency access. The use of a two-operator ultrasound-guided basilic vein cannulation technique has been shown to be a safe and effective technique for use on Emergency Department patients. However, the one-operator technique is more customary by other services. We sought to compare the more customary one-person technique to the two-person technique in basilic vein cannulation in novice operators. This was a prospective, randomized controlled trial of two techniques of ultrasound-guided basilic vein cannulation (one-operator vs. two-operators) in healthy adult volunteers. Each volunteer underwent each technique, one technique on each arm. We selected the initial arm and technique using computer-generated block randomization. In the one-operator technique, a single operator held the transducer in transverse short-axis plane while attempting cannulation using a 20-gauge, 1.88-inch catheter. In the two-operator technique, a second operator held the transducer in place while the first operator attempted cannulation. The primary outcome variable was first-attempt cannulation success. Secondary outcome variables were overall success, number of attempts, time-to-cannulation, complications, and ease-of-technique rated by the operators. There were 32 subjects enrolled. One-operator first-attempt success was 18/32 (56%); two-operator was 21/32 (65%), with a mean difference in proportion of -9% (95% confidence interval [CI] -33-14%). Overall success for one operator was 23/32 (72%) and two-operator was 24/32 (75%), with mean difference in proportion of -3% (95% CI -24-18). The median number of attempts for one-operator was 1.6 (interquartile range [IQR] 1-5) and two-operator was 1.4 (IQR 1-5) (p = 0.8). Time to cannulation for one-operator was 57 s (+/- 62) and two-operator was 44 s (+/- 37) (p = 0.33). The median score for ease-of-technique for one-operator was 4.3 (IQR 1-6) and for two-operator was 3.6 (IQR 1-6) (p = 0.26). There were no complications with either technique (95% CI 0-10%). Novice operators can reliably perform a basilic vein cannulation using ultrasound guidance. However, we were unable to demonstrate any advantage for any particular technique in cannulating the basilic vein.

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Free EPIC2 conference 2009

A FREE intravenous therapy study day aimed at helping your hospital implement national guidelines in preventing bloodstream infections is announced. This national programme in January has been jointly developed by the Infection Prevention Society (IPS) and the EPIC2 authors/Thames Valley University. 

Each day is chaired by Martin Kiernan, President of the Infection Prevention Society and speakers include Andrew Jackson IV Nurse Consultant, Carol Pellowe – Principal Lecturer at Thames Valley University, Yvonne Curran – Nurse Consultant Infection Control, Health Protection Scotland and many other high profile speakers. It is free to all healthcare workers and includes educational handouts and all catering.

Register early - spaces are limited to 150 per venue:

• Newcastle 15th January 2009
• Glasgow 16th January 2009
• Dublin 19th January 2009
• Belfast 20th January 2009

To register free visit www.fitwise.co.uk/events_2008.htm or click here to complete a paper application.

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Intramuscular injection in neonates

Kashaninia, Z., Sajedi, F., Rahgozar, M. and Noghabi, F.A. (2008) The effect of kangaroo care on behavioral responses to pain of an intramuscular injection in neonates. Journal for Specialists in Pediatric Nursing. 13(4), p.275-280.

Abstract:
PURPOSE. This study aims to assess the efficacy of Kangaroo Care (KC) on behavioral responses of term neonates to the pain of an intramuscular injection. DESIGN AND METHODS. One hundred healthy term neonates were enrolled and randomly assigned to intervention and control groups. In the intervention group, the neonate was held in KC for 10 min before the injection and remained in KC for the duration of the procedure. The primary outcome measure was the cumulative Neonatal Infant Pain Scale (NIPS) score immediately after injection. RESULTS. The cumulative NIPS score immediately after injection in the intervention group was significantly lower (p < .001) than in the control group. PRACTICE IMPLICATIONS. KC given before injection seems to effectively decrease pain and should be considered for minor invasive procedures in neonates.
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Injection site reactions

Jolly, H., Simpson, K., Bishop, B., Hunter, H., Newell, C., Denney, D. and Oleen-Burkey, M. (2008) Impact of warm compresses on local injection-site reactions with self-administered glatiramer acetate. Journal of Neuroscience Nursing. 40(4), p.232-239.

Abstract:

Patients with multiple sclerosis (MS) report a number of adverse events related to immunomodulator injections, including local injection-site reactions (LISRs). Reactions characterized by pain, swelling, redness, or inflammation have been experienced by patients who self-inject glatiramer acetate, interferon beta-1b, or interferon beta-1a. Although these reactions rarely are serious, they can foster negative attitudes about self-injection and undermine a patient’s commitment to treatment, especially in the early stages of therapy. This randomized crossover study of 50 patients who had initiated or restarted glatiramer acetate therapy within the 3 months before the study examined whether applying a warm compress to the injection site before self-injection would lower the incidence of LISRs compared with the patients’ usual methods of injection preparation. Fewer LISRs were reported both 2 minutes and 5 minutes postinjection when warm compresses were used compared with the usual injection-site preparation (p < .001). Patients also were less bothered by LISRs when using warm compresses, as shown by mean scores on the Bothersome Scale (p = .02). Because warm compresses are easy to apply and appear to be at least modestly effective, they should be considered when recommending alternatives for patients who experience LISRs associated with glatiramer acetate. Warm compresses may be of particular benefit for those who have recently begun therapy with glatiramer acetate to help improve the likelihood of adherence to long-term treatment.

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Snapped needles

China said on Friday it had recalled a batch of disposable medical needles after one snapped when inserted into an infant’s vein. Health organizations were ordered to stop using the needles, made by a Shanghai-based firm, after tests on another six from the same batch showed they all broke easily. The incident with the needle was reported by a maternity center in southeastern Guangdong province in mid-October.

Click here to view the full story.

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IV conference from IPS 2009

The IPS are celebrating the past and looking at the future. The annual Infection Prevention Society conference and exhibition will celebrate fifty years of infection prevention and control nursing. As part of the celebrations an Intravenous Therapy Conference will run concurrently with the IPS conference and exhibition. The IPS conference and exhibition will take place at the Harrogate International Centre from the 21st to the 23rd September 2009. Further details of the IV conference will be announced shortly.

If you are interested in joining the IPS IV Forum email ips@fitwise.co.uk

Visit the IPS website at www.ips.uk.net

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3rd national joint HAI conference

The 3rd  national joint conference on healthcare associated infection is announced. The conference ‘Everybody’s role, everybody’s responsibility: reducing infection across the community’ will take place on Wednesday 14th January 2009 at the Majestic Hotel, Harrogate.

The Department of Health, the Royal College of Nursing and the National Patient Safety Agency are committed to joint professional working which promotes and facilitates patient safety. This is the third joint national conference, and is aimed at all levels of health care professionals and clinicians who wish to reduce levels of HCAI. Our speakers will explore the current position in relation to HCAI and how we can further improve standards of care through collaborative working with our partner organisations.

Click here for the conference flyer and booking form.

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Hickman line pneumothorax

Following the insertion of a “Hickman’ type tunneled silastic catheter a patient developed a pneumothorax which contributed to his death. Black Country coroner Robin Balmain, sitting in Walsall, ruled Mr Shakespeare died of natural causes, however, the family has promised to take legal action.

Mr Balmain said: “I’m perfectly satisfied Mr Shakespeare had excellent care at the hospital – clearly he was very ill. My verdict is that he died of natural causes, contributed to by a known, if rare, complication of this elective surgical procedure.”

Victoria Blankstone, the Shakespeare family solicitor from Birmingham law firm Irwin Mitchell, said: “We believe there were significant failings – in particular the decisions to send Alan home while he still had both a chest infection and MRSA and then, when he was readmitted, to insert a Hickman line that inadvertently penetrated his right lung resulting in a pneumothorax”.

Click here for the full story.

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Differential time to positivity

Acuna, M., O’Ryan, M., Cofre, J., Alvarez, I., Benadof, D., Rodriguez, P., Torres, M.T., Aguilera, L. and Santolaya, M.E. (2008) Differential time to positivity and quantitative cultures for noninvasive diagnosis of catheter-related blood stream infection in children. Pediatric Infectious Disease Journal. 27(8), p.681-5.

Abstract:

BACKGROUND: Accurate diagnosis of catheter-related blood stream infection (CRBSI) is necessary to make a decision about removal of the catheter. Differential time to positivity (DTP) and the ratio of quantitative cultures (RQC) between central and peripheral blood cultures have not been evaluated against a strict standard in children, namely catheter tip culture. OBJECTIVE: Our aim is to compare DTP and RQC in the diagnosis of catheter tip-confirmed catheter-related infection in children. METHOD: Prospective study performed in 2 large hospitals in Santiago, Chile. Children with clinically suspected CRBSI had 2 peripheral and central vein blood samples obtained for automated culture in Bact/Alert and for quantitative cultures in 5% sheep blood agar plate. The catheter tip was cultured. Sensitivity, specificity, positive predictive value, negative predictive value, likelihood ratios (LR), and accuracy of DTP and RQC were compared against catheter tip-confirmed CRBSI. RESULTS: During a 3-year period, 344 clinically suspected CRBSIs were diagnosed in children of which 124 episodes met study criteria. Catheter tip culture-confirmed CRBSI in 25 (20%) of 124 episodes. A total of 34 microorganisms were cultured from 25 CRBSI; 8 of 25 (32%) episodes were polymicrobial. Staphylococcus aureus followed by coagulase-negative Staphylococcus were the most common microorganisms. For CRBSI, DTP and RQC reached a sensitivity of 75% versus 24% (P < 0.001), specificity of 86 versus 94%, positive predictive value of 58% versus 50%, negative predictive value of 93% versus 82%, LR of 5.48 versus 4.50, and accuracy of 0.84 versus 0.79. CONCLUSIONS: In children, DTP was better than RQC for diagnosis of catheter tip-confirmed CRBSI.

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Central venous catheter guidelines

Freel, A.C., Shiloach, M., Weigelt, J.A., Beilman, G.J., Mayberry, J.C., Nirula, R., Stafford, R.E., Tominaga, G.T. and Ko, C.Y. (2008) American College of Surgeons Guidelines Program: a process for using existing guidelines to generate best practice recommendations for central venous access. Journal of the American College of Surgeons. 207(5), p.676-682.

Abstract:

Background: Many professional organizations help their members identify and use quality guidelines. Some of these efforts involve developing new guidelines, and others assess existing guidelines for their clinical usefulness. The American College of Surgeons Guidelines Program attempts to recognize useful surgical guidelines and develop research questions to help clarify existing clinical guidelines.

We used existing guidelines about central venous access to develop a set of summary recommendations that could be used by practitioners to establish local best practices.

Study Design: A comprehensive literature search identified existing clinical guidelines for short-term central venous access. Two reviewers independently rated the guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Highly scored guidelines were analyzed for content, and their recommendations were compiled into a summary table. The summary table was reviewed by an independent panel of experts for clinical utility.

Results: Thirty-two guidelines were identified, and 23 met inclusion criteria. The AGREE rating resulted in four guidelines that were strongly recommended and five that were recommended with alterations. Three comprehensive tables of recommendations were produced: procedural, maintenance, and infectious assessment. A panel of experts came to consensus agreement on the final format of the best practice recommendations, which included 30 summary recommendations.

Conclusions: Our process combined assessing existing guidelines methodology with expert opinion to produce a best practice list of guidelines that could be fashioned into local care routines by practicing physicians. The American College of Surgeons guidelines program believes this process will help validate the clinical utility of existing guidelines and identify areas needing further investigation to determine practical validity.

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Antimicrobial central venous catheter

Lorente, L., Lecuona, M., Ramos, M.J., Jimenez, A., Mora, M.L. and Sierra, A. (2008) The use of rifampicin-miconazole-impregnated catheters reduces the incidence of femoral and jugular catheter-related bacteremia. Clinical Infectious Diseases. 47(9), p.1171-5.

