Central line misplacement
March 29, 2009
Intravenous literature: Rath, G.P., Bithal, P.K., Toshniwal, G.R., Prabhakar, H. and Dash, H.H. (2009) Saline flush test for bedside detection of misplaced subclavian vein catheter into ipsilateral internal jugular vein. British Journal of Anaesthesia. 102(4), p.499-502.
Abstract:
BACKGROUND: The most common misplacement during subclavian vein (SCV) catheterization is into the ipsilateral internal jugular vein (IJV). Chest radiography is the gold standard for the confirmation of correct placement. However, it is time-consuming and has the disadvantage of radiation exposure. We assessed the sensitivity and specificity of our previously reported ‘flush test’ for confirming correct central line placement.
METHODS: All neurosurgical patients who underwent successful SCV catheterization on the right side by an infraclavicular approach were enrolled in this study. The flush test was performed by injecting 10 ml of normal saline in the distal port of catheter, while anterior angle of ipsilateral neck was palpated by an independent observer. A thrill of fluid elicited on the palm of hand (positive test) was suggestive of misplaced catheter into ipsilateral IJV. This was confirmed with chest fluoroscopy.
RESULTS: SCV catheterization was performed in 570 patients. The flush test was positive in 19 patients (3.3%) and negative in 551 patients (96.7%). There were 26 (4.6%) misplacements as detected by chest radiography; 19 entered the IJV (3.3%) and seven the contralateral SCV (1.2%). In all patients who had a misplaced catheter into the ipsilateral IJV, the flush test results were positive, whereas the results were negative in patients who had normally placed catheter or misplaced catheter elsewhere. It was found that the test had 100% sensitivity and specificity to detect misplacement of SCV catheter into the ipsilateral IJV.
CONCLUSIONS: Saline flush test is a simple and sensitive bedside test that successfully detects misplaced SCV catheters into ipsilateral IJV.
CLABSI rates 1997-2007
March 29, 2009
Intravenous literature: Burton, D.C., Edwards, J.R., Horan, T.C., Jernigan, J.A. and Fridkin, S.K. (2009) Methicillin-resistant Staphylococcus aureus central line-associated bloodstream infections in US intensive care units, 1997-2007. JAMA: Journal of the American Medical Association. 301(7), p.727-736.
No abstract available.
Central line IV dressings
March 29, 2009
Intravenous literature: Keene, D., Hennessey, I. and Rakoczy, G. (2009) Central venous line dressings: can you stick it?. Journal of Pediatric Surgery. 44(2), p.432-5.
Abstract:
AIM: The objective of this study is to investigate which central venous catheter dressing is most secure.
BACKGROUND: Central venous catheter insertion is a common procedure. A secure dressing is essential to prevent early line displacement. Many different dressings are used, but there is no consensus in choosing an optimal dressing.
METHODS: A sandwich, loop-line, or bridge technique was used to apply each of the dressings. Two mechanisms of displacement were tested: dressing adherence to skin and dressing adherence to line. Dressing to skin adherence was tested on a relatively hairless part of the upper arm. Weights were added sequentially until the dressing peeled off. Dressing to line adherence was tested by applying the dressing to a 7F Dual Lumen Bard Hickman line passing through a piece of foam (measuring 13 x 12 cm). Weights were attached to the line until the cuff was pulled through the foam.
RESULTS: Dressing to skin adherence was poorest for the clear dressings, followed by Mefix and Sleek, and greatest for a combination of Tegaderm and Mefix. Dressing to line adherence was improved using a sandwich technique instead of a loop-line technique and most secure when a bridge technique was used to the thicker shaft of the line.
CONCLUSIONS: The dressings used for securing Hickman lines are not all equally secure. The least effective is the IV 3000 loop-line dressing. Tegaderm-Mefix bridge and Tegaderm-Mefix-Sleek combination dressings are the most secure and cost effective.
CVC related endocarditis
March 29, 2009
Intravenous literature: Ahmed, M.S., Nistal, C., Jayan, R. and Kuduvalli, M.H. (2009) Achromobacter xylosoxidans, an emerging pathogen in catheter-related infection in dialysis population causing prosthetic valve endocarditis: a case report and review of literature. Clinical Nephrology. 71(3), p.350-4.
Abstract:
Introduction: Dialysis catheter-related infection is a major cause of morbidity and mortality in patients on dialysis. In recent years, there have been reported cases of infections with opportunistic environmental organism, Achromobacter xylosoxidans (AX) causing bacteremia in patients on dialysis. However, no previous such reports on prosthetic valve endocarditis in a dialysis patient with Achromobacter xylosoxidans were found after a Medline search. We report such a case and review the literature. Case: A 69-year-old diabetic man with bioprosthetic aortic valve replacement developed end-stage renal disease following infective endocarditis with Staphylococcus epidermidis. Even though he was treated successfully for his endocarditis, he developed further bacteremia with AX from his peripherally inserted central catheter (PICC) and the line was removed. He had further episodes of bacteremia with AX while having dialysis with tunneled line and the line was also removed. He was re-admitted with pyrexia and vegetations both in mitral and prosthetic aortic valve confirmed with transesophageal echo. His antimicrobial therapy with etrapenum, tigecycline and cotrimoxazole failed. He had both mitral and prosthetic aortic valve replacements but postoperatively developed multiorgan failure and died despite the intensive support. Discussion: Achromobacter xylosoxidans is an aerobic, Gram-negative bacillus and considered to be an opportunistic pathogen with low virulence. Infective endocarditis is a potentially lethal complication of bacteremia. The choice of appropriate antibiotic is crucial in these cases. AX strains are highly resistant to antibiotics. The organism is usually susceptible to antipseudomonal penicillins, carbapenems and trimethoprim-sulfamethoxazole. Conclusion: AX is an emerging pathogen in catheter-related infection in the dialysis population and, therefore, needs vigilance and prompt treatment. Antimicrobial treatment should include susceptibility and synergy testing. Removal of central intravenous catheter should also be considered at the time of early presentation in patients at high risks of developing infective endocarditis.
