IV pumps in home care
February 27, 2009
Intravenous news: In a report published today, the Netherlands Health Care Inspectorate writes there is inadequate collaboration between professionals involved in the use of IV pumps in home care.
The inspectorate argues that the lack of collaboration between doctors, nurses, home care organisations and suppliers of medical equipment can lead to dangerous situations in which patients receive too little or too much medication.
In the past two years, 26 people died in hospital as the result of incorrect use of intravenous drips; there are no figures available about the number of deaths in home care.
Click here for the full story.
Syringe recycling scandal
February 27, 2009
Intravenous news: Modasa’s deadly Hepatitis-B trail has led investigators to a major medical waste recycling racket in Ahmedabad’s own backyard. A whopping 50 tonnes of biological waste, including syringes and needles, which has been impounded, could expose the city and the whole state to the threat of not just Hepatitis-B, but other deadly infections, spread through intravenous treatment.
Usually such waste has to be segregated and destroyed in an incinerator. But these were probably to be repackaged and sold.
Update on the Times Online – 10th March 2009.
Click here for the full story.
CLABSI prevention
February 26, 2009
Intravenous news: A widely heralded Johns Hopkins safety initiative to reduce bloodstream infections in intensive care units (ICUs) Read more
PICC comparison
February 25, 2009
Intravenous Literature: Di Giacomo, M. (2009) Comparison of three peripherally-inserted central catheters: pilot study. British Journal of Nursing. 18(1), p.8-16.
Abstract:
Peripherally-inserted central catheters (PICCS) are non-tunnelled, central catheters inserted through a peripheral vein of the arm. They are 50–60?cm long and are usually made of either silicone or second-third generation polyurethane. PICCs can be used for prolonged, continuous or intermittent infusion therapies (up to 3 months) both in hospitalized patients and in patients treated as outpatients, in a hospice, or at home. When establishing a vascular service it is key to select a PICC that meets the requirements of safety, cost-effectiveness, high resistance (ability to take increasing fluid volumes with high pressure devices) and durability, and low complications rate. The complications and dwell times of three different PICCs were studied: coated polyurethane, valved silicone and power-injectable. The study was conducted at the chemotherapy suite at the author’s hospital with the aim of selecting the right PICC based on low incidence of complications, resistance and enhanced dwell time. Results show a low incidence of complications and long dwell time among patients with the power-injectable PICC. Furthermore, this study demonstrated a reduction on the rate of occlusion and rupture with power-injectable PICCs, which makes them safer to use for administration of chemotherapy and other vesicant agents, as well as for the management of patients in critical care.
Aseptic technique variations
February 25, 2009
Intravenous literature: Aziz, A-M. (2009) Variations in aseptic technique and implications for infection control. British Journal of Nursing. 18(1), p.26-31.
Abstract:
Healthcare-acquired infections (HAIs) are a serious concern, costing the NHS £1 billion a year and causing 5000 deaths annually despite increased funding. A contributing factor is the variety of aseptic techniques in use in different hospitals and even within a single hospital. These cause problems for healthcare workers as well as increasing the risk of HAI. This article examines a number of traditional approaches to aseptic technique, highlighting their differences and the implications for infection control. It concludes that improvement in aseptic technique could be achieved by implementation of a single unified approach to aseptic technique that can be standardized and audited annually, such as the aseptic non-touch technique (ANTT), which has been recommended for adoption throughout the UK. It ends with suggestions for measures that could be introduced and strengthened to improve aseptic technique, and ultimately reduce the rate of HAI.
IV particles lead to drug recall
February 25, 2009
Intravenous news: Health Canada, the federal agency that regulates the country’s healthcare delivery, is recalling lots of a drug used to treat iron and aluminum toxicity in dialysis patients due to the possibility of tiny particles forming after the drug is prepared for intravenous administration.
Health Canada said it is working with manufacturer Hospira Healthcare Corp. in recalling certain lots of Desferrioxamine Mesilate for Injection, which treats acute or chronic iron toxicity and chronic aluminum overload in dialysis patients with end-stage renal disease. The formation of particles in the affected lots might produce cloudiness after preparation. These particles can block small blood vessels after injection.
The following are being recalled: Lot U072231AA in a 500-mg format and Lot U102237AA in a 2-g format. The lot number is on the label of the carton as well as on the vial.
Click here for the full story.
Gemstar infusion system
February 25, 2009
Intravenous products: Hospira, Inc., a global specialty pharmaceutical and medication delivery company, today announced the introduction of the with GemStar(TM) Infusion Suite software, an advanced version of the market-leading, multi-application, GemStar pump. The GemStar SP infusion system is designed to help caregivers better incorporate patient safety best practices right at the patient’s bedside.
GemStar SP incorporates GemStar Infusion Suite software, a stand-alone personal computer (PC)-based application designed to enhance safe and efficient medication administration. In an effort to help clinicians combat the 1.5 million medication errors that occur annually(1), GemStar SP allows healthcare facilities to tailor the pump to meet specific clinical objectives.
The compact and portable pump has configurable settings to help streamline the programming process for clinicians and provide flexible drug protocols with hard limits to help prevent medication errors. GemStar also offers several security features including four keypad lockouts, integral set-based free flow protection and mandatory confirmation screens, to help minimize the risk of medication delivery errors.
Click here for the full press release.
Triple lumen PICC
February 24, 2009
Intravenous products: Teleflex Medical, a division of Teleflex Incorporated, has introduced the Arrow® Pressure Injectable Triple Lumen PICC (Peripherally Inserted Central Catheter), the latest in the company’s portfolio of venous access solutions designed for clinician and patient safety, as well as patient comfort. With a non-tapered body, contoured tip and strong polyurethane construction that softens in situ, Arrow PICCs are designed to improve vessel health preservation and reduce the risk of thrombosis and infection associated with venous catheters.
The Arrow Pressure Injectable Triple Lumen PICC provides the ability to pressure-inject contrast media, clear and useful product labeling, a non-tapered catheter body, and the unique Arrow Blue FlexTip®, which is a contoured design for smooth maneuverability through narrow vessels. The Blue FlexTip is designed to reduce patients’ vessel trauma. The catheter’s firmness also maintains patency throughout treatment, as it withstands high-pressure injection procedures. This unique tip design, with its staggered ports, is designed to reduce the risk of medications mixing and forming a precipitate that could obstruct other trimmed catheters. The Arrow Pressure Injectable Triple Lumen PICC is also indicated for central venous pressure monitoring.
It is capable of pressure injection of contrast media at 300 psi and a maximum flow rate of six milliliters per second. The improved catheter polymer is designed to have clear visualization under fluoroscopy and other radiographic studies.
The Arrow Pressure Injectable Triple Lumen PICC will be available in the U.S. as part of the Arrow Maximal Barrier Tray, which is an integrated kit designed to address sources of catheter-related bloodstream infection, specifically environmental contamination and skin flora. The Arrow Maximal Barrier Tray also includes prefilled saline syringes, BIOPATCH® Antimicrobial Dressing, Tegaderm® Transparent Dressing, protective apparel and upgraded sharps safety devices. Its components are aligned with the latest guidelines from the Centers for Disease Control (CDC), the Occupational Safety & Health Administration (OSHA) and the Institute for Healthcare Improvement (IHI).
Click here for the full press release.
Contaminated syringe prosecutions
February 24, 2009
Intravenous news: A North Carolina company is accused of bypassing sterilization tests for medical syringes in a cost-cutting move prosecutors say sickened hundreds of patients and led to five deaths.
U.S. Attorney George Holding said Tuesday that federal authorities have launched an international search for the executive charged with rushing shipments of bacteria contaminated syringes from an AM2PAT Inc. plant. Two former plant workers who provided prosecutors details about the plant’s operations have pleaded guilty for their roles in shipping tainted syringes.
The syringes contained Heparin, a blood thinner, and saline, and were recalled in December 2007 after an outbreak of illnesses. Health inspectors identified bacterial infections in Colorado, Texas, Illinois and Florida.
Click here for the full story on Associated Press.
Needlestick injury in Delhi
February 24, 2009
Intravenous literature: L.P. Simon (2009) Prevention and management of needlestick injury in Delhi. British Journal of Nursing. 18(4), p.252 – 256.
Abstract:
Needlestick and sharps injuries are the most common cause by which blood borne pathogens are transmitted between patients and health-care workers. A study was conducted to assess the knowledge and existing practices of staff nurses regarding needlestick injuries (NSIs) and evaluate the effectiveness of guidelines developed for the prevention and management of NSIs in a selected government hospital of Delhi. The study revealed that 70% of staff nurses had sustained NSI. The majority 24 (68%) got NSI with a hollow-bore needle. There was lack of awareness among staff nurses regarding prevention and management of NSIs. Among the nurses who sustained NSI, the majority (71%) did not report it. The developed guidelines regarding prevention and management of NSI was found to be effective in enhancing the knowledge and improving the practices of staff nurses. It is useful for British nurses to be able to compare their experience of NSI with that of nurses in Delhi, to see if lessons can be learnt that can be applied British nursing.
Intraosseous access sites
February 23, 2009
Intravenous literature: Ong, M.E., Chan, Y.H., Oh, J.J. and Ngo, A.S. (2009) An observational, prospective study comparing tibial and humeral intraosseous access using the EZ-IO. American Journal of Emergency Medicine. 27(1), p8-15.
Abstract:
INTRODUCTION: Intraosseous (IO) access is an alternative to conventional intravenous access. The proximal tibia and proximal humerus have been proposed as suitable sites for IO access. METHODS: A nonrandomized, prospective, observational study comparing flow rates and insertion success with tibial and humeral IO access in adults using the EZ-IO-powered drill device was conducted. The tibia was the first site of insertion, and a second IO was inserted in the humerus if clinically indicated for the same patient. RESULTS: Twenty-four patients were recruited, with 24 tibial and 11 humeral insertions. All EZ-IO insertions were successful at the first attempt except for 1 tibial insertion that was successful on the second attempt. All insertions were achieved within 20 seconds. Mean ease of IO insertion score (1=easiest to 10=most difficult) was 1.1 for both sites. We found tibial flow rates to be significantly faster using a pressure bag (165 mL/min) compared with those achieved without a pressure bag (73 mL/min), with a difference of 92 mL/min (95% confidence interval [CI]: 52, 132). Similarly, humeral flow rates were significantly faster using a pressure bag (153 mL/min) compared with humeral those achieved without pressure bag (84 mL/min), with a difference of 69 mL/min (95% CI: 39, 99). Comparing matched pairs (same patient), there was no significant difference in flow rates between tibial and humeral sites, with or without pressure bag infusion. CONCLUSIONS: Both sites had high-insertion success rates. Flow rates were significantly faster with a pressure bag infusion than without. However, we did not find any significant difference in tibial or humeral flow rates.
CVC monitoring
February 23, 2009
Intravenous literature: Smuszkiewicz, P., Trojanowska, I. and Tomczak, H. (2009) Venous catheter microbiological monitoring. Necessity or a habit?. Medical Science Monitor. 15(2), p.SC5-8.
Abstract:
BACKGROUND: Usefulness and economic aspects of microbiological analysis of central venous catheter (CVC) tips in diagnosis of the catheter-related bloodstream infection (CRBSI). MATERIAL/METHODS: Retrospective study of an adult intensive care unit in a university hospital. Catheter removal was performed when the clinical state of the patient indicated that the catheter could be the source of infection or inflammation was observed at the puncture site. RESULTS: We microbiologically studied 238 CVC tips according to the Maki method and 723 blood samples from 120 septic patients treated during a 21-month period (32.9% of all patients treated in this time period). In 115 cases (48.4%), the tips were positive. Bacteremia was ascertained in 181 blood samples (24.1%), and 168 samples were collected at the time of CVC removal. In blood samples taken from 20 patients (3% of total blood samples), 25 cases of the same pathogens were isolated from CVC tips. In 12 cases, pathogens found in blood and CVC tips were also cultured in other places. In 13 cases (5.5% of tips), CVCs were the source of CRBSI. Positive predictive value (PPV) and negative predictive value reached 11% and 91%, respectively. The total cost of CVC tip monitoring was about 4000 euro. CONCLUSIONS: Our data support the hypothesis that colonization of CVC is rarely responsible for CRBSI. Relatively low PPV renders tips culture useless as a method of diagnosing CRBSI. Based on these results, the routine microbiological monitoring of CVC tips was discontinued to reduce the cost of treatment.