Abstract:

BACKGROUND: The guidelines of the Centers for Disease Control and Prevention do not recommend the use of an antimicrobial- or antiseptic-impregnated catheter for short-term use. In previous studies, we have found a higher incidence of central venous catheter-related bacteremia among patients with femoral and central jugular accesses than among patients with other venous accesses. OBJECTIVE: The objective of our study was to determine the incidence of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters and standard catheters in patients with femoral and central jugular venous accesses. METHODS: This was a cohort study, conducted in the 24-bed polyvalent medical-surgical intensive care unit of a university hospital. We included patients who were admitted to the intensive care unit from 1 June 2006 through 30 September 2007 and who underwent femoral or central jugular venous catheterization. RESULTS: We inserted 184 femoral (73 rifampicin-miconazole-impregnated catheters and 111 standard catheters) and 241 central jugular venous catheters (114 rifampicin-miconazole-impregnated catheters and 127 standard catheters). We found a lower rate of central venous catheter-related bacteremia associated with rifampicin-miconazole-impregnated catheters than with standard catheters among patients with femoral access (0 vs. 8.62 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.86; P = .03) and among patients with central internal jugular access (0 vs. 4.93 cases per 1000 catheter-days; odds ratio, 0.13; 95% confidence interval, 0.00-0.93; P = .04). CONCLUSIONS: Rifampicin-minonazole-impregnated catheters are associated with a statistically significant reduction in the incidence of catheter-related bacteremia in patients with short-term catheter use at the central jugular and femoral sites.

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Central venous catheter choice

Graham, J., Hiremath, S., Magner, P.O., Knoll, G.A. and Burns, K.D. (2008) Factors influencing the prevalence of central venous catheter use in a Canadian haemodialysis centre. Nephrology Dialysis Transplantation. 23(11), p.3585-3591.

Abstract:

Background. The arteriovenous (AV) fistula is the optimal vascular access for chronic haemodialysis (HD) patients. The Dialysis Outcomes and Practice Patterns Study (DOPPS II) reported a high use of central venous (CV) catheters for HD in Canadian centres. We studied factors influencing the choice of access in a prevalent HD population at a Canadian centre.

Methods. This was a cross-sectional study of all HD patients at the Ottawa Hospital (Ottawa, Canada). Demographic information, the type of HD vascular access used and the factors influencing access choice were obtained from medical records. Nephrologists at the Ottawa Hospital were surveyed to identify attitudes that might influence the choice of HD access.

Results. In the survey of nephrologists (n = 17), there was 100% agreement that the AV fistula is the optimal HD access. In 599 prevalent chronic HD patients, AV fistulae were used in 58.0% (n = 347), CV catheters in 39.7% (n = 238) and only 2.3% had AV grafts (n = 14). By multivariate logistic regression, female gender, peripheral vascular disease and shorter duration of HD were independent predictors of CV catheter use. Of the patients with CV catheters, 68.9% had vascular factors or medical contraindications that precluded AV fistula creation. System/resource limitations influenced choice of access in only 19.3% of patients with CV catheters, although these factors were more important in patients within the first 6 months of HD initiation.

Conclusions. The relatively high prevalence of CV catheter use at our HD centre is due mainly to patient-specific factors (e.g. unsuitable vessels or medical co-morbidities), rather than resource limitations or physician attitudes. Target setting for AV fistula use requires consideration of these factors as well as the effect of HD duration.

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Vascular access complications

Zaritsky, J.J., Salusky, I.B., Gales, B., Ramos, G., Atkinson, J., Allsteadt, A., Brandt, M.L. and Goldstein, S.L. (2008) Vascular access complications in long-term pediatric hemodialysis patients. Pediatric Nephrology. 23(11), p.2061-5.

Abstract:

Current data demonstrate pediatric patients who remain on hemodialysis (HD) therapy are more likely to be dialyzed via central venous catheters (CVCs) than arteriovenous grafts (AVGs) and fistulae (AVFs). We retrospectively compared complications and health-related quality of life (HRQOL) associated with different vascular access types at two large centers over a 1-year period. Patients included in the study were younger than 25 years of age, weighed >20 kg, and had received HD for at least 3 months. Thirty CVC patients and 21 AVG/AVF patients received a total of 2,393 and 3,506 HD treatments, respectively. The infectious complication rate was higher for CVC patients, who were hospitalized 3.7 days for each 100 HD treatments versus 0.2 days for AVG/AVF patients (p < 0.01). CVC patients also had a much higher rate of access revision, needing 2.7 hospital days every 100 HD treatments compared with 0.2 days for AVG/AVF patients (p < 0.01). HRQOL scores did not differ between groups. Thus, despite similar HRQOL, CVCs were associated with more complications and greater morbidity when compared with AVG/AVFs. These findings further emphasize the need to use AVG/AVFs as primary HD access for pediatric patients expected to receive a long course of maintenance HD.

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Central venous catheter-associated infections

Zingg, W., Cartier-Fassler, V., Walder, B. (2008) Central venous catheter-associated infections. Best Practice & Research Clinical Anaesthesiology.22(3), p.407-421.

Abstract:

Most patients in the hospital need vascular access: a peripheral venous line, a short-term non-cuffed central venous catheter (CVC), a long-term cuffed CVC, an implantable port or an arterial line. Such devices, although often indispensable and of benefit, may have the disadvantage of mechanical complications, local exit-site infections or catheter-associated bloodstream infections (CRBSI). Apart from peripheral venous lines, non-cuffed CVCs are the most frequent catheter type in hospitals. The risk for CRBSI of such catheters is high with an incidence density of 2 to 7 episodes per 1000 catheter-days depending on ward-type, institution and geographical region. This review describes the epidemiology, the frequency and the risk of CRBSI among non-cuffed CVCs, provides accepted definitions as well as descriptions of diagnostic techniques and highlights various prevention measures.

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Central venous catheter outcomes

Zganjer, M., Cizmic, A., Butkovic, D., Matolic, M., Karaman-Ilic, M. and Stepan, J. (2008) Central Venous Catheters for Chemotherapy of Solid Tumors – Our Results in the Last 5 Years. Collegium Antropologicum. 32(3), p.767-770.

Abstract:

Central venous catheters provide an easy access for intravenous medications. Having a central line in place will relieve a child from the discomfort and danger of multiple regular intravenous lines for chemotherapy. The use of indwelling central venous catheters has become commonplace in the management of children undergoing oncological treatment.

There are two types of central lines commonly used. There are Broviac catheters and Port-A-Cath (PAC) catheters. In the last 5 years we inserted 194 catheters in 175 children. We inserted 121 Broviac catheters and 73 PAC catheters. During the follow up of 39382 catheter days 44 complications were observed. In Broviac group the median follow up was 155 days and in PAC group was 230 days. We observed differences in the incidence between two devices. In Broviac group infections were more frequent and in PAC group other complications were more frequent than infections.

Click here for full text pdf.

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CRBSI catheter comparison

Lorente, L., Jimenez, A., Garcia, C., Galvan, R., Castedo, J., Martin, M.M. and Mora, M.L. (2008) Catheter-related bacteremia from femoral and central internal jugular venous access. European Journal of Clinical Microbiology & Infectious Diseases. 27(9), p.867-871.

Abstract:

The objective of this prospective observational study was to determine the influence of femoral and central internal jugular venous catheters on the incidence of catheter-related bacteremia (CRB). We included patients admitted to a 12-bed polyvalent medico-surgical intensive care unit over 4 years who received one or more femoral or central internal jugular venous catheters. We diagnosed 16 cases of CRB in 208 femoral catheters and 22 in 515 central internal jugular venous catheters. We found a higher incidence of CRB with femoral (9.52 per 1,000 catheter days) than with central internal jugular venous access (4.83 per 1,000 catheter days; risk ratio = 1.93; 95% confidence interval: 1.03–3.73; P = 0.04). Central internal jugular venous access could be considered a safer route of venous access than femoral access in minimizing the risk of central venous catheter-related bacteremia.

Click here for a full text preview.

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Alternative vascular access technique

Chen, P.T., Yen, C.R., Wang, C.C., Sung, C.S., Chang, W.K. and Chan, K.H (2008) A Modified Supraclavicular Approach for Central Venous Catheterization by Manipulation of Ventilation in Ventilated Patients. Seminars in Dialysis. 21(5). p.469-473.

Abstract:

Background: Because of overuse and multiple implantations of hemodialysis catheters through internal jugular or subclavian vein (SCV) in patients with chronic hemodialysis, these veins often become stenotic or occlude, therefore necessitating alternative access. We introduce a new technique in ventilated patients for placement of tunneled cuffed chronic hemodialysis catheter: modified supraclavicular approach by cease of ventilation.

Methods: Patients who received implantation of the tunneled cuffed chronic hemodialysis catheters by supraclavicular approach were collected from February 2003 to July 2005. Right subclavian, right innominate or left SCVs were accessed through the supraclavicular approach for catheter insertion. The procedures were performed by certificated anesthesiologists. The following parameters were recorded: co-morbidities, laboratory examinations before the procedure, method for catheterization, duration of procedure, complications related to catheterization and long-term outcome of hemodialysis catheters.

Results: Eleven catheters were inserted in nine patients (two patients received twice) by supraclavicular approach during this period. All patients were mechanically ventilated and these catheters (seven at right and four at left) were implanted using the modified supraclavicular approach with lung deflation during venipuncture, advance of guidewire, and insertion of catheter. There were no procedural complications. The average duration of whole procedure was 36.6 minutes (30-45  minutes) and the mean catheter survival days were 62.1 days (13-152 days). The estimated duration was <1 minute of each period of lung deflation. There were no desaturation or pneumothorax during the whole procedure.

Conclusion: The modified supraclavicular approach with lung deflation for tunneled cuffed chronic hemodialysis catheter in ventilated patients is at least as effective as traditional approach and can be easily performed by surgeons as well as experienced physicians. Based on the results, this simplified technique using lung deflation may be particularly useful to decrease procedural complications.

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Hand hygiene compliance

Pan, A., Domenighini, F., Signorini, L., Assini, R., Catenazzi, P., Lorenzotti, S., Patroni, A., Carosi, G. and Guerrini, G. (2008) Adherence to hand hygiene in an Italian long-term care facility. American Journal of Infection Control. 36(7), p.1527-3296.

Abstract:

In an Italian long-term-care facility (LTCF), we observed a 17.5% adherence to hand hygiene (HH), as well as 47.5% rate of glove use. Performing a procedure at high risk for cross-transmission of germs was the factor most strongly associated with noncompliance (odds ratio = 13.3; 95% confidence interval = 6.2 to 28.8; P.

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Dialysis conference 2009

The Annual Dialysis Conference: the Twenty-ninthth Annual Conference on Peritoneal Dialysis, Fifteenth International Symposium on Hemodialysis and Twentieth Annual Symposium on Pediatric Dialysis is presented by the University of Missouri School of Medicine, Department of Internal Medicine, Division of Nephrology; Continuing Medical Education; the University of Missouri-Columbia Sinclair School of Nursing; and the Academy for Postgraduate Health Care Education.

This conference convenes an international group of practitioners and researchers to discuss current developments in the field of dialysis. The conference is designed for health professionals involved in established dialysis programs, as well as those working in new and developing programs. Both researchers and clinicians will find sessions of interest to them. Extensive commercial exhibits give participants a chance to see for themselves what is new in PD and HD products.

Click here for the conference brochure.

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Insulin pump design

Juri Bukvald has designed an insulin pump with an original design with a clear function, simple and perfect shaping. Juri states… “For a diabetic is vital to know his or her sugar level in the blood. Therefore I designed a large OLED display placed on a clip so it would be always legible and clear. The integrated clip makes the pump suitable for comfortable wearing. The large numbers on display show sugar blood and the darts represent rate and direction of sugar level.

Click here for the full story.

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Clinical skills conference

The Third International Clinical Skills Conference organisers invite the submission of abstracts on papers for presentation at the conference. Abstracts should relate to research in clinical skills education at undergraduate, postgraduate and continuing health professional levels.

The Third International Clinical Skills Conference is in Prato, Tuscany and will look at researching clinical skills and showcasing best practice for students and practitioners.

Important Dates

 

• Abstracts due: Sunday, 7th December 2008
• Abstracts notification: Friday, 6th February 2009
• Conference dates: Wednesday, 1st July – Saturday, 4th July 2009

 

Abstracts for should relate to one or more of the following topics:

 

• Which research strategies can advance the clinical skills movement?
• Solution Research in clinical skills
• Transfer factors : from sim