CVP versus PAC
March 29, 2009
Intravenous literature: Jules-Elysee, K.M., Yadeau, J.T. and Urban, M.K. (2009) Pulmonary artery versus central venous catheter monitoring in the outcome of patients undergoing bilateral total knee replacement. Hss Journal. 5(1), p.27-30.
Abstract:
Bilateral total knee replacement (BTKR) has been associated with a higher incidence of fat embolism (FES) compared to single knee replacement. Consequently, intraoperative monitoring with a pulmonary artery catheter (PAC) has been recommended. This study compares clinical outcome in BTKR patients monitored with central venous pressure versus PAC. A retrospective chart review of 249 consecutive patients undergoing BTKR, 132 of whom had PAC insertion versus 117 who had central line insertion, over a 1-year period were included in the study. Their medical records were reviewed for co-morbidities, baseline characteristics, and type of intraoperative monitoring. Need and duration for postoperative monitoring in the postoperative care, length of hospital stay (LOHS), signs of fat embolism, development of arrhythmias, and respiratory failure were all outcome measures. A total of four patients (1.6%) had FES as per Schonfeld criteria. One of these patients died within 48 h of surgery. They all had PAC monitoring intraoperatively. Pulmonary artery pressure (PAP) remained unchanged during surgery which raises doubt as to the clinical utility and advisability of the use of PAC’s in this setting. There was no statistically significant difference in cardiac or pulmonary complications, or LOHS between the two groups. Central venous pressure monitoring appears to be sufficient in patients undergoing BTKR.
Heparin-bonded central lines
March 29, 2009
Intravenous literature: Anton, N., Cox, P.N., Massicotte, M.P., Chait, P., Yasui, Y., Dinyari, P.M., Marzinotto, V. and Mitchell, L.G. (2009) Heparin-bonded central venous catheters do not reduce thrombosis in infants with congenital heart disease: a blinded randomized, controlled trial. Pediatrics. 123(3), p.e453-8.
Abstract:
BACKGROUND: Infants with congenital heart disease who require central venous lines are at increased risk of thrombosis. Heparin-bonded catheters provide protection from thrombotic events in some children. However, heparin-bonded catheters may not be as effective in infants </=1 year old because of other potential risk factors (smaller vessel size, longer duration of catheter use). No studies have assessed the benefit of heparin-bonded catheters in such specific high-risk populations. The objective of this study was to assess the efficacy of heparin-bonded catheters for preventing thrombosis in infants aged </=1 year with congenital heart disease. Study DESIGN: This study was designed as a randomized, controlled, blinded single-center trial. Infants </=1 year old with congenital heart disease requiring a central venous line for clinical care were randomly assigned to receive either a heparin-bonded catheter or a standard non-heparin-bonded catheter. Catheters were visually indistinguishable. The primary outcome was incidences of both silent and clinically noticeable thrombosis confirmed by ultrasound. Ultrasounds were reviewed by a blinded central adjudication committee. Interim analysis was performed after enrollment of 97 patients. RESULTS: Eighty-seven patients were evaluable (41 of the patients were female). Thrombotic events occurred in 17 (42.5%) of 40 patients in the non-heparin-bonded catheter group and in 21 (44.7%) of 47 patients in the heparin-bonded catheters group. The study was stopped when the interim analysis showed convincing evidence for no difference between groups over the alternative hypothesis of 50% risk reduction. CONCLUSIONS: Infants with congenital heart disease are at significant risk of both silent and clinically identified thrombosis. There seems to be no advantage in using heparin-bonded catheters in infants </=1 year of age.
Emergency haemodialysis access
March 29, 2009
Intravenous literature: Frampton, A.E., Kessaris, N., Hossain, M., Morsy, M. and Chemla, E.S. (2009) Use of the femoral artery route for placement of temporary catheters for emergency haemodialysis when all usual central venous access sites are exhausted. Nephrology Dialysis Transplantation. 24(3), p.913-8.
Abstract:
BACKGROUND: Urgent dialysis via a temporary central line may be impossible when all central veins are obstructed.
METHODS: We report 10 patients (7 males and 3 females) over a 5-year period who lost all venous access sites, due to multiple peripheral venous thromboses with a superior vena cava obstruction or stenosis in 50%. These patients required urgent haemodialysis prior to general anaesthetic for a surgical intervention, but in all cases a traditional central venous line could not be used. They were therefore dialysed via a femoral artery catheter (FAC) before surgical rescue or creation of a more definite vascular access (VA). The median age of these patients was 64.7 years. None were suitable for peritoneal dialysis or urgent transplantation. Thirteen FACs (11F dual lumen dialysis catheter) were inserted into the common femoral artery. Both lumens were perfused continuously with heparinized saline (12 000 IU/24 h). All patients underwent a surgical procedure (rescue of previous access/creation of a new exotic one). First dialysis adequacy was assessed and compared to the rescued or new access.
RESULTS: All patients had been on haemodialysis for a median period of 4.4 years. The mean number of previous access procedures was 17 (range 10-28). The duration of FAC use ranged from 1 to 12 days (mean 5 days). Dialysis adequacy was satisfactory for all patients. Seven patients had a complex vascular access formed and six had thrombectomy of their previous access. There were two complications related to FAC use, which were distal ischaemia and bleeding. Three patients died from access-related problems at 0, 4.6 and 15.0 months. Seven are still dialysed through their fistula or graft as outpatients with a mean follow-up of 14.0 months (range 0-50.9 months).
CONCLUSION: Femoral artery dialysis is an effective means of haemodialysis as a method to bridge the gap before definitive vascular access formation when all other options have been exhausted.
Vascular access skin preparation
March 29, 2009
Intravenous literature: Stonecypher, K. (2009) Going around in circles: is this the best practice for preparing the skin? Critical Care Nursing Quarterly. 32(2), p.94-8.
Abstract:
Hospital-acquired infections, which include bloodstream infections and surgical site infections, result in high rates of morbidity and mortality in the United States annually. Proper aseptic care of the skin prior to any skin breach is of paramount importance to reduce these outcomes. The application of the most appropriate skin preparation solution is significant but possibly not as important as the technique employed to apply the solution itself. Historically, concentric circles were the method of choice taught to nurses prior to any venipuncture. More recently, the back-and-forth friction method is being promoted. There is no evidence to support either method, yet effective reduction of infections is occurring. It is the intent of this article to address concerns for hospital-acquired infections and offer evidence-based suggestions to improve outcomes, as one method of skin preparation demonstrates greater efficacy.
Drug interactions
March 27, 2009
Intravenous literature: Shepherd, M. (2009) A guide to understanding and managing drug interaction. Nursing Times. 105(5), p.21.
Abstract:
Medicines Management series. Causes and mechanisms of drug interactions. The differences between pharmaceutical, pharmacodynamic and pharmacokinetic interactions are briefly explained and management is discussed, highlighting the need for medication review.
External jugular cannulation
March 26, 2009
Intravenous literature: Pettit, J. (2009) External Jugular Cannulation in Infants and Children. Journal of Infusion Nursing. 32(2), p.93-97.
Abstract:
Placement of a peripherally inserted central catheter (PICC) is commonplace in infants and children for the infusion of medications, hydration, and nutritional solutions. Vein depletion caused by repeated and prolonged need for vascular access devices has forced practitioners to consider alternate veins for providing care. The external jugular vein has a positive history of use for insertion of the PICC and is becoming increasing popular for this purpose. Pertinent anatomy, patient selection criteria, preparation, and catheter insertion and maintenance processes related to the catheter placed and residing in the external jugular vein are discussed.
Primary hyperparathyroidism review
March 26, 2009
Intravenous literature: Owens, B.B. (2009) A Review of Primary Hyperparathyroidism. Journal of Infusion Nursing. 32(2), p.87-92.
Abstract:
Primary hyperparathyroidism is the inappropriate secretion of parathyroid hormone and is the most common cause of hypercalcemia. Most patients with primary hyperparathyroidism are asymptomatic, and the disease is more common in postmenopausal women than in older men. Primary hyperparathyroidism can be treated with medication and long-term monitoring; however, surgical removal of the affected parathyroid gland is the definitive treatment. Rarely occurring, parathyroid crisis must be treated promptly to prevent deleterious effects to the patient. The patient experiencing parathyroid crisis benefits from the infusion nurse’s knowledge of drug and fluid therapies and expertise in peripheral access.
CRBSI literature review
March 26, 2009
Intravenous literature: Meyer, J. (2009) A Broad-Spectrum Look at Catheter-Related Bloodstream Infections: Many Aspects, Many Populations. Journal of Infusion Nursing. 32(2), p.80-86.
Abstract:
The issue of central vascular catheter-related bloodstream infections is prominent in medical literature and practice today, both in the United States and throughout the international healthcare community. In its 2002 report on Guidelines for the Prevention of Intravascular Catheter-Related Infections, the Centers for Disease Control and Prevention estimated that 250,000 cases of central vascular catheter-related infections occur annually. This article is a review of current literature pertaining to catheter-related bloodstream infections. Included are resources from 2004 onward, as well as resources such as the Centers for Disease Control and Prevention, the Institute for Healthcare Improvement, and the National Guideline Clearinghouse.
Infusion phlebitis treatment
March 26, 2009
Intravenous literature: Reis et al (2009) Pharmacological Interventions to Treat Phlebitis: Systematic Review. Journal of Infusion Nursing. 32(2), p.74-79.
Abstract:
This study presents a systematic review for evaluating effective pharmacological actions for the treatment of phlebitis stemming from infusion therapy. The studies reviewed were categorized according to the type of therapeutic approach proposed by the author and by the level of evidence presented. The review found that topical nitroglycerin and notoginseny were more effective in the reduction of the inflammatory process when compared with other proposed alternatives. Nevertheless, the development of research related to possible alternatives for the treatment of phlebitis is important.
Insulin overdose death
March 26, 2009
Intravenous news: A nurse used a regular ‘IV’ syringe to administer insulin rather than an insulin syringe. “A newly-qualified community Read more
Biopatch randomized controlled trial
March 24, 2009
Intravenous literature: Timsit, J.F., et al (2009) Chlorhexidine-Impregnated Sponges and Less Frequent Dressing Changes for Prevention of Catheter-Related Infections in Critically Ill Adults A Randomized Controlled Trial. JAMA. 301(12), p.1231-1241.
Click here to view the full article.
Context: Use of a chlorhexidine gluconate–impregnated sponge (CHGIS) in intra-vascular catheter dressings may reduce catheter-related infections (CRIs). Changing catheter dressings every 3 days may be more frequent than necessary.
Objective: To assess superiority of CHGIS dressings regarding the rate of major CRIs (clinical sepsis with or without bloodstream infection) and noninferiority (less than 3% colonization-rate increase) of 7-day vs 3-day dressing changes.
Design, Setting, and Patients: Assessor-blind, 2 x 2 factorial, randomized controlled trial conducted from December 2006 through June 2008 and recruiting patients from 7 intensive care units in 3 university and 2 general hospitals in France. Patients were adults (>18 years) expected to require an arterial catheter, central-vein catheter, or both inserted for 48 hours or longer.
Interventions: Use of CHGIS vs standard dressings (controls). Scheduled change of unsoiled adherent dressings every 3 vs every 7 days, with immediate change of any soiled or leaking dressings.
Main Outcome Measures: Major CRIs for comparison of CHGIS vs control dressings; colonization rate for comparison of 3- vs 7-day dressing changes.
Results: Of 2095 eligible patients, 1636 (3778 catheters, 28 931 catheter-days) could be evaluated. The median duration of catheter insertion was 6 (interquartile range [IQR], 4-10) days. There was no interaction between the interventions. Use of CHGIS dressings decreased the rates of major CRIs (10/1953 [0.5%], 0.6 per 1000 catheter-days vs 19/1825 [1.1%], 1.4 per 1000 catheter-days; hazard ratio [HR], 0.39 [95% confidence interval {CI}, 0.17-0.93]; P = .03) and catheter-related bloodstream infections (6/1953 catheters, 0.40 per 1000 catheter-days vs 17/1825 catheters, 1.3 per 1000 catheter-days; HR, 0.24 [95% CI, 0.09-0.65]). Use of CHGIS dressings was not associated with greater resistance of bacteria in skin samples at catheter removal. Severe CHGIS-associated contact dermatitis occurred in 8 patients (5.3 per 1000 catheters). Use of CHGIS dressings prevented 1 major CRI per 117 catheters. Catheter colonization rates were 142 of 1657 catheters (7.8%) in the 3-day group (10.4 per 1000 catheter-days) and 168 of 1828 catheters (8.6%) in the 7-day group (11.0 per 1000 catheter-days), a mean absolute difference of 0.8% (95% CI, −1.78% to 2.15%) (HR, 0.99; 95% CI, 0.77-1.28), indicating noninferiority of 7-day changes. The median number of dressing changes per catheter was 4 (IQR, 3-6) in the 3-day group and 3 (IQR, 2-5) in the 7-day group (P < .001).
Conclusions: Use of CHGIS dressings with intravascular catheters in the intensive care unit reduced risk of infection even when background infection rates were low. Reducing the frequency of changing unsoiled adherent dressings from every 3 days to every 7 days modestly reduces the total number of dressing changes and appears safe.
Click here to view the full article.
Synthetic human blood
March 24, 2009
Intravenous news: BBC News report that “UK scientists plan a major research project to see if synthetic human blood can be made from embryonic stem cells. Led by the Scottish National Blood Transfusion Service, the three year trial could provide an unlimited supply of blood for emergency transfusions. The blood should be free of infections like the human form of mad cow disease.
Teams will test human embryos left over from IVF treatment to find those destined to develop into the universal “O-negative” blood donor group”.
Click here for the full story on BBC News
Anti-bacterial coating research
March 24, 2009
Intravenous news: News-Medical.net report that “Researchers at the University of Bath are to be part of a 3 million Euros Europe-wide research collaboration to pioneer research into safer, more effective anti-bacterial plastics and coatings that can be used in items such as food packaging, medical devices to wound dressings, and nappies.
The Bath team has developed a range of new compounds which have been shown to be highly effective against common hospital bacterial infections such as MRSA and are safer than existing anti-bacterials based on silver nanoparticles. They will develop these compounds so they can be cheaply and efficiently incorporated into a wide range of materials from medical devices, wound dressings, food packaging and even nappies.
Led by Dr Toby Jenkins at the University of Bath, the research team comprises chemists Dr Andrew Johnson and Dr Gareth Price, and biologist Dr Nick Waterfield as well as colleagues in Barcelona, Exeter, St. Gallen (Switzerland), Mainz and Cologne (both Germany)”.
Click here for the full story on News-Medical.net
Cleans hands save lives
March 22, 2009
Intravenous news: The Star Online report the clean hands save lives. “Hand hygiene is important. We all know that. But its practice remains capricious even in healthcare centres. Now hospitals are taking active measures to improve. It was a busy day in the outpatient emergency department – one of those days where patients needing drips, oxygen or sutures filed in by the dozens.
As the medical officer’s tired eyes scanned yet another request for an intravenous (IV) drip for a mildly dehydrated young girl, he reached into the storage cabinet with gloved hands for the drip set. He then ushered the girl to an armchair and comforted her as he uncapped the drip needle. With swift, practised moves, he swabbed the puncture site with alcohol and the needle was painlessly inserted into a vein in the girl’s arm. Satisfied, he moved on to the next patient.
He has done everything right: he responded immediately to the request, he made an effort to comfort the patient and administered the drip with the least pain possible.
Now, here’s a trick question: Could the medical officer have done better?
Actually, he could have – as you will find out if you have read the guidelines for hand hygiene by the WHO, US Centers for Disease Control and Prevention (CDC) or the UK National Patient Safety Agency.
For starters, he could have changed into a new pair of gloves before touching every patient. And, it would be better if he also washed his hands before and after each encounter (even if you wear gloves, you still need to clean your hands)”.
Click here for the full story on thestar.com
CLABSI reduction by 90%
March 21, 2009
Intravenous news: InfectionControlToday.com report “Central line-associated bloodstream infections (CLABSI) fell by more than 90 percent during the past three years at the Hospital of the University of Pennsylvania due to a multi-pronged approach combining leadership initiatives, electronic infection surveillance, checklists to guide line insertion and maintenance, and implementation of the Toyota Production System to encourage best practices in line care. The findings, which Penn physicians say provide a road map for cutting the deadly, costly toll of hospital-acquired infections nationwide, were presented March 20 at the annual meeting of the Society for Healthcare Epidemiology of America (SHEA).”
Click here for the full news story on InfectionControlToday.com
Material resists biofilm growth
March 21, 2009
Intravenous news: InfectionControlToday.com report on the “tale of two biological substances — cells from mammals and bacteria. It’s a story about the havoc these microscopic entities can wreak on all manner of surfaces, from mighty ships to teeth and medical devices, and how two SyracuseUniversity researchers are discovering new ways to prevent the damage.
Under moist conditions, bacteria form what scientists call biofilms — a sticky, slimy buildup on almost any kind of surface. Biofilms can corrode the hulls of ships, produce green slime on rocks, pollute drinking water systems, form plaque on teeth and stick to medical devices implanted in humans, resulting in infection or rejection.
It’s critically important, therefore, for scientists to gain a better understanding of how biofilms are formed and use that knowledge to develop surfaces that will resist such biofouling. In an unusual, interdisciplinary collaboration, SU researchers have found that if you can prevent protein from sticking to a surface, you can prevent both bacteria and mammalian cells from doing likewise. In the process, they developed a novel surface technology that scientists can use to study biofilms in ways that were not previously possible”.
Click here for the full news story on InfectionControlToday.com
Pulse oximetry detects fluid volume
March 21, 2009
Intravenous products: Masimo the inventor of Pulse CO-Oximetry and Measure-Through Motion and Low-Perfusion pulse oximetry, today announce that a new clinical study, independently conducted by researchers from the University of California-San Francisco (UCSF), demonstrates that Masimo PVI accurately and reliably reflects acute changes in intravascular fluid volume (preload). The study, presented at the International Anesthesia Research Society (IARS) 83rd Scientific Congress on March 14th in San Diego, Calif., affirms PVI as a highly predictive indicator of patient fluid status.
Assessing whether a patient needs fluid to increase their cardiac index (amount of blood the heart pumps each minute) is one of the biggest challenges anesthesiologists face during surgery. Although fluid administration is critical to optimizing patient status and enabling end organ preservation, unnecessary fluid administration is associated with increased morbidity and mortality and traditional invasive measurements are only 50 to 60% accurate at predicting improvement in cardiac index after volume administration. PVI—a new method for noninvasive and automatic assessment of fluid responsiveness—has been shown in multiple studies to predict fluid responsiveness in mechanically ventilated patients, helping clinicians to optimize fluid administration and improve patient outcomes.
In the study, Errol P. Lobo, M.D., PhD, at UCSF in San Francisco, Calif., and colleagues used Masimo Radical-7 Pulse CO-Oximeters to noninvasively measure and continuously track PVI, perfusion index (PI) and pulse rate (PR) data during 16 consecutive liver transplant operations. Researchers extracted and analyzed the noninvasive data at three critical points where preload changes occur rapidly: 1) immediately before clamping, 2) during clamping, and 3) immediately after clamping of the inferior vena cava (IVC), and found that PVI changed rapidly and significantly in response to known acute changes in preload (clamping and unclamping of IVC) in 100% of the cases.
Click here for the full press release.
IV Station from Health Robotics
March 21, 2009
Intravenous products: PharmacyEurope.net report that a “US medical technology firm has unveiled a robot designed to deliver accurate and efficient intravenous (IV) mixtures to patients in a safe and cost effective way. The IV Station from Health Robotics can automatically mix compounds while producing ready to administer IV doses in a variety of syringes, bags, vials, and tamper-evident caps.
The launch at the European Association of Hospital Pharmacists, in Barcelona, Spain, was also accompanied by a display of the company’s CytoCare, a pioneering chemotherapy IV robot.
Health Robotics said the new IV device was designed to minimise medication errors, and address high costs, lack of sterility and difficulties in maintaining adequate and trained staff. The firm has already reached agreements for the delivery of 16 IV Stations to medical facilities in countries across the globe, including the UK, Japan, Turkey and Italy”.
Click here for the full story on PharmacyEurope.net
FDA insulin pen alert
March 21, 2009
Intravenous news: News-Medical.net report that the “U.S. Food and Drug Administration has issued an alert to health care professionals reminding them that single-patient insulin pens and insulin cartridges should not be used to administer medication to multiple patients due to the potential risk of transmitting blood-borne pathogens such as HIV and the hepatitis viruses.
Insulin pens are pen-shaped injector devices that contain a disposable needle and either an insulin reservoir or an insulin cartridge. The devices typically contain enough insulin for a patient to self-administer several doses of insulin before the reservoir or cartridge is empty. All insulin pens are approved only for single-patient use (one device for only one patient).
The FDA is aware of incidents at two undisclosed hospitals involving more than 2,000 people in which the cartridge component of the insulin pens were used to administer insulin to multiple patients, although the disposable needles were reportedly changed among patients”.
Click here for the full story on News-Medical.net
IV dressing change frequency
March 18, 2009
Intravenous literature: Vokurka, S., Bystricka, E., Visokaiova, M,. and Scudlova, J. (2009) Once- versus twice-weekly changing of central venous catheter occlusive dressing in intensive chemotherapy patients: results of a randomized multicenter study. Medical Science Monitor. 15(3), p.CR107-10), 1643-3750.
Abstract:
BACKGROUND: Changing a central venous catheter occlusive dressing on a twice-weekly basis is usually recommended in hemato-oncological patients. A longer interval is believed to give rise to infections. However, frequent dressing changes might cause local cutaneous damage. MATERIAL/METHODS: Local cutaneous damage and infections were compared in patients with once-weekly versus twice-weekly changes of central venous catheters occlusive dressings. This was a prospective, randomized, multicenter trial. RESULTS: Eighty-one patients with acute myeloid leukemia being treated with intensive chemotherapy were enrolled (twice-weekly group: n=42, once-weekly group: n=39). They had a non-tunneled polyurethane central venous catheter inserted into the vena subclavia and the insertion site was covered by a polyurethane semi-permeable occlusive dressing. No differences were observed between the groups with respect to local cutaneous damage, fevers, or positive catheter blood cultures. There were more insertion-site inflammations in the twice-weekly group (55% vs. 25%, p=0.008). In the once-weekly group it was necessary to change the occlusive dressing sooner in 42% of the cases, mostly due to a soiled dressing and local bleeding, and the real mean interval of changes was 5.4 days. CONCLUSIONS: Prolonging the frequency of occlusive dressing change to a once-weekly interval was limited by an increasing number of unplanned dressing changes. The prolonged interval of dressing changes, with a real mean interval of 5.4 days, did not lead to an increased number of local cutaneous complications or central venous catheter blood culture positivity and even contributed to reduced insertion-site inflammation occurrence.
Blood culture incubator time
March 18, 2009
Intravenous literature: Kerremans, J.J., van der Bij, A.K., Goessens, W., Verbrugh, H.A. and Vos, M.C. (2009) Needle-to-incubator transport time: logistic factors influencing transport time for blood culture specimens. Journal of Clinical Microbiology. 47(3), p.819-22.
Abstract:
The maximum recommended transport time for blood cultures is 4 h [L. S. Garcia (ed.), 2007 Update: Clinical Microbiology Procedures Handbook, 2nd ed., 2007]. In a previous study, we found that the average transport time was 10 h. In this cohort study, we measured transport times for blood cultures in a larger sample and identified predictors for transport times. A total of 4,322 blood cultures from 1,313 patients were included. The median transport time was 3.5 h, with 47% of cultures exceeding the recommended 4 h. Off-site location and type of clinical specialty were the most important predictors of long transport times. Cultures collected during weekend days or on wards at the largest distances from the laboratory were also associated with long transport times.
Central line care bundles
March 18, 2009
Intravenous news: The following question was recently put forward on MedScape.com “I have seen many references to “bundles” lately. What are bundles, and how can they be used to prevent infection in the ICU setting”?
Which is answered by Professor Ruth M. Kleinpell.
“Bundles” have emerged as frameworks for addressing clinical healthcare conditions with evidence-based practices. A bundle is a set of interventions (usually 3 to 5), when grouped and implemented together, promote best outcomes with a greater impact than if performed individually. Care bundles aim to ensure that patients receive recommended treatments on a consistent basis. The Institute for Healthcare Improvement (IHI) is one of the main drivers of the bundle concept. It is recommended that when planning bundle-based care, each aspect be well defined and based on evidence from at least 1 systematic review of multiple well-designed randomized controlled trials (RCT) or on data from at least 1 well-designed RCT.
Click here for the full response on MedScape.com
Zero CLABSI bundles
March 18, 2009
Intravenous news: The number of critically ill patients catching infections while in hospital is falling, new figures reveal. New care procedures put in place as part of the two-year 1,000 Lives campaign in Wales are behind the fall in infections.
Fewer patients who are on ventilators are contracting pneumonia in Wales and there has been a reduction in the number of blood stream infections associated with patients who need intravenous medicines or fluids.
None of the seven intensive care units across Wales have reported a blood stream infection from a central line in a patient for the past five months.
Click here to read the full story at WalesOnline.co.uk
TauroLock catheter lock solution
March 18, 2009
Intravenous products: The Peninsula (Qatar) has reported on TauroLock, an anti-microbial catheter lock solution that prevents catheter-related bloodstream infections in dialysis, oncology and parenteral nutrition, got the nod of the Infection Control Department of the Hamad Medical Corporation and the Al Amal Hospital.
“We got a positive response from the oncology department of the Hamad and Al Amal hospitals… and the Infection Control Department of Hamad has endorsed the product,” said Prof Dr Claus Herdeis, managing director of the German company TauroPharm.
Herdeis said TauroLock, which was introduced in the European market in 2004 and was just brought in to Doha, is a solution placed in catheters to prevent infection.
Click here for the full news story on thepeninsularqatar.com
Safe IV injection technique
March 14, 2009
Intravenous news: OHS report on APIC tips for reducing infection risk in outpatient clinics. One aspect they focus upon is safe intravenous (IV) injection techniques, stating
“In 2008, more than 60,000 people were notified of their risk of hepatitis C due to reuse of syringes at a Nevada endoscopy clinic. There have also been reports of reuse of finger stick devices and insulin injection devices meant for individual use. Reused syringes can transport tiny fragments of a patient’s blood to the next medication vial, potentially infecting other patients. Syringes and needles must be used one time only. Before receiving an injection, ask if the needle and syringe have been newly opened for you. Inquire if the center uses single-dose vials of medication or multi-dose vials with strict controls. If they use multi-dose vials, ask if they unwrap a new syringe and needle for each dose of medication. If you will receive intravenous fluids, ask that they do not use the bag for other patients or set up the intravenous tubing until they are ready to administer to you”.
Click here for the full story on OHSonline.com
Inadvertent arterial injection
March 13, 2009
Intravenous literature: Shukla, A.N., Ghaffar, Z.B.A. and Joshi, S.C. (2009) Inadvertent intra arterial injection of rocuronium: a case report. Internet Journal of Anesthesiology. 19(1), p.17.
Abstract:
Accidental intra-arterial injection of drugs is a potentially dangerous complication of intravenous therapy. All the personnel using intravenous therapy must be aware of this possibility and signs symptoms and management of it. We report a case of accidental intra-arterial injection of Rocuronium and Fentanyl. Patient developed sever hyperemia and sluggish capillary refill distal to site of injection. The patient was given injection lignocaine 2% 60 mg and 30 ml of heparinised saline was infused intra-arterial. The hyperemia resolved slowly and capillary refill improved back to normal over next hour. There were no long terms sequelae.
Intravenous immunoglobulin therapy
March 13, 2009
Intravenous literature: Kirmse, J. (2009) The nurse’s role in administration of intravenous immunoglobulin therapy. Home Healthcare Nurse. 27(2), p.104.
Abstract:
Intravenous immunoglobulin is a valuable therapeutic agent for many patients with primary immune deficiency disorders and for some with secondary immunodeficiency, and its use has expanded to other areas such as neurologic, hematologic, and infectious disorders. Nurses administer the majority of immunoglobulin. This article discusses indications for various immunoglobulin products available, potential adverse reactions, routes of administration, and the important role of the nurse in the administration of immunoglobulin.
Self-administration IV therapy
March 13, 2009
Intravenous literature: Bygum, A., Andersen, K.E. and Mikkelsen, C.S. (2009) Self-administration of intravenous C1-inhibitor therapy for hereditary angioedema and associated quality of life benefits. European Journal of Dermatology. 19(2), p.147-51.
Abstract:
Hereditary angioedema (HAE) is often debilitating with a serious effect on quality of life (QOL). Treatment of acute HAE attacks is usually with C1 esterase inhibitor (C1-INH) concentrates; however, treatment can be delayed by patients’ travel time for attending emergency units. We assessed the impact of self-administered home therapy with intravenous C1-INH concentrate on QOL in patients with HAE. Nine patients experiencing frequent or severe debilitating HAE attacks were offered self-administration of C1-INH concentrate. QOL was assessed prior to and following home therapy using the Dermatology Life Quality Index (DLQI) and 36-Item Short Form Survey (SF-36) questionnaires. Seven patients were recruited into the study. QOL was assessed at baseline and after 3 to 48 months of home therapy. The mean DLQI score fell from 12.6 +/- 4.65 to 2.7 +/- 1.38 (P < 0.001). Mean SF-36 scores for the individual and combined components also improved significantly. No serious complications were documented during a follow-up period of 27 to 72 months. Self-administration of C1-INH improved QOL on both physical and psychological parameters. Patients were able to resume a normal life without restrictions caused by the condition.
HepC after needlestick
March 13, 2009
Intravenous literature: Gruener, N.H., Heeg, M., Obermeier, M., Ulsenheimer, A., Raziorrouh, B., Diepolder, H., Zachoval, R. and Jung, M.C. (2009) Late appearance of hepatitis C virus RNA after needlestick injury: necessity for a more intensive follow-up. Infection Control & Hospital Epidemiology. 30(3), p.299-300.
Abstract not available.
Needlestick-prevention devices
March 13, 2009
Intravenous literature: De Carli, G., Puro, V., Studio Italiano Rischio Occupazionale da HIV (SIROH) Group and Jagger, J. (2009) Needlestick-prevention devices: we should already be there. Journal of Hospital Infection. 71(2), p.183-4.
Abstract not available.
Needlestick injury advice
March 13, 2009
Intravenous literature: O’Connor, M.B. (2009) Needlestick injury advice in the UK and Ireland. Journal of Hospital Infection. 71(2), p.185-6.
Abstract not available.
Reducing needlestick injuries
March 13, 2009
Intravenous literature: Gabriel, J. (2009) Reducing needlestick and sharps injuries among healthcare workers. Nursing Standard. 23(22), p.41-4.
Abstract:
The risk of needlestick or sharps-related injuries to healthcare staff with statistical data about numbers of injuries, and how blood-borne viruses can be transmitted. Prevention and management of sharps injuries is discussed.
Needlestick injury with introcan
March 13, 2009
Intravenous literature: Pham, M. and Neustein, S.M. (2009) A needlestick injury with the introcan safety needle. Anesthesia & Analgesia. 108(2), p.669-70.
Abstract not available.
Attitudes toward universal precautions
March 13, 2009
Intravenous literature: Reda, A.A., Vandeweerd, J.M., Syre, T.R. and Egata, G. (2009) HIV/AIDS and exposure of healthcare workers to body fluids in Ethiopia: attitudes toward universal precautions. Journal of Hospital Infection. 71(2), p.163-9.
Abstract:
There are no studies describing the attitude of healthcare workers (HCWs) towards universal precautions (UPs) in Ethiopia, in the context of the human immunodeficiency virus/acquired immunodeficiency syndrome pandemic. We investigated HCWs’ knowledge and perceptions concerning UPs and exposure to blood and body fluids in two regions of eastern Ethiopia. All HCWs in 19 health institutions were surveyed using a questionnaire for data collection. Descriptive statistics and multivariate analysis using logistic regression were performed. The HCWs had insufficient knowledge and perception of UPs, along with a one-year prevalence of needlestick injury of 29.1% (95% confidence interval: 24.2-34.0). Policies and more intensive training are required for HCWs in Ethiopia.
Intensive care drug errors
March 13, 2009
Intravenous literature: The BBC news website reports “Errors in the administration of injected medication in intensive care units occur frequently, a study across 27 countries suggests. Austrian researchers collected data on more than 1,300 patients, 200 of them in the UK, over a 24-hour period. Of the 441 patients affected, seven suffered permanent harm and five died partly because of the error, the British Medical Journal reported”.
The report continues “Medical staff often cited stress and tiredness as contributing factors. Data was collected by researchers from Rudolfstiftung Hospital from a total of 113 intensive care units, of which 17 were in the UK. Nearly half of the affected patients suffered more than one mistake during the period covered. The most frequent errors were related to the wrong time of administration and missing doses altogether”.
Click here for the full story on BBC news.
Baxter IV pump alert
March 11, 2009
Intravenous products: Baxter International Inc. has found more problems with its long-troubled “Colleague” intravenous fluid pumps, including software glitches the company needs to fix and user problems it has advised customers to avoid.
The Deerfield, Ill., company sent a letter to customers on Jan. 23, a day after its fourth-quarter earnings call, to highlight the newfound issues with its entire roster of 275,000 Colleague pumps around the world, including pumps the company issued during remediation efforts to fix other problems. Colleague pumps were first pulled in 2005 amid a host of problems and defects linked to some deaths.
The latest problems came under the spotlight Wednesday when Baxter said the U.S. Food and Drug Administration had assigned a “Class 1″ recall status to the matter, which is the agency’s most serious recall classification.
Click here to view the full news item on CNNMoney.com
Alaris IV pump alert
March 11, 2009
Intravenous products: This Safety Alert informs you about a potential risk when the Alaris® PCA module (model 8120) is used with the Alaris® PC Unit (model 8000 and model 8015) with software versions 8 through 9.1. The Alaris® PCA module can potentially infuse above or below the intended infusion dose.
Click here to view the full safety notice.
Betsy McCaughey webinar
March 10, 2009
Intravenous conference: Pharmacy OneSource, creator of web applications to enable swift and safe healthcare, is pleased to announce an upcoming complimentary webinar: “Hospital Infection: Essential New Information to Support Cleaning and Screening.”
Betsy McCaughey, Ph.D., former Lieutenant Governor of New York State and Chairman/Founder of the Committee to Reduce Infection Deaths (RID), will provide startling new evidence on how surface bacterial contamination leads to increases in the rates of colonization and infection. Dr. McCaughey will present innovative practical steps on how to protect patients from contracting healthcare-associated infections.
Throughout her presentation, Dr. McCaughey will cite examples of success stories — hospitals that have significantly reduced infection rates of SSI, MRSA, CLABSI, etc. Her presentation is based on the latest research published in peer-reviewed journals and/or supported by extensive clinical surveillance.
Click here to register for the free webinar
Click here for the full news item on PR-inside.com
Safe practices webinar
March 10, 2009
Intravenous conference: To guide healthcare systems in providing care that is free from error and harm the National Quality Forum (NQF) is releasing its 2009 Safe Practices for Better Healthcare. To accelerate the pace of adoption of Safe Practices nationwide, a year-long Webinar series will begin in April to provide Safe Practices implementation strategies and commentary from experts in the field.
“The Safe Practices offer clear tools for those who provide, purchase, and use healthcare to ensure that harm is reduced and care is safe. While improvements have been made in patient safety, they must spread farther and faster,” said Janet Corrigan, NQF president and CEO. “We cannot afford — in lives or dollars — to provide care that is unsafe. Every patient deserves safe, high-quality healthcare, every time they receive care.”
Preventable errors cost the United States an estimated 98,000 lives annually, $17 billion to $29 billion per year in healthcare expenses, lost worker productivity, lost income, and disability. Even more troubling, while healthcare spending grows more than seven percent per year, it is estimated that patient safety is improving by only 1 percent or 2 percent.
Click here for the full story on ICT.
Baxter charitable donations
March 10, 2009
Intravenous news: Baxter International Inc. and The Baxter International Foundation, the philanthropic arm of Baxter, today announced their combined 2008 charitable giving, which focused on increasing access to healthcare, helping developing nations and countries in crisis, and addressing other critical community needs. In 2008, combined giving from the company and its foundation totaled nearly $44 million, comprising:
$28.9 million from Baxter’s businesses and facilities to address critical local needs in more than 40 countries;
$10.9 million from donations of Baxter products to 58 developing nations and countries in crisis; and
$4.0 million from The Baxter International Foundation, including nearly $1.4 million in grants to organizations outside of the U.S. and nearly $740,000 to more than 750 organizations through the Foundation’s Dollars for Doers and Matching Gifts programs, which support employees’ philanthropic efforts.
“Baxter’s charitable giving activities align with and support the company’s mission of saving and sustaining lives,” said Robert L. Parkