Happy New Year from IVTEAM
December 31, 2008
Happy New Year to all those people who visit IVTEAM. We hope you have enjoyed the updates we provide just as much as we enjoy compiling them.
We have worked very hard during 2008 to present a no frills IV news website that delivers exactly what it set out to deliver. We wanted to provide IV news that will enlighten and inform; straight to your desktop in a simple no fuss fashion. I hope that you agree that is exactly what IVTEAM provides.
To celebrate the last twelve months and to welcome the next twelve IVTEAM have put together the top twelve news stories from 2008. Enjoy!
- January 2008 - Central line tip placement.
- February 2008 - Coroner hears of nurse who died following needlestick.
- March 2008 - New edition of Intravenous therapy in nursing practice Dougherty & Lamb (2008) is issued.
- April 2008 - EPIC2 & saving lives study days. Click here for information on the free re-run in January 2009.
- May 2008 - The concept of prescription only cannulae is introduced.
- June 2008 - Neil MacGillivray writes about Dr Thomas Latta, one of the forefathers of infusion therapy.
- July 2008 - FDA update on heparin.
- August 2008 - IV panda. A little mid-year fun.
- September 2008 - Medicaid stop reimbursement for some reasonably preventable nosocomial infections.
- October 2008 - Syringes reused during endoscopy in Alberta.
- November 2008 - Eye of the needle report from the Health Protection Agency.
- December 2008 – Our hope for 2009. Syringe label award. If this became an industry standard it would be one of the greatest breakthroughs in medication safety.
Best wishes for 2009 from IVTEAM.
Electronic infection tracking
December 30, 2008
At Hershey Medical Center, a sophisticated computer program serves as a watchdog for infection outbreaks. With a few mouse clicks on a Web browser, the hospital’s infection-control staffers can quickly generate reports with charts and graphs illustrating how many patients within a particular unit are infected, and which lab specimen contained the germs.
“It’s more for us to look at the hospital as a whole and look for trends,” said Dr. Kathleen Julian, an infection disease physician. “Is there a cluster of problems in this unit?”
Pennsylvania health officials view the nascent technology as a critical tool for helping hospitals reduce health care costs by identifying potential systemic infection-control problems sooner than is possible by reviewing paper records by hand — an approach some health professionals call “shoe-leather epidemiology.”
Click here for the full story.
Barcode chip blood testing
December 29, 2008
A new barcode chip developed by a multi-institutional team of investigators promises to revolutionize diagnostic medical testing. In less than 10 minutes and using just a pinprick’s worth of blood, the chip can measure the concentrations of dozens of proteins, including those that herald the presence of diseases such as cancer and heart disease.
The device, known as the Integrated Blood-Barcode Chip (IBBC), was developed by members of the Nanosystems Biology Cancer Center, one of eight Centers of Cancer Nanotechnology Excellence (CCNEs) funded by the National Cancer Institute’s (NCI) Alliance for Nanotechnology in Cancer initiative. This team was led James R. Heath, Ph.D., California Institute of Technology (Caltech), and Leroy Hood, M.D., Ph.D., Institute for Systems Biology. The group’s work was published in the journal Nature Biotechnology.
An IBBC is about the size of a microscope slide and is made out of a glass substrate covered with silicone rubber. The chip’s surface is molded to contain a microfluidics circuit. After a pinprick of blood is injected into this system of microscopic channels, the device separates the blood into protein-rich plasma and then measures a panel of protein biomarkers.
Click here for the full story.
Epidemiology of bloodstream infections
December 29, 2008
Opilla, M. (2008) Epidemiology of bloodstream infection associated with parenteral nutrition. American Journal of Infection Control. 36(10), p.S173.e5-S173.e8.
Abstract:
Epidemiology - Catheter-related bloodstream infections (CR-BSIs) occur in 1.3% to 26.2 % of patients with central venous catheters used to administer parenteral nutrition (PN). Because of their nutritional components, PN solutions can support microbial growth. Contamination during preparation and handling is rare in hospitals and home-infusion pharmacies but may be difficult to control in a home setting. The risk of infection is increased in hospitalized patients because of malnutrition-associated immunosuppression, hyperglycemia exacerbated by dextrose infusion, microbial colonization/contamination of catheter hubs and the skin surrounding insertion site, and poor nursing care. During long-term catheter use for PN, an intraluminal biofilm, catheter-tip fibrin sheath or tail, or central venous thrombosis creates sites for microbial seeding and infection. Chronic conditions and psychosocial issues also increase the risk of infection. In hospitalized patients with BSIs, the most common organisms are coagulase-negative staphylococcus, Staphylococcus aureus, Enterococcus, Candida spp, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In the long-term PN population, approximately 60% of CR-BSIs are caused by coagulase-negative Staphylococcus.
Treatment - The best plan of care for a suspected or known infected catheter in a hospitalized patient is to reinsert a new central line after 48 hours of antibiotic treatment and negative blood cultures. In patients who receive long-term PN, hospitalization increases the risk of a nosocomial infection because the catheter can be contaminated by staff. A patient with fungemia must always be admitted and catheter removed. With gram-positive and gram-negative organisms, the catheter may not need to be removed. In most patients receiving PN at home, removing a long-term venous-access device is challenging. Peripheral vein access or peripherally inserted central catheters are needed until a new permanent device can be inserted after negative blood cultures are obtained. Evaluation of remote site infection also is necessary. Strategies to reduce or prevent infection include catheter lock therapy, daily evaluation of continued need for PN, enteral rather than PN support, and avoiding overfeeding. More studies are needed to demonstrate conclusively the benefits of immunonutrition, such as the use of omega-3 or glutamine supplements to reduce CR-BSIs in patients receiving PN.