More IV news at IVTEAM
Time to positivity
February 23, 2009
Intravenous literature: Passerini, R,, Riggio, D., Radice, D., Bava, L., Cassatella, C., Salvatici, M., Zorzino, L. and Sandri, M.T. (2009) Interference of antibiotic therapy on blood cultures time-to-positivity: analysis of a 5-year experience in an oncological hospital. European Journal of Clinical Microbiology & Infectious Diseases. 28(1), p.95-8.
Abstract:
This study performed a retrospective analysis on the relationship between blood culture time-to-positivity (TP) and type of isolated microorganism, antibiotic administration, and immunological status of the patients. We analyzed the data related to 1,218 positive blood cultures. When compared to Gram positive bacteraemia, the percentage of Gram negative growth was higher and the mean TP significantly shorter (p < 0.0001). In patients receiving antibiotics, median and mean TPs of blood culture were different for Gram positive bacteraemia (log-rank p = 0.0022, Wilcoxon p < 0.0001) but not for Gram negative (log-rank p = 0.4011, Wilcoxon p = 0.1585). No statistically significant effect on TP was found for sampling site, interaction between sampling site and antibiotic administration, and immunological status of the patient. In conclusion, TP is independent of antibiotic therapy in cases of Gram negative bacteraemia, while for Gram positive bacteraemia a prolongation of TP occurs.
More IV news at IVTEAM
Tourniquet impact on blood results
February 23, 2009
Intravenous literature: Connes, P., Uyuklu, M., Tripette, J., Boucher, J.H., Beltan, E., Chalabi, T., Yalcin, O., Chout, R., Hue, O., Hardy-Dessources, M.D. and Baskurt, O.K. (2009) Sampling time after tourniquet removal affects erythrocyte deformability and aggregation measurements. Clinical Hemorheology & Microcirculation. 41(1), p.9-15.
Abstract:
Venipuncture procedures are widely thought to influence biochemical, hematological or hemorheological measurements. In line with the preparation of the new Guidelines for the standardization of hemorheological measurement, we compared various blood rheological parameters (i.e., red blood cell deformability and aggregation indices) assessed in blood samples obtained after 5, 30, 60 and 90 s following the tourniquet removal and a blood sample obtained without applying a tourniquet (control sample). A slight but significant improvement in red blood cell (RBC) deformability after the removal of tourniquet compared to the control sample was observed. RBC deformability was maximal in the samples obtained 30 s after tourniquet removal and remained slightly higher than the control in the following samples (at 60 and 90 s after tourniquet removal). The aggregation index (AI) decreased with time after tourniquet removal reaching significantly lower values than the control at 90 s after tourniquet removal. This finding was supported by a greater half time for RBC aggregation in the samples obtained 60 and 90 s after tourniquet removal. In conclusion, this study revealed that RBC deformability and aggregation might be significantly altered in the samples obtained after the application and removal of a tourniquet, as a part of the blood sampling procedure. Recommendation “remove the tourniquet at least 5 s prior to the start of blood sampling” may need to be revised.
Ultrasound-enabled topical anesthesia
February 23, 2009
Intravenous literature: Stowell, C.P., Trieu, M.Q., Chuang, H., Katz, N. and Quarrington, C. (2009) Ultrasound-enabled topical anesthesia for pain reduction of phlebotomy for whole blood donation. Transfusion. 49(1), p.146-53.
Abstract:
BACKGROUND: Ultrasound-facilitated delivery of topical anesthetics has been used to achieve effective anesthesia within 5 minutes for venipuncture and the insertion of intravenous access devices, but has never been studied for blood donation. STUDY DESIGN AND METHODS: This study was a single-center, prospective, randomized, sham treatment-controlled, single-blinded clinical evaluation. Repeat donors were randomly assigned to undergo treatment with ultrasound and topical anesthetic or sham ultrasound and placebo anesthetic before phlebotomy for whole blood donation. The primary outcome measures were pain assessments using the Verbal Categorical Scale (VCS) and the Visual Analogue Scale and the assessment of skin irritation at the target site. RESULTS: One-hundred subjects were enrolled and all completed the study. Compared to the sham/placebo control group, donors receiving ultrasound/anesthetic had lower pain scores on the VCS (1.81 +/- 0.67 vs. 2.17 +/- 0.68; p = 0.01) and Visual Analog Scale (17.2 +/- 15.5 vs. 27.6 +/- 19.5; p = 0.006). The proportion of subjects in the treatment group who experienced skin irritation (8%) was similar to that in the control group (2%; p = 0.20). CONCLUSION: Ultrasound-enhanced delivery of topical anesthetic was demonstrated to be a safe means of quickly achieving clinically meaningful reduction in the pain of phlebotomy for whole blood donation compared to sham/placebo treatment.
Venous access choices
February 23, 2009
Intravenous literature: Gorski, L.A. (2009) The peripheral intravenous catheter: an appropriate yet often overlooked choice for venous access. Home Healthcare Nurse. 27(2), p.130-2.
“Over my 23 years of practicing home healthcare and home infusion therapy, I have witnessed the evolution and growth in vascular access devices. Improved catheter materials and placement techniques have made it easier and safer for patients to receive infusion therapy at home.due to neurologic illness and can transfer only with the use of a lift. The home health nurse tells the physician that the patient’s veins are poor and that a PICC is required, which the physician readily orders based on the nurse’s assessment…” click here for the full text pdf.
Intravenous maintenance fluids
February 23, 2009
Intravenous literature: Yung, M. and Keeley, S. (2009) Randomised controlled trial of intravenous maintenance fluids. Journal of Paediatrics & Child Health. 45(1-2), p.9-14.
Abstract:
AIM: Traditional paediatric intravenous maintenance fluids are prescribed using hypotonic fluids and the weight-based 4:2:1 formula for administration rate. However, this may cause hyponatraemia in sick and post-operative children. We studied the effect of two types of intravenous maintenance fluid and two administration rates on plasma sodium concentration in intensive care patients. METHODS: A Factorial-design, double-blind, randomised controlled trial was used. We randomised 50 children with normal electrolytes without hypoglycaemia who needed intravenous maintenance fluids for >12 h to 0.9% saline (normal saline) or 4% dextrose and 0.18% saline (dextrose saline), at either the traditional maintenance fluid rate or 2/3 of that rate. The main outcome measure was change in plasma sodium from admission to 12-24 h later. RESULTS: Fifty patients (37 surgical) were enrolled. Plasma sodium fell in all groups: mean fall 2.3 (standard deviation 4.0) mmol/L. Fluid type (P = 0.0063) but not rate (P = 0.12) was significantly associated with fall in plasma sodium. Dextrose saline produced a greater fall in plasma sodium than normal saline: difference 3.0, 95% confidence interval 0.8-5.1 mmol/L. Full maintenance rate produced a greater fall in plasma sodium than restricted rate, but the difference was small and non-significant: 1.6 (-0.7, 3.9) mmol/L. Fluid type, but not rate, remained significant after adjustment for surgical status. One patient, receiving normal saline at restricted rate, developed asymptomatic hypoglycaemia. CONCLUSION: Sick and post-operative children given dextrose saline at traditional maintenance rates are at risk of hyponatraemia.
Intravenous rehydration
February 23, 2009
Intravenous literature: Reid, S.R. and Losek, J.D. (2009) Rehydration: role for early use of intravenous dextrose. Pediatric Emergency Care. 25(1), p.49-52.
Abstract:
Acute gastroenteritis is a common reason for children to seek health care. Among the potential complications of acute gastroenteritis, the most common is dehydration. For mild to moderate dehydration, treatment options include oral and intravenous rehydration. Outpatient treatment failure for either method, when it occurs, is often due to persistent nausea and vomiting. Some authorities have suggested that the early administration of dextrose to patients receiving intravenous rehydration may help terminate vomiting and result in fewer outpatient treatment failures. The purpose of this report was to review the evidence supporting the effectiveness of early intravenous dextrose administration in the outpatient management of dehydration in children with acute gastroenteritis.
Infection prevention in IV therapy
February 23, 2009
Intravenous conference: Registration for the free ‘Successful Implementation of Infection Prevention Guidelines in IV Therapy’ one day conference (EPIC2) is now available online.
The three national multidisciplinary study days, will take place at:
- Monday 20th April – Cardiff – Mercure Holland House Hotel
- Tuesday 21st April – Brighton – Hilton Brighton Metropole
- Wednesday 22nd April – Peterborough – Holiday Inn West Hotel
This national programme in April has been jointly developed by the Infection Prevention Society (IPS) and the EPIC2 authors/Thames Valley University. Each day is chaired by a Board Member of the Infection Prevention Society and speakers include Andrew Jackson IV Nurse Consultant, Carol Pellowe – Principal Lecturer at Thames Valley University, David Tucker – Senior Infection Control Nurse/IPS Board member, Sheila Inwood – Clinical Nurse Specialist at the Royal Berkshire Hospital and many other high profile speakers.
It is free to all healthcare workers and includes educational handouts and catering provision.
Contaminated blood
February 23, 2009
Intravenous news: A public inquiry has condemned the failings that led to thousands of people being infected with HIV and hepatitis C from contaminated blood. The independent privately-funded inquiry called the use of contaminated blood products to treat patients with haemophilia a “horrific human tragedy”. The report suggested UK authorities had been slow to react, but accepted it was hard to directly apportion blame.
In the 1970s and 1980s, nearly 5,000 people were exposed to hepatitis C. Of these, more than 1,200 were also infected with HIV. Almost 2,000 of those people have since died as a result.
Click here for the full story on the BBC news website.
Click here to view an interview of a patient on the BBC.
Nerve damage following IV
February 20, 2009
Intravenous news: The Eastern Regional Health Authority (ERHA) has been sued by a 62-year-old seamstress, who suffered injury to her hand after an intravenous needle was badly inserted while at the Sangre Grande Hospital three years ago.
Annette Hamilton Gladstone, of Red Hill, D’abadie, is a diabetic, and visited the hospital on May 6, 2006, for treatment of an associated condition.
In her claim filed by attorneys Anand Ramlogan and Cindy Bhagwandeen at the San Fernando High Court, Gladstone says a female doctor concluded that it was necessary to administer antibiotics. An intravenous line was inserted into her right hand, which allegedly became bluish in colour.
Gladstone says she noticed during the week following that she was unable to properly use her hand as it was painful, swollen, bruised and there was a loss of sensation. She visited the Port of Spain General Hospital on May 15, 2006, and a clinical examination of her hand revealed that it was swollen, bluish, tender and cold. It was suspected that the condition arose out of a complication with the insertion of the intravenous needle, not into a vein but in the tissue of the arm. An operation was performed on May 16, 2006, to decompress the nerves on the hand and to drain the remaining antibiotic fluid.
Click here for the full story.
Coding central venous access procedures
February 20, 2009
Intravenous literature: Simply put, venous catheterization is a way to access veins. A central venous access catheter or device is used to deliver medications, intravenous fluids or obtain blood samples. Central venous access catheters and central venous access devices (VADs) are two different methods of venous catheterization. The appropriate procedural coding of central venous catheters and central venous devices (CVD) is somewhat problematic for many coders. This is in part due to the terminology used by physicians when describing the catheters and devices inserted. Some physicians use the term “vascular access device” to mean any type of central venous catheterization without providing adequate information as to the precise type inserted, whether it is a non-tunneled or tunneled central venous catheter or the insertion of a tunneled, implantable, either partially or totally, central VAD as defined in Coding Clinic and CPT Assistant. Also, the physician may not always document if the insertion site is central or peripheral. This lack of precise documentation for the procedures causes confusion and frustration on the part of the coder. This article will clarify the procedures and their associated codes for the insertion of intravenous central venous access catheters or devices, from both CPT and ICD-9-CM perspectives.
Vol. 14 • Issue 1 • Page 12
Click here for the full article.
Rev Vac safety syringe FDA approval
February 20, 2009
Intravenous products: Revolutions Medical Corporation (OTCBB: RMCP) has received notification from the FDA that the 510K application for the Rev Vac safety syringe is approved. This represents a major step forward for the company towards realizing its goal in becoming a major player in the safety syringe market.
The Rev Vac safety syringe uses patented technology to draw the needle back into the syringe chamber after use. This safety syringe should result in a decrease in accidental needle stick injuries. Another important safety feature is that it will disallow the reuse of the syringe. This may significantly decrease the spread of HIV and other blood borne diseases. This safety syringe takes only one hand to use, which is a very important feature for the health care practitioner or medical personnel. There are no clumsy clamps, sheaths or other complex safety features that require two handed use.
“We are pleased to receive 510K FDA clearance for our Rev Vac safety syringe. I want to congratulate all of our patient, loyal shareholders. This important step forward will enable the company to aggressively pursue its goal of getting this important safety syringe into the marketplace. Our Rev Vac safety syringe has significant advantages over our competitors and we expect a warm reception from the medical industry,” states Ron Wheet, CEO of Revolutions Medical Corporation.
Click here for the full story.
Click here to view the product video.
Project to reduce CRBSI
February 19, 2009
Intravenous news: Hospital associations in 10 states have been selected to participate in a program to test methods of reducing central line-associated bloodstream infections in hospital intensive care units (ICUs), according to HHS’ Agency for Healthcare Research and Quality.
The states are California, Colorado, Florida, Massachusetts, Nebraska, North Carolina, Ohio, Pennsylvania, Texas and Washington. In addition, the California Hospital Patient Safety Organization, the North CarolinaCenter for Hospital Quality and Patient Safety, and the Ohio Patient Safety Institute will participate in the project.
The hospital associations and patient safety groups were chosen to participate based on their capability and infrastructure to implement the safety protocols being tested in the project. In addition, they provide a broad geographic representation.
Funding for HAI reduction
February 19, 2009
Intravenous news: The Association for Professionals in Infection Control and Epidemiology (APIC) says it applauds Congress and President Obama for acting on the comments of more than 2,000 of its members who urged their representatives to include funding to help eradicate healthcare-association infections (HAIs) in the stimulus package.
APIC members appealed to their Congressional representatives, urging them to include funding for HAI reduction strategies in the American Recovery and Reinvestment Act of 2009. The stimulus bill passed the House and Senate on Feb. 13 and was signed into law by President Obama on Feb. 17.
As part of this $787 billion stimulus package, $1 billion was included to fund prevention and wellness programs with $50 million going to states to implement HAI reduction strategies.
Click here for the full story.
Home infusion conference 2009
February 18, 2009
Intravenous conference: March 1 – 5, 2009 – Balitmore. The National Home Infusion Association (NHIA) has assembled an extensive, on-target educational program that includes:
- Join your peers at all three NHIA General Sessions to receive critical information about the state of our industry, to hear about progress being made around our legislation and to grasp how emerging trends will impact our future—come and learn how we can all better collaborate together to chart our course for success!
- Gain a humor-based perspective on the state of our government when the immensely entertaining comic team, the Capitol Steps, brings their unique brand of comedy to the NHIA stage.
- Become a vital part of the NHIA grassroots advocacy effort to secure meaningful coverage for home infusion therapies under Medicare by actively participating in our March 5th Legislative Hill Day, as historic numbers of our members travel to Washington, DC (on roundtrip buses) to lobby on Capitol Hill!
- Make the most of the opportunities to meet with all of your key product and service vendors, buying groups, and many more in the three-day 2009 NHIA Exposition by sending your team on a “product and service reconnaissance mission” in the exhibit hall and then comparing notes to reach the best decisions for your patients and your business—and don’t miss the NHIA Exposition Grand Opening Reception on Sunday, March 1 from 5:30 to 7:30 p.m.
- Take part in lively discussions with your friends and colleagues as you network at the NHIA Roundtables program—and for the first time ever, earn pharmacy and nursing CE credit for this shared-learning experience.
- Sustain long-time professional relationships and friendships, initiate new associations, and explore ways to better collaborate to advance our field—all while engaging in the festive, new NHIA Fellowship & Networking Event, open to all conference registrants, on Tuesday evening (March 3 at 7:00 p.m.) at the National Aquarium in Baltimore.
- Choose from over 45 Annual Conference programs to create an educational experience that will surpass your professional needs—all while becoming acquainted with peers from hundreds of other alternate-site infusion companies dealing with the same realities you face!
Click here to visit the conference website.
Blood imports may increase
February 18, 2009
Intravenous news: UK safety advisers are considering increasing imports of blood to reduce the risk of further infections of variant CJD, the human form of BSE, through blood transfusions.
The move comes as the Health Protection Agency yesterday confirmed the first case of an NHS patient contracting the human form of BSE after being treated with infected blood products. The man, who was over 70, died from an unrelated condition after showing no symptoms of vCJD or any other neurological condition, but the infection was identified during a postmortem on his spleen.
Another four people are thought to have been infected by the long-incubating vCJD via blood transfusion before measures to remove more infective white cells were introduced a decade ago, but uncertainty remains about the size of the public health threat.
Increasing the importing of blood is one of the measures being considered by the government’s advisory committee on the safety of blood, tissues and organs (Sabto).
Click here for the full story.
Incidence of central line infection
February 17, 2009
Intravenous literature: Infection Control Today report on a study that indicates that some MRSA infections in ICU patients have been decreasing in recent years. The website states…
“To provide information on the recent trend in the incidence of MRSA central line-associated BSIs in U.S. intensive care units, Deron C. Burton, MD, JD, MPH, of the Centers for Disease Control and Prevention (CDC), and colleagues analyzed national healthcare-associated infection surveillance data reported by hospitals to the CDC. These data, covering the period from 1997-2007, were used to calculate annual central line-associated BSI incidence rates for seven types of adult and pediatric ICUs.
From 1997 through 2007, 1,684 ICUs reported 33,587 central line-associated BSIs, of which 2,498 (7.4 percent) were MRSA and 1,590 (4.7 percent) were methicillin-susceptible Staphylococcus aureus (MSSA). The researchers found that although the overall percentage of S. aureus central line-associated BSIs due to MRSA (called “percent MRSA”) increased 25.8 percent from 1997 through 2007, the overall incidence rate of MRSA central line–associated BSIs declined 49.6 percent from 1997 through 2007. This overall decline occurred despite an initial increase in infection rate from 1997 through 2001, after which the rate steadily declined through 2007.
From 2001 through 2007, MRSA central line–associated BSI incidence declined significantly in all six adult ICU types and was stable in pediatric ICUs. Changes in MRSA central line–associated BSI incidence ranged from −51.5 percent in medical-surgical ICUs without a major teaching affiliation to −69.2 percent in surgical ICUs. In every ICU type, MSSA central line-associated BSI incidence declined continuously and significantly from 1997 through 2007, with estimated incidence changes ranging from −60.1 percent in surgical ICUs to −77.7 percent in medical ICUs.
The authors suggest that these decreases in incidence may be attributable to efforts by health care facilities to improve adherence to CDC’s evidence-based prevention guidelines, the implementation of strategies designed to improve central line insertion and care practices, and increasing success in preventing MRSA transmission between patients by healthcare facilities”.
Original reference: JAMA. 2009;301[7]:727-736; JAMA. 2009;301[7]:772-773.
Read the full report on ITC here.
WHO hand hygiene initiative
February 17, 2009
Intravenous news: As part of the Save Lives: Clean your hands campaign the World Health Organization (WHO) is hosting a global hand hygiene initiative on 5th May 2009.
Hospitals and healthcare facilities throughout the world are invited to take part in a global initiative, raising hand hygiene awareness and reducing healthcare acquired infection (HAI). Already over 100 hospitals from more than 30 countries all over the world have registered.
Click here to view details the WHO clean your hands campaign.
Reuse of sharps containers
February 17, 2009
Intravenous products: A recent survey on use and reuse of sharps containers by Novation, Irving, Texas, asked members of its two owner groups, VHA and University Health System Consortium (UHC), their views on the topic. The survey, released in late October 2008, showed 60 percent of materials managers, nurses, risk managers and other hospital officials consider reusable sharps containers to be safe, a major increase over Novation’s 2006 survey, when only 38 percent of respondents thought so.
This article first appeared in the January 2009 issue of Materials Management in Health Care.
Click here for the full story.
Enteralok prevents IV errors
February 17, 2009
Intravenous products: A new range of enteral syringes has been launched by Sheffield based InterVene® Ltd. In recent years, numerous deaths have occurred by administering enteral medication via intravenous (IV) lines. The enteral syringe which was designed in UK, has been produced in response to National Patient Safety Agency (NPSA) guidelines aimed at preventing maladministration of enteral medication via IV routes.
The syringe employs a ‘reverse luer’ or ‘female luer’ tip which cannot be interchanged with a conventional IV syringe. A purple plunger immediately identifies the syringe as an enteral device and the words ‘Enteral / Oral’ are clearly displayed on the barrel.
Click here for the full press release.
Click here to visit the Enteralok website.
CareFusion® formed by Cardinal
February 16, 2009
Cardinal Health, a global provider of products and services that improve the safety and productivity of healthcare, has selected a name for the medical technology company that will be formed through the proposed spin-off of its clinical and medical products businesses.
The new company will be named CareFusion®, reflecting a diverse blend of medical technologies the company will offer to improve the safety and quality of care. From infusion and medication safety technologies to respiratory equipment, automated medical supply dispensing and infection prevention offerings, CareFusion® will be the largest medical technology company with a singular focus on patient safety. The new company expects to trade on the New York Stock Exchange under the ticker symbol CFN.
Click here for the full story.
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Treatment of biofilms
February 15, 2009
Intravenous news: Peter Moeller of the National Oceanic and Atmospheric Administration’s Hollings Marine Laboratory in Charleston, South Carolina, who is working with researchers at the Medical University of South Carolina and North Carolina State University, said the team noticed a sponge thriving in what was an otherwise dead coral reef. The team found that these bits of sponge were able to repel bacterial biofilms – a slimy substance bacteria form to help stick to surfaces.
“What we found is these (sponge) derivatives actually dispersed existing bacterial biofilms as well as inhibited production of subsequent bacterial biofilms,” Moeller said.
“This is a very exciting result when you realise that 65 to 80% of all human pathogenic infections are based on biofilms,” he added. Moeller said the team tested the substance on some of the toughest pathogens, including MRSA.
Since the compounds are non-toxic, Moeller said the team is now working with a number of medical device companies to incorporate it into the plastic materials used to make devices like stents used to prop open diseased arteries or in intravenous lines used in critically ill patients. He declined to name the companies.
Click here for the full story.
VeinViewer in Australia
February 14, 2009
Intravenous products: One Sydney hospital is among the first in Australia to trial a revolutionary machine that lets clinicians see the veins mapped out on the surface of the skin, reducing the number of failed attempts at cannulation.
The VeinViewer, which will be tested in the hematology unit at Royal Prince Alfred Hospital, displays infra-red images on the skin of the underlying veins. The light shows up the hemoglobin in red blood cells and the image is captured by video camera. The images are processed by a computer and projected onto the patient’s skin using a green light.
The machine, which costs about $50,000, can detect veins six millimetres beneath the skin surface or in the scalp beneath hair and was named by Time magazine as being one of the best medical inventions of 2004.
Click here for the full story.
Infection prevention seminar
February 14, 2009
Intravenous conference: The Northern and Southern New Jersey chapters of the Association for Professionals in Infection Control and Epidemiology (APIC) will host a “Principles of Infection Prevention and Control” seminar March 30 through April 3 at the Clarion Hotel in Princeton, N.J. The cost for the five-day event is $425, which includes materials, continental breakfast, lunch and refreshments. The seminar will address a wide range of infection prevention-related topics and will run from 8 a.m. to 4:30 p.m. each day. For more details, call Christine Armenti at (609) 588-7520 or Kathy Roye-Horn at (908) 788-6169. The deadline for registration is March 6.
Click here to view the original news story on ICT.
Barcode medical equipment
February 14, 2009
Intravenous news: More than a third of nurses waste up to two hours a shift searching for missing medical equipment, a survey suggests. This equates to 40 hours a month and £900m of NHS wages a year spent hunting for missing pumps, drip stands, thermometers and drugs cupboard keys. Of the 989 nurses surveyed, nearly all had spent up to an hour locating kit.
The not-for-profit data standards group GS1 UK, which commissioned the study with Nursing Times, said bar code scanning could solve this.
Click here to read the full news story.
Safety syringe deal
February 13, 2009
Intravenous products: Inviro Medical Devices, an industry leader in infection control products, has recently been awarded a three-year contract with Novation, one of the nation’s largest and most respected GPOs, or group provider organizations. As Novation members represent 20% of the nation’s community hospitals and clinics, Inviro now has a greater opportunity to market its manually retractable safety syringe products to a wider medical and health care audience. Inviro’s partnership with the GPO, which began on February 01, 2009, also underscores the high level of quality all Novation product contracts must possess.
Click here to view the full press release.
Follow IVTEAM on Twitter
February 12, 2009
Intravenous news: Here at IVTEAM we are always looking for new ways of using technology to communicate effectively with our readers. IVTEAM has established itself as the premier IV news site. Now things have just got better 
If you have an iPhone you can now follow IVTEAM on Twitter.
Click here to follow IVTEAM on Twitter.
Dialysis machine inventor dies
February 12, 2009
Intravenous news: Willem Kolff, who died on February 11 aged 97, was one of the great creative geniuses of 20th century medicine, responsible for the invention of the kidney dialysis machine and instrumental in the development of the artificial heart and the artificial eye; more remarkable still, his greatest achievements took place in the Netherlands at the height of the German occupation.
Click here for the full story.
Transfusion and Jehovah’s Witness
February 12, 2009
Intravenous literature: Effa-Heap, G. (2009) Blood transfusion: implications of treating a Jehovah’s Witness patient. British Journal of Nursing. 18(3), p.174-177.
Abstract:
Jehovah’s Witnesses believe that an individual’s life is contained within blood, and that accepting transfusion of blood and blood products is sinful. The administration of blood to a Jehovah’s Witness who has refused to accept transfusion may lead to criminal or civil proceedings. From an ethical viewpoint, if a rational adult who has been fully apprised of the consequences of not receiving this treatment persists in a refusal, the decision should be respected. Medical and nursing staff faced with such a problem should explore fully with the patient any transfusion alternatives that the patient might find acceptable, such as cell salvage, volume expanders, antifibrinolytics and pharmaceutical options, such as erythropoietin. This article examines the legal and consent issues around blood transfusion in Jehovah’s Witness patients and their implications for medical and surgical management.
Osteomyelitis: intravenous or oral
February 12, 2009
Intravenous literature: When treating hospitalized children with acute osteomyelitis — a bacterial bone infection — an early changeover from intravenous (IV) antibiotic delivery to oral antibiotics is just as effective as continuing the IV therapy, according to pediatric researchers.
In addition, the oral drugs are more convenient for children and families, and avoid a major drawback of IV use: increased risk of complications from using central catheters, such as infections or breaks in the catheter.
A study team from The Children’s Hospital of Philadelphia analyzed hospital records for nearly 2,000 children treated at 29 U.S. pediatric hospitals between 2000 and 2005. Their report appeared in the February issue of Pediatrics. “There had been previous reports with small numbers of patients suggesting that early transition to oral antibiotics was safe and effective,” said study leader Theoklis Zaoutis, MD, MSCE, an infectious diseases specialist at the Center for Pediatric Clinical Effectiveness of Children’s Hospital. “This was the first large study of outcomes to directly compare the two practices.”
Cathflo buyout
February 12, 2009
Intravenous products: Roche has announced that it is commencing a cash tender offer for all outstanding publicly-held shares of Genentech for US$86.50 per share.
Genentech are the manufacturers of Cathflo® Activase® (Alteplase) which is indicated for the restoration of function to central venous access devices (CVADs) as assessed by the ability to withdraw blood.
Click here for the full news story.
Central venous catheter video
February 11, 2009
Intravenous literature: Andrew F. Shorr, MD, Associate Professor of Medicine, Department of Pulmonary & Critical Care Medicine, George Washington University presents a video review of central venous catheters treated with anti-infective agents in preventing catheter-related bloodstream infections.
Sonix ultrasound obtains CE Mark
February 10, 2009
Intravenous products: Ultrasonix Medical Corporation, a leading developer and manufacturer of high quality diagnostic ultrasound imaging systems announced today that it has received the CE Mark for the SonixTOUCH ultrasound imaging system.
SonixTOUCH is a, compact, portable diagnostic ultrasound system developed around Ultrasonix’s next generation OpenSONIX platform. The SonixTOUCH is capable of generating premium-level image quality with a completely touch-screen-driven reconfigurable user interface. The system can be configured for virtually any ultrasound application and use model, making it the world’s first truly market-adaptable ultrasound system. The SonixTOUCH received FDA (510k) clearance in November 2008 with shipments beginning in December.
Click here for the full press release.
Needlestick rates stuck
February 10, 2009
Intravenous news: Hospitals are stuck in a holding pattern in their sharps safety programs. Injury rate dropped implementation of safer sharps in 2001, but many facilities have since reached a plateau.
In about half the cases, the safety mechanisms were not activated, according to sharps injury databases, which indicates that either health care workers haven’t been instructed how to use the devices properly or they don’t feel comfortable activating them. Conventional devices still are commonplace, as well, the data indicate.
For example, for Massachusetts hospitals, the rate was 19.7 sharps injuries per 100 licensed beds in 2002. It dropped to 18.4 per 100 licensed beds in 2003, but then stayed the same in 2004.
Among hospitals in the EPINet network of the International Health care Worker Safety Center at the University of Virginia in Charlottesville, needlesticks declined significantly from 1999 to 2001, but then remained stable since then.
Click here for the full story.
IV medication error payout
February 10, 2009
Intravenous news: A jury has awarded $5 million in a Pennsylvania malpractice lawsuit filed over a hospital medication error where a woman developed permanent brain damage after being given eight times the amount of sodium that her doctor prescribed to treat an electrolyte deficiency.
The lawsuit was filed by Mary Ellen Pfeifer against University of Pittsburgh Medical Center’s (UPMC) McKeesport Hospital in the Court of Common Pleas of Allegheny County, Pennsylvania. Pfeifer was admitted to the emergency room on December 21, 2006, and blood test revealed that she was suffering from confusion and difficulty walking caused by critically low sodium. The treatment plan called for her low sodium to be corrected at a rate of 125 cc per hour. However, due to a medication error by the hospital staff, she received 1000 cc in one hour.
Click here for the full story.
More IV news at IVTEAM
Sharps safety audit
February 5, 2009
Intravenous literature: Aziz, A.M., Ashton, H., Pagett, A., Mathieson, K., Jones, S. and Mullin, B. (2009) Sharps management in hospital: an audit of equipment, practice and awareness. British Journal of Nursing. 18(2), p.92-98.
Abstract:
The safe handling and disposal of needles and other sharp instruments forms part of an overall strategy to protect staff, patients and visitors from exposure to blood-borne pathogens. As with many infection prevention and control policies, the assessment and management of the risks associated with the use of sharps is paramount, and safe systems of work and engineering controls must be in place to minimize any identified risks. The use of sharps in hospitals should be avoided where possible; when their use is essential, particular care is required in handling and disposal – if possible, use safer sharps devices. An audit of sharps management was undertaken to observe equipment, practice and awareness. The audit reported very positive results. However, some areas needed further review to improve practice. The infection control team implemented an action plan as a result of the audit and set about initiating measures for training and awareness. It is necessary to audit sharps management routinely to have an accurate assessment of current practice and prevent occupational exposure to blood-borne pathogens.
Free intravenous conference
February 4, 2009
Intravenous conference: Due to popular demand the highly successful EPIC2 tour is returning for a third set of dates. Topics covered in the day include CRBSI, EPIC2, ANTT and building a business case. Click here to register
The following information has been released by the IPS and EPIC2 teams:
- 20th April 2009 – Cardiff
- 21st April 2009 – Brighton
- 22nd April 2009 – Peterborough
Official details have not been released yet. Click here to register. Further information may be obtained from stacy@fitwise.co.uk
IV glucose investigation
February 4, 2009
Intravenous news: A premature baby whose death is the subject of a police inquiry spent most of her short life at a Norfolk hospital. Poppy Read more
Safe Point device award
February 3, 2009
Intravenous products: A needle safety product emerged victorious at the third annual Banbury Innovation Award. Steve Cooley, a 43-year-old dentist from Adderbury, took home the prize after impressing the Dragons’ Den-style judging panel with his Safe Point needle remover.
The device, which Mr Cooley envisages becoming, at the least, a part of every dentist’s surgery in the UK, safely removes used surgical needles from a syringe, avoiding the current risk of getting a ‘needle stick’ cut by doing it manually.
Click here for the full story.
Community IV therapy service
February 3, 2009
Intravenous news: A nurse-led community IV therapy service at a trust in Cheshire has saved the NHS over one million in just three years. The service, run by nurses at Warrington PCT, provides an alternative to hospital admission by enabling nurses to administer IV therapy to patients within their own homes.
Nurses involved in the service have shared their latest audit data with Nursing Times. Of the 751 patients treated by the ‘admissions avoidance’ service between September 2005 and November 2008, only 27 had to be admitted to hospital – just 3.6% of the total number of patients referred to the service during that time.
This resulted in over 7,000 bed days saved. At a cost of around £2,353 per patient for IV therapy treatment in hospital – compared to just £886 for patients using the IV service – the trust saved almost £1,500 per patient.
Click here for the full story.
Biofilm detachment and CRBSI
February 3, 2009
Intravenous literature: Sellam, A., Al-Niemi, T., McInnerney, K., Brumfield, S., Nantel, A. and Suci, P.A. (2009) A Candida albicans early stage biofilm detachment event in rich medium. BMC Microbiology. 9(25), doi:10.1186/1471-2180-9-25
Dispersal from Candida albicans biofilms that colonize catheters is implicated as a primary factor in the link between contaminated catheters and life threatening blood stream infections (BSI). Appropriate in vitro C. albicans biofilm models are needed to probe factors that induce detachment events. Results: Using a flow through system to culture C. albicans biofilms we characterized a detachment process which culminates in dissociation of an entire early stage biofilm from a silicone elastomer surface. We analyzed the transcriptome response at time points that bracketed an abrupt transition in which a strong adhesive association with the surface is weakened in the initial stages of the process, and also compared batch and biofilm cultures at relevant time points. K means analysis of the time course array data revealed categories of genes with similar patterns of expression that were associated with adhesion, biofilm formation and glycoprotein biosynthesis. Compared to batch cultures the biofilm showed a pattern of expression of metabolic genes that was similar to the C. albicans response to hypoxia. However, the loss of strong adhesion was not obviously influenced by either the availability of oxygen in the medium or at the silicone elastomer surface. The detachment phenotype of mutant strains in which selected genes were either deleted or overexpressed was characterized. The microarray data indicated that changes associated with the detachment process were complex and, consistent with this assessment, we were unable to demonstrate that transcriptional regulation of any single gene was essential for loss of the strong adhesive association. Conclusion: The massive dispersal of the early stage biofilm from a biomaterial surface that we observed is not orchestrated at the level of transcriptional regulation in an obvious manner, or is only regulated at this level by a small subpopulation of cells that mediate adhesion to the surface.
Click here for the provisional pdf of the full text.
More IV news at IVTEAM
Abstract (provisional):
Safe tube-feeding in hospitals
February 3, 2009
Intravenous news: As part of their commitment to safety, Nestle HealthCare Nutrition and the American Society for Parenteral and Enteral Nutrition, or A.S.P.E.N., today announced the launch of a new initiative to promote safe tube-feeding in hospitals.
The “Be A.L.E.R.T.” campaign is designed to raise awareness of key steps that should be taken in order to administer tube feedings more safely and reduce the risk of tubing misconnections. The program complements the A.S.P.E.N. Enteral Nutrition Practice Recommendations, a comprehensive set of safety guidelines issued this week during Clinical Nutrition Week.
Tubing misconnections caused by human error are a serious problem in our nation’s health-care facilities. A leading health-care organization reports that more than 300 people died or suffered serious injury from tubing misconnections between 2000 and 2004. (“Tubing Misconnections: A Perilous Design Flaw,” Materials Management in Health Care, November 2006: 36-39.)
“Solving this industry-wide problem requires all of us — hospitals, health-care professionals, regulators, quality improvement groups and manufacturers — to work together to raise awareness, implement design change and create the tools that nurses and others need to provide the highest-quality care possible,” said Carol Siegel, MS, RD, manager of professional services at Nestle HealthCare Nutrition, a unit of Nestle Nutrition. “This new education initiative is a significant step forward in our ongoing effort to improve patient safety.”