Intravenous iron management
December 29, 2008
Bhandari, S. and Naudeer, S. (2008) Intravenous iron management for anaemia associated with chronic kidney disease: linking treatment to an outpatient clinic, optimizing service provision and patient choice. Journal of Evaluation in Clinical Practice. 14(6), p.996-1001.
Abstract:
Rationale – The National Service Framework advocates correction of anaemia in patients with chronic kidney disease (CKD). Oral iron is insufficient, while intravenous (IV) supplementation replenishes and maintains iron stores. In Yorkshire numerous peripheral clinics exist to reduce travel for patients, but patients must travel to the main unit for IV iron therapy. Therefore an outpatient service in tandem with a routine clinic for administration of IV CosmoFer was created.
Purpose - To evaluate the feasibility and benefits of IV iron therapy in the outpatient clinic during active patient review for CKD patients.
Design - A cross-sectional study of patients attending for total dose IV iron (n = 57) at a peripheral clinic. Iron was administered and monitored according to protocol by one of the clinic nurses with medical staff available in the adjoining room. Haemoglobin, ferritin and renal function were recorded pre-infusion and after 4-6 months. Results are given as medians/means ± standard error.
Results - A total of 76 IV infusions were carried out with no reported side effects or haemodynamic instability. Haemoglobin (median 10.9 vs. 11.3 g dL−1, P = NS), creatinine and estimated glomerular filtration rate (eGFR) over the 6-month period remained stable. Serum ferritin rose significantly [80.9 ± 6.2 vs. 186.4 ± 18.2 g L−1 (P < 0.001)]. Hospital time saved 380 day case bed hours, doctor hours saved 76 hours, and patient hours saved 3 hours/patient. Cost savings for TDI CosmoFer in peripheral clinic versus in centre therapy and versus sucrose, respectively, for 76 treatments was £5749.40 and £46 320.80 respectively.
Conclusion - We have demonstrated, in a resource-limited service, the feasibility and cost-effectiveness of a management care pathway for patients with CKD, in a peripheral clinic, to receive total dose IV CosmoFer without disruption of a functioning renal clinic.
Outpatient antibiotic therapy with PICC
December 29, 2008
Van Winkle, P. and Whiffen, T. (2008) Experience Using Peripherally Inserted Central Venous Catheters for Outpatient Parenteral Antibiotic Therapy in Children at a Community Hospital. Pediatric Infectious Disease Journal. 27(12), p.1069-1072.
Abstract:
Background: Outpatient parenteral antibiotic therapy with peripherally inserted central catheters (PICCs) is safe, clinically effective, and cost effective in pediatric populations cared for at academic and free-standing pediatric hospitals. Our study evaluates the transferability of these findings to a community hospital setting.
Methods: Data were retrospectively collected on PICCs used in children at a community hospital from December 2003 to September 2006. The Fisher exact test and a logistic regression were used for statistical analysis.
Results: Thirty-nine PICCs were placed in 34 patients. The total number of catheter days at home was 800 (mean 20.5 +/- 13.9). We demonstrated a 97% success rate in completing therapy at home, with 82.3% completion with a single PICC. Our overall complication rate was 33.3%, consisting of occlusion, accidental displacement, cracks in the catheters, and local irritation. There were no instances of phlebitis or suspected or confirmed catheter infection or sepsis. There were no statistically significant differences in these values compared with reports from major pediatric centers. The cost savings was $1070 per day of home health care when compared with costs of inpatient hospitalization.
Conclusions: We believe that this is the first study to demonstrate the effectiveness of PICC use for outpatient parenteral antibiotic therapy in pediatric patients in a community hospital setting, and demonstrates the ability for this to be done at the standard of care expected at major pediatric centers.
Top ten health hazards
December 24, 2008
In a recent Health Devices guidance article, ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, reveals its 2008 list of the 10 most dangerous health technology hazards facing hospitals. The list—updated annually based on problems reported to and investigated by ECRI Institute—includes detailed descriptions of these hazards, as well as concrete information on how to avoid them. The article is being offered to healthcare professionals for free to help them understand and prevent these dangerous—and sometimes deadly—hazards.
In creating its annual list, ECRI Institute draws upon its 40 years of experience in investigating device-related incidents on behalf of healthcare facilities. And the clear, realistic recommendations offered within are distilled from dozens of in-depth articles and thousands of hours of expert analysis.
The top five health technology hazards identified in the 2008 list are:
1. Alarm Hazards
2. Needlesticks and Other Sharps Injuries
3. Air Embolism from Contrast Media Injectors
4. Retained Devices and Un-retrieved Fragments Left in Patients
5. Surgical Fires
“Our list is based on serious technology safety concerns that can be prevented with appropriate attention and planning. We hope that the list can help raise awareness about these problems, which should be on every hospital’s quality improvement agenda,” says James P. Keller, Jr., vice president, health technology evaluation and safety, ECRI Institute.
Click here for the full story.
Free healthcare safety seminar
December 24, 2008
Intravenous conference: ECRI Institute, an independent nonprofit that researches the best approaches to improving patient care, is offering a free educational breakfast seminar, “Hazard and Recall Management: Best Practices,” which will be held at ECRI Institute’s Headquarters in Plymouth Meeting, PA, on Wednesday, January 21, 2009.
The seminar is designed for hospital-based biomedical and clinical engineers, materials managers, risk managers, patient safety officers, and other health professionals responsible for responding to product alerts. The program is aimed at providing insight into identifying and locating affected healthcare products and putting an effective alert management process in place.
“Managing hundreds of device recalls can be a daunting task for hospitals,” says James P. Keller, Jr., M.S., vice president, health technology evaluation and safety, ECRI Institute. “Through this seminar, participants will learn about ways to efficiently manage this process so that critical information about potentially dangerous products does not fall through the cracks.”
Seminar attendees will also learn the common missteps in the hazard and recall process, as well as how to establish executive-level buy-in to the alert process. In addition, the seminar will feature a panel/audience discussion on the five most common challenges of hazard and recall management.
Click here for the full story.
Neonatal zero CRBSI
December 24, 2008
At St. Bernardine Medical Center, doctors and nurses work around the clock to make a difference in the lives of the hospital’s tiniest patients.
And as of today, the neonatal intensive care unit, otherwise known as the NICU, where premature babies spend the first days or even months of their lives, has gone 298 days without a catheter-associated blood stream infection in any infant.
Click here for the full story.
How biofilms form
December 23, 2008
While bacterial cells tend to be rather solitary individuals, they are also known to form intricately structured communities called biofilms. But until now, no one has known the mechanisms that cause isolated bacteria to suddenly aggregate into a social network. New insights from the lab of HarvardMedicalSchool microbial geneticist Roberto Kolter reveal previously unknown communication pathways that cause such social phenomenon.
Using the non-pathogenic Bacillus subtilis as a model organism, Kolter and postdoctoral researcher Daniel Lopez discovered a group of natural, soil-based products that trigger communal behavior in bacteria. One molecule in particular, surfactin, is produced by B. subtilis. Biofilm formation begins when surfactin, and other similar molecules, cause bacteria to leak potassium. As potassium levels decline, a membrane protein on the bacterium stimulates a cascade of gene activity that signals neighboring cells to form a quorum. As a result, biofilms form.
Hand washing rules
December 22, 2008
Doctors and nurses who do not wash their hands could be sacked under new rules to prevent the spread of hospital superbugs.
The Scottish Government is to introduce a “zero tolerance” regime on hand hygiene for hospital staff in January. Those who repeatedly fail to comply have been warned they could face disciplinary action when the new rules are implemented. Ministers previously set a 90% target for handwashing, to be met by February.
Click here for the full story.
Intramuscular (IM) injection research
December 21, 2008
Malkin, B. (2008) Are techniques used for intramuscular injection based on research evidence? Nursing Times. 104(50/51), p.48-51.
Abstract:
The technique for delivering intramuscular injection remains rooted in custom and practice. This literature review examines the evidence on this commonly performed nursing procedure covering all aspects including site and needle selection.
CVC parenteral nutrition review
December 21, 2008
Ainsworth, S., Clerihew, L. and McGuire W. (2007) Percutaneous central venous catheters versus peripheral cannulae for delivery of parenteral nutrition in neonates. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD004219. DOI: 10.1002/14651858.CD004219.pub3.
Abstract:
Background
Neonatal parenteral nutrition may be delivered via a peripheral cannula or a central venous catheter (either umbilical or percutaneous). Because of the complications associated with umbilical catheters, many neonatal units prefer to use percutaneous catheters following initial stabilisation. Although potentially more difficult to place, these catheters may be more stable than peripheral cannulae and need less frequent replacement. Both delivery methods may be associated with different risks of adverse events, including acquired systemic infection and extravasation injury.
Objectives
To determine the effect of infusion via percutaneous central venous catheter vs. peripheral cannulae on nutrient input, growth and development, and complications in hospitalized neonates receiving parenteral nutrition.
Search strategy
The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 2, 2008), MEDLINE (1966 – May 2008), EMBASE (1980 – May 2008), conference proceedings, and previous reviews.
Selection criteria
Randomised controlled trials that compared delivery of intravenous fluids (primarily parenteral nutrition) via percutaneous central venous catheters vs. peripheral cannulae in hospitalized neonates.
Data collection and analysis
Data were extracted using the standard methods of the Cochrane Neonatal Review Group, with separate evaluation of trial quality and data extraction by each author, and synthesis of data using relative risk (RR), risk difference (RD) and mean difference (MD).
Main results
Five trials recruiting a total of 432 infants were found. One study showed that use of a percutaneous central venous catheter was associated with a a smaller deficit between prescribed and actual intake during the trial period: Mean difference -7.1% (95% CI -11.02, -3.2). Infants in the percutaneous central venous catheter group needed significantly fewer catheters/cannulae: Mean difference -4.3 (95% CI -5.24, -3.43). Meta-analysis of data from all five trials did not find any evidence of an effect on the incidence of invasive infection: typical relative risk 0.93 (95% CI 0.69, 1.23); typical risk difference -0.02 (95% CI -0.10, 0.06).
Authors’ conclusions
Data from one small study suggest that using a percutaneous central venous catheter to deliver parenteral nutrition improves nutrient input. The significance of this in relation to long-term growth and developmental outcomes is unclear. Three studies suggested that the use of a percutaneous central venous catheter decreases the number of catheters/cannulae needed to deliver the nutrition. No evidence was found to suggest that percutaneous central venous catheter use increased the risk of adverse events, particularly systemic infection.
Click here for the full review.
Needlestick safety and prevention
December 21, 2008
After 20 years of intense regulatory and legislative activity and innovative changes to the design and handling of needles, U.S. healthcare workers are now significantly safer from needlestick injuries, according to a new study from the University of Virginia International Healthcare Worker Safety Center.
“Since the U.S. Needlestick Safety and Prevention Act was passed in 2000, American healthcare workers have benefited from an unprecedented level of protection from occupationally transmitted diseases,” says Janine Jagger, M.P.H., Ph.D., director of the Center and co-author of the study published in the December 8 issue of the Journal of Infection and Public Health.
Click here for the full story.
Intravenous medication errors
December 17, 2008
Intravenous (i.v.) medication errors are twice as likely to cause harm to patients as medications delivered by other routes of administration (such as tablets or liquids), according to research commissioned by the American Society of Health-System Pharmacists (ASHP). This week, ASHP and leading healthcare organizations released recommended actions to prevent these potentially life-threatening events.
The recommendations, published in the December 15, 2008, issue of the American Journal of Health-System Pharmacy, are a result of an IV Safety Summit convened this summer by ASHP. The Summit’s goal was to initiate actions that prevent harm and death from I.V. medication errors.
Because errors can occur anywhere in the I.V. medication-use process and effects can be immediate and serious, healthcare leaders and experts participating in the Summit agreed that the issue of i.v. safety urgently needs to be addressed. They achieved consensus on a core set of best practices that everyone should follow to ensure safe i.v. medication use.
Best practices included standardization of infusion concentrations and dosages; comprehensive standardized procedures for ordering, preparing, and administering i.v. medications; and the use of ready-to-administer doses whenever possible.
Participants identified actions that are needed to support universal adoption of best practices.
Actions recommended to be taken within the next one to three years include:
- Universally standardizing concentrations of “high-alert” i.v. medications (those most likely to cause harm if an error occurs) for all patients, including highly vulnerable patients, such as elderly, newborns, and those with chronic medical conditions;
- Streamlining the process to bring ready-to-administer standardized infusion concentrations to market;
- Using “intelligent” i.v. pumps (e.g., those with safety features that help prevent unsafe rates and doses);
- Making the business case for i.v. safety to hospital leadership;
- Establishing multidisciplinary medication safety committees in hospitals to address the prevention of i.v. medication errors.
Long-term recommendations include:
- Using standardized, easily readable bar codes to verify i.v. drugs and doses;
- Establishing multidisciplinary medication safety training for healthcare professionals;
- Providing tools and resources to facilitate adoption of the i.v. safety practices;
- Exploring new methods to stimulate error reporting and share lessons learned; and
- Developing a framework for future research on i.v. medication safety.
Co-conveners of the Summit, along with ASHP, include the ASHP Research and Education Foundation, the United States Pharmacopeia, the Institute for Safe Medication Practices, the Infusion Nurses Society, the National Patient Safety Foundation, and The Joint Commission.
For more information about the summit and these recommendations, visit www.ashp.org/iv-summit.
Blood donor age limit
December 16, 2008
The age limit which prevents regular blood donors from continuing to give blood beyond their 70th birthday has been scrapped. The NHS’s Blood and Transplant authority said it was based on the fact that older donors were healthier and fitter than in the past. The change could see an extra 15,000 donations a year across the UK.
Hand washing research
December 16, 2008
Research conducted by University of Denver (DU) associate professor Renée Botta suggests that it takes ”gross” messaging to get undergraduate students to wash their hands more frequently after going to the bathroom.
In the fall quarter of 2007, researchers posted messages in the bathrooms of two DU undergraduate residence halls. The messages said things like, “Poo on you, wash your hands” or “You just peed, wash your hands,” and contained vivid graphics and photos. The messages resulted in increased handwashing among females by 26 percent and among males by 8 percent.
Injection alternative
December 14, 2008
Pain and fear surrounding medical injections could become things of the past with a revolutionary new treatment that allows patients to inhale drugs rather than endure a needle and syringe.
Millions being treated for cancer, diabetes and even vaccines are set to be helped by the groundbreaking ‘microcrystal’ treatment created by Scottish scientists. Around one in six people admit to having a fear of needles, and yet for some patients, such as those suffering from diabetes or cancer, injections are a regular necessity. But yesterday Marie-Claire Parker, chief executive of XstalBio Limited, a spin-off from Glasgow and Strathclyde Universities, said patients could be able to receive inhalable forms of their medications within five years.
Click here for the full story.
Syringe label award
December 13, 2008
Schreiner MediPharm, a Germany-based printer of pharmaceutical labels, has won a FINAT Award, a World Label Association Award, a German Packaging Award and the Baxter Award for its packaging innovations.
Schreiner MediPharm won the first place award in the screen printing category for its Japanese syringe label at the European FINAT competition. It was then selected by the FINAT Association to enter the global competition for the World Label Association Award which Schreiner MediPharm also won in the screen line category. The syringe label provides safety features including a scaled, transparent window, which allows the content of the syringe to be seen and a detachable label section for documentation to be applied to a patient’s medical records.
Click here for the full story on labels and labeling.
Hemopure clinical trial
December 13, 2008
U.S. Naval Medical Research Center (NMRC) has submitted to the FDA a revised investigational new drug application to begin a clinical trial of Hemopure® [hemoglobin glutamer - 250 (bovine)], a stabilized hemoglobin, for pre-hospital battlefield treatment of trauma patients. The study is entitled “Operation Restore Effective Survival in Shock” (Op RESUS).
The drug, a product of Biopure Corp, a Cambridge, Mass company, has been under development for many years now. At present, Hemopure® has been approved for marketing in South Africa, where it is “indicated for the treatment of adult surgical patients who are acutely anaemic. Hemopure is indicated for the purpose of eliminating, delaying, or reducing the need for allogenic red blood cells.” The company says Hemopure provides “an oxygen treatment bridge” in surgical patients by buying time for patients to build up their own reserves of red blood cells following surgery, hence eliminating the need for red blood cell transfusions in the immediate post operative period.
Click here for the full story on medgadget.
Guide-wire assisted peripheral catheter
December 13, 2008
Telesso Technologies Limited announced today it has entered into a strategic agreement with Vascular Pathways, Inc. (VPI), a Delaware company based in California, to fund a multi-center clinical trial of VPI’s guidewire device and to potentially acquire VPI.
VPI’s technology uses a first-in-class retractable nitinol guidewire system which Telesso anticipates will result in faster and more reliable peripheral IV placement with less patient discomfort. Telesso believes that VPI’s device is the first clinically meaningful advancement in peripheral IV access since automatic needle retraction catheters and addresses significant unmet needs in peripheral intravenous access.
Telesso expects that VPI’s clinical trials will be conducted at world-class hospitals in the US and Israel. Peter Rosenthal, Ph.D., a member of the VPI’s board of directors, commented, “I am delighted to enter into this relationship with Telesso Technologies. Since our technology already has FDA approval, our clinical trial of roughly 300 patients is designed to be a side-by-side comparison with traditional catheters to clearly measure our device’s distinct advantages.” Trial sites have been identified and the trial is scheduled to begin in Q1-2009.
Click here for the press release.
MicroAccess WAND FDA approval
December 13, 2008
Access Scientific, Inc. has received FDA clearance for its MicroAccess WAND(R), the world’s first all-in-one safety introducer. This sophisticated new medical device enables clinicians to more quickly and safely insert a sheath or catheter into the peripheral vasculature.
The MicroAccess WAND is the first of several planned WAND devices from Access Scientific to receive FDA clearance. The devices combine all components of the older, Modified Seldinger Technique into a unitary device that provides faster, safer, simpler over-wire vascular access.
“The MicroAccess WAND is the first device to enable clinicians to perform the Accelerated Seldinger Technique, which we believe is the ultimate refinement in vascular access technology,” said Steve Bierman, M.D., CEO of Access Scientific. “FDA clearance of the first version of The WAND marks a major step forward in making the Accelerated Seldinger Technique available to clinicians.”
The first clinical sites will begin using the device immediately, Dr. Bierman said, now that it has received FDA clearance.
Click here for the full press release.
Blood tracking
December 11, 2008
The Georgia Tech College of Computing, working in partnership with the Centers for Disease Control and Prevention, has developed a Web-based tool for tracking blood safety.
The tool is expected to help developing countries improve the adequacy and safety of their national blood supplies through better monitoring and evaluation.
The tool, which is accessed through a standard Web browser, tracks about 80 blood safety indicators continuously at the hospital and provincial levels. A pilot test in Zambia showed that the tool could improve the timeliness and accuracy of data collection efforts, allowing blood safety officials to better forecast or predict regional and seasonal blood usage patterns.
Click here for the full story.
Syringe pen
December 11, 2008
Fife Constabulary has condemned the sale of fake syringe pens after one was mistaken for a real syringe on a school bus (writes Aileen Robertson). What appeared to be a blood-filled hypodermic syringe was found on a bus taking pupils home from Denend Primary in Cardenden at the end of day.
After it was established the syringe was no more than a novelty pen, police expressed concern that children could struggle to tell the difference between the toy and the real thing.
Detective Constable Kenneth Cameron said, “At a time when children and young people are being encouraged to report the finding of needles to police and environmental services to ensure they do not fall victim to a needle-stick injury, it seems incredible such a novelty pen should be freely available to buy.
“My concern is that a child picks up a real syringe and suffers injury owing to the confusion brought about through the availability of this toy.”
Intravenous fluid alert
December 11, 2008
Hospira, Inc., a global specialty pharmaceutical and medication delivery company, is following up on a nationwide voluntary recall issued Sept. 18 of one lot (lot number 65-620-FW, expiration date May 1, 2010, NDC 0409-7902-09) of 20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride Injection, USP in 1000 mL flexible plastic containers because a small number of the containers may be incorrectly labeled with a bar code for 5% Dextrose Injection, USP (NDC 0409-7922-09). The incorrect bar code could lead to a medication error resulting in the wrong drug being delivered to a patient if a bar code system is used to confirm the medication. Potential adverse events related to an error of this type include electrolyte imbalance, cardiac dysfunction, gastrointestinal disturbances, paresthesia and mental confusion.
The product contains 20 mEq Potassium Chloride in 5% Dextrose and 0.45% Sodium Chloride. The product name and National Drug Code (NDC) number printed on the container are correct. The affected lot was shipped to U.S. customers between July 2008 and September 2008. No other lots are affected by this recall.
Click here to read the full news release.
Groshong versus open-ended PICC
December 7, 2008
This poster publication presents overview of the Groshong® versus Open-ended PICCs and was presented at the following conference: Gavecelt Conference 2008.
Thank you to Christel Janssens for granting permission to publish this poster.
Click here to view the poster.
National IV nurse day
December 7, 2008
On January 25, infusion nurses and other healthcare professionals will observe National IV Nurse Day. In 1980, the US House of Representatives designated this day each year to honor and recognize the accomplishments of the nation’s infusion nurse specialists, as well as the Infusion Nurses Society (INS).
This year’s theme, “IV Nurses—With You Every Step of the Way,” says it all. IV Nurse Day allows you and your colleagues the opportunity to highlight the advancement of the specialty and simultaneously recognize more than three decades of continuing education, advocacy, and professional development offered by the infusion nursing community. This year, let your colleagues in other specialties know the many ways you contribute to overall patient care in your practice setting. Infusion nurse professionals across the country have reason to celebrate as more and more infusion nurses are recognized as vital part the healthcare continuum.
January is fast approaching, so preparation for IV Nurse Day 2009 should start today. Show your appreciation and infusion pride by purchasing promotional products specifically designed for the day. This year, an array of items can be found online at www.jimcolemanltd.com/ins. We encourage you to share this e-mail with colleagues and administrators so they too can share in this day of appreciation and recognition for our valued infusion team members.
Intravenous therapy and self-care
December 6, 2008
O’Halloran, L., El-Masri, M.M. and Fox-Wasylyshyn, S. (2008) Home Intravenous Therapy and the Ability to Read more
Intradialytic parenteral nutrition
December 6, 2008
Moore, E. (2008) Challenges of Nutrition Intervention for Malnourished Dialysis Patients. Journal of Infusion Nursing. 31(6), p.361-366.
Abstract:
Malnutrition, or protein energy wasting (PEW), is prevalent in patients with chronic kidney disease stage 5 dialysis (CKD-5). One criterion of PEW strongly associated with morbidity and mortality in CKD-5 dialysis patients is the serum albumin level. Serum albumin levels have not improved over the past 10 years. Typical intervention strategies need to be reevaluated. Intradialytic parenteral nutrition (IDPN) is a form of parenteral nutrition delivered during dialysis that is a convenient and assured route of nutrition alimentation for high-nutrition-risk PEW patients who cannot improve nutrition status by oral and enteral routes. Recent qualification criteria for IDPN changes in Medicare part D have made this therapy an available option for many more of these high-nutrition-risk PEW patients. Nutrition support knowledge in clinicians is essential to administer IDPN effectively and to optimize clinical response. An improved understanding of the milieu of uremia and PEW of CKD-5, as well as the study of nutrition interventions inclusive of IDPN, will allow for effective strategies toward improved outcomes in the future.
Neonatal infusion
December 6, 2008
Flint, A. and Davies, M. (2008) The Intravenous Cannula for Newborn Infants Requiring Only Intravenous Medication: Continuous Infusion or Intermittent Flushing?. Journal of Infusion Nursing. 31(6), p.346-349.
Abstract:
In August 2003, the practice in the Royal Brisbane and Women’s Hospital neonatal unit changed to the use of intermittent flushing of intravenous cannulas (instead of running a continuous infusion) for infants who only required an intravenous cannula for medications. In this historical cohort comparison study, the authors determined that the duration of cannula use and the numbers of cannulas needing removal were similar before and after the change. The authors conclude that the use of intermittent flushing for intravenous cannulas is a safe and viable alternative to continuous infusion for well term infants who only require intermittent intravenous antibiotics.
Intravenous therapy in rheumatoid arthritis
December 6, 2008
Furfaro, N. and Mease, P.J. (2008) Nursing Considerations for Infusion Therapy in Rheumatoid Arthritis Versus Malignancy. Journal of Infusion Nursing. 31(6), p.350-360.
Abstract:
Therapeutic agents in use for years may receive Food and Drug Administration approval for new indications, challenging infusion nurses to keep in mind differences in therapy for more than 1 disease state. For example, many infusion nurses are familiar with using rituximab in an oncology setting; however, because it has been approved relatively recently (February 2006) for treatment of rheumatoid arthritis (RA), infusion specialists must improve their understanding of how dosing and administration differ in the RA setting. This article focuses on the specific pathophysiology of the RA disease state and patient characteristics that may affect infusion therapy, illustrated by a case study.
Prostanoid infusion
December 6, 2008
Doran, A., Harris, S. and Goetz, B. (2008) Advances in Prostanoid Infusion Therapy for Pulmonary Arterial Hypertension. Journal of Infusion Nursing. 31(6), p.336-345.
Abstract:
Pulmonary arterial hypertension is a rare but progressive and life-threatening disease that presents considerable challenges for both the patient and the caregiver. Though complex, intravenous epoprostenol and treprostinil may improve long-term survival, exercise capacity, hemodynamics, and other clinical symptoms of pulmonary arterial hypertension. Recent advances in infusion pump technology offer ambulatory pump sizes as small as a pager and continuous infusion flow rates as low as 0.1 mL/h, which may provide quality-of-life advantages for patients treated with treprostinil. Transition methods from epoprostenol to treprostinil vary and require close patient monitoring for up to several months. Patients and clinicians must be aware of the differences among delivery systems and the potential for adverse events.
Double gloving
December 6, 2008
Wittmann, A., Kralj, N., Köver, J., Gasthaus, K. and Hofmann, F. (2009) Study of Blood Contact in Simulated Surgical Needlestick Injuries With Single or Double Latex Gloving. Infection Control & Hospital Epidemiology. DOI: 10.1086/593124
Abstract:
Objective. Needlestick injuries are the most common injuries that occur among operation room personnel in the health care service. The risk of infection after a needlestick injury during surgery greatly depends on the quantity of pathogenic germs transferred at the point of injury. The aim of this study was to measure the quantity of blood transferred at the point of a percutaneous injury by using radioactively labeled blood.
Design. This study was conducted to evaluate the risk of infection through blood contact by simulating surgical needlestick injuries ex vivo. The tests were conducted by puncturing single and double latex gloves with diverse sharp devices and objects that were contaminated with Technetium solution–labeled blood.
Results. A mean volume of 0.064 μL of blood was transferred in punctures with the an automatic lancet at a depth of 2.4 mm through 1 layer of latex. When the double-gloving indicator technique was used, a mean volume of only 0.011 μL of blood was transferred (median, 0.007 μL); thus, by wearing 2 pairs of gloves, the transferred volume of blood was reduced by a factor of 5.8.
Conclusions. The results revealed that double gloving leads to a significant reduction in the quantity of blood transferred during needlestick injury.
Bloodstream infection financial costs
December 6, 2008
Chen, Y-Y., Wang, F-D., Liu, C-Y. and Chou, P. (2009) Incidence Rate and Variable Cost of Nosocomial Infections in Different Types of Intensive Care Units. Infection Control & Hospital Epidemiology. DOI: 10.1086/592984
Abstract:
Objective. Nosocomial infection (NI) is one of the most serious healthcare issues currently influencing healthcare costs. This study estimates the impact of NI on costs in intensive care units (ICUs).
Design. Prospective surveillance by a retrospective cohort study.
Setting. A medical ICU, a surgical ICU, and a mixed medical and surgical ICU in a large tertiary referral medical center.
Methods. Surveillance for NIs was conducted for all patients admitted to adult ICUs from 2003 through 2005. Retrospective chart review was conducted for each patient. The generalized linear modeling approach was used to assess the relationship of NIs to the increase in variable costs in individual ICUs and in all ICUs.
Results. A total of 401 NIs occurred in 320 of 2,757 screened patients. The incidence rate was 12.1% in the medical ICU, 14.7% in the surgical ICU, and 16.7% in the mixed medical and surgical ICU ( ). All of the mean variable costs were significantly higher for patients with NI than they were for patients without NI, after controlling for covariates. The medical ICU had the greatest increase in mean cost ($13,456, which was 3.52 times [95% confidence interval {CI}, 2.94–4.22 times] the mean cost for patients without NI), followed by the mixed medical and surgical ICU ($6,748, which was 2.74 times [95% CI, 2.33–3.22 times] the mean cost for patients without NI) and the surgical ICU ($5,433, which was 2.46 times [95% CI, 1.99–3.05 times] the mean cost for patients without NI). Mean cost increases according to the site of NI were $6,056 for bloodstream infection (2.36 times [95% CI, 1.97–2.84 times] the mean cost for patients without NI), $4,287 for respiratory tract infection (1.91 times [95% CI, 1.57–2.32 times] the mean cost for patients without NI), $1,955 for urinary tract infection (1.42 times [95% CI, 1.18–1.72 times] the mean cost for patients without NI), and $1,051 for surgical site infection (1.23 times [95% CI, 0.90–1.68 times] the mean cost for patients without NI).
Conclusions. The medical ICU had the lowest rate of NI and the largest excess costs, the surgical ICU had the lowest excess costs, and the mixed medical and surgical ICU had the highest rate of NI. The cost is largely attributable to bloodstream infection and respiratory tract infection.
Central line placement case-study
December 6, 2008
Sethi, N.K., Torgovnick, J., Sethi, P.K. and Arsura, E. (2008) Ipsilateral hemispheric ischaemic hypoxic changes during central line placement: a video-electroencephalogram correlate. Emergency Medicine Journal. 25(12), p.831.
Abstract:
When venous access is needed for intravenous fluids or antibiotics and a peripheral site is unavailable or not suitable, a central line is placed either in the neck or the groin. Complications have been reported during central line placement including (but not limited to) pneumothorax, haemothorax, arrhythmias, air embolism and introduction of infection. The case history is reported of a patient who developed ipsilateral hemispheric ischaemic hypoxic changes during central line placement. This was represented on the surface electroencephalogram by ipsilateral hemispheric voltage attenuation.
Video-electroencephalogram (EEG) recording was requested on a 65-year-old man with septicaemia and renal failure for evaluation of episodes of altered awareness. During review of the overnight record, note was made of a sudden change in the EEG background with abrupt appearance of left hemispheric voltage attenuation (figs 1–3 in online supplement). This lasted for about 30 s before a return to baseline (fig 4 in online supplement). Upon review of the video record it was noted that a central line had been inserted in the left neck with pressure being applied at the base of the neck. Abrupt onset of left hemispheric voltage attenuation occurred and the patient was noted to have violent jerks of his arms and legs (see online video). With removal of the pressure at the base of neck, the EEG returned to baseline.
Intraosseous drill
December 6, 2008
A new piece of equipment at the Poulsbo Fire Department is putting paramedics on an even faster track when saving lives in the field. The intraosseous drill, better known as an IO drill, is a new technology that allows medication to be infused straight into the bloodstream through a small bone-drilling tool. Though the technology is new to fire departments, it’s been used since the 1920s in hospitals and by the military.
Click here for the full story.
Intravenous cannula history
December 5, 2008
Today we stumbled across another piece of IV history, this time on the Sheffield Museum of Anaesthesia website – click here to view. The website presents various devices of intravenous interest, including the first one-piece plastic IV cannula, introduced by B Braun (Germany) in 1962 as the ‘Braunule’. Imported into the UK by Armour Pharmaceutical Co Ltd and the name was anglicised to ‘Braunula’.
They also present an interesting selection of various intravenous needles used prior to the introduction of plastic cannulae – click here to view.
IV access training online
December 5, 2008
An online learning programme is set to be introduced at West Cumberland Hospital. Hospitals throughout North Cumbria (UK) will all benefit from the programme which has been developed by award winning cancer specialist Mark Irving. Courses on offer include: Venepuncture, Peripheral Intravenous Cannulation, and IV drug administration.
Director of Nursing for North Cumbria University Hospitals NHS Trust Sandy Brown said: “The trust is making significant investment in training and development by providing staff with additional, flexible learning opportunities. This will also benefit patients as skills develop.”
Staff have been invited to log on and complete online courses. To date the site has 750 members in the north of the county and 22,000 members worldwide. The tool will be launched at West Cumberland Hospital on Friday.
Click here to visit the site at www.nclearning.org.uk
Click here for the news release.
Latex allergies
December 5, 2008
Graham Johnson reports that health and safety fears about latex allergy have prompted some NHS trusts and health boards to consider switching from surgical and examination gloves made of natural rubber latex (NRL) to synthetic alternatives. This strategy may be misguided.
The 2002 Court of Appeal support for a civil claim for damages by a nurse who had developed an allergy as a result of wearing NRL gloves (Dugmore vs Swansea NHS Trust) was incorrectly interpreted by some to mean that the use of NRL gloves should be outlawed.
Many NHS trusts still believe that the Health and Safety Executive (HSE) has banned NRL gloves. This is not the case, and some trusts may have over-reacted in deciding to switch to a latex-free policy.
Click here for the news release.
BBraun made in Sheffield
December 5, 2008
B.BRAUN Medical is celebrating 10 years in Sheffield as one of the fastest growing healthcare companies in the country. The UK arm of the global health care giant saw sales leap by 35 per cent to £83.1 million during 2007, and despite continued pressure on costs, is confident of continued expansion. B.Braun Medical is still on course for consolidated sales in excess of £100m during the current financial year and also expects its workforce to reach 1,000.
Hans Hux, Group Chief Executive, said: “World class and made in Sheffield – it’s no coincidence that B.Braun Medical’s headquarters are in Sheffield, a city long associated with excellence in business.
Looking ahead, work has started on a new, £2m state-of-the-art medical facility at its Thorncliffe Park site. The revolutionary Aseptic Unit will feature one of the most advanced drug preparation robots in Europe which can manipulate highly toxic and time sensitive drugs for people undergoing chemotherapy treatment for cancer.
The unit will be able to prepare drugs with a very limited shelf life and distribute them to any destination in a two-hour radius of the facility, including 180 hospitals in Leeds, Manchester, Nottingham, Leicester, Derbyshire and South Yorkshire.
Click here for the news item in the Sheffield Telegraph.
Texas Hospital Association endorses MedMined
December 5, 2008
Cardinal Health and the Texas Hospital Association (THA) announced today that hospitals across Texas have a new way to safeguard patients and combat deadly health care associated infections (HAIs).
The Texas Hospital Association and its marketing subsidiary, HealthShare, recently endorsed MedMined™ services from Cardinal Health as an effective tool to help combat HAIs, improve patient care and dramatically reduce infection-related costs.
MedMined™ services offer infection surveillance for the entire hospital that alerts clinicians to early signs of an emerging infection issue to target improvement efforts at the right place and the right time. Using data mining tools similar to those used by credit card companies to monitor unauthorized purchases, this patented technology automatically identifies patterns indicative of specific and correctable quality breakdowns to prevent and treat HAIs successfully.
Click here for the news release.
Vascular access then delayed treatment
December 3, 2008
Two Hardin County residents have filed suit against Memorial Hermann Baptist Hospital and a doctor, alleging their infant son was not treated in a timely or appropriate manner when they brought him to the hospital. Kenneth Brimer and Ashley King claim they brought their son, Alan, to Beaumont’s Memorial Hermann Baptist Hospital emergency room on March 18, 2007, because of his shortness of breath and listlessness, according to the complaint filed Nov. 19 in Jefferson County District Court.
At 1:35 p.m., doctors placed an intravenous catheter into Alan, but it is unclear whether glucose was administered until at least 2:10 p.m., when he had a blood sugar value of 133, according to the complaint. Signs of sepsis appeared at 3:22 p.m. when the emergency room physician was notified of a CO2 value of 10 and a potassium value of 7.9, the suit states. However, Alan received no treatment at the time of the findings, Brimer and King claim.
Because of the treatment he received, Alan suffered serious personal injuries, disfigurement, mental anguish, physical pain and suffering, impairment, disability and medical expenses, the suit states.
Click here for the full story.
Man receives 1500th transfusion
December 2, 2008
A man who owes his life to 1500 blood donors has called on Scots to donate this Christmas to prevent a “donor deficit”. Willie Mack, 35, from Edinburgh, has just received his 1500th transfusion as part of his treatment for Blackfan Diamond Anaemia. In some sufferers the condition can lead to congenital abnormalities such as thumb or upper lip problems, cardiac defects and cleft palate.
Mr Mack, a government worker, will rely on blood donors for the rest of his life. He had his first transfusion just hours after he was born, and needs three pints of donor blood every twoweeks to keep him alive.
Click here to read the full story.
Flexicath Firmgrip aqcuires funding
December 2, 2008
The Zitelman Group announced today it has led a $600,000 Series B Preferred equity round for Israel-based medical device firm, Flexicath, Ltd. Flexicath received a 510(k) clearance from FDA in October, allowing it to place its FirmGrip(TM) sterile catheter intravenous (IV) system in the U.S. market. The funding will be used to ramp-up U.S. and international sales and marketing for the FirmGrip(TM) catheter.
The patent pending Flexicath FirmGrip(TM) is designed to meet the market needs for the largest segment of IV catheterizations, those lasting up to 29 days. FirmGrip(TM) may save the need for a sterile sheet by enclosing the catheter in a special self-contained package that permits insertion without removing the catheter from the sterilized coating sleeve until the procedure is complete and the catheter is in the vein.
Click here for the full story.
Medegen patent decision reversed
December 2, 2008
Medegen, a leading innovator in infusion therapy medical products, announced today that it has won an important legal victory in the United States Court of Appeals for the Federal Circuit in Washington, D.C. The appellate court’s decision reverses a judgment issued by a district court judge in the Central District of California of patent non-infringement entered in favor of ICU Medical Inc.
Medegen argued successfully that the decision below inappropriately narrowed the definition of key terms of one of its patents (U.S. Patent No. 5,730,418). This patent covers a number of Medegen’s novel inventions in needleless connectors, including the use of positive displacement technology.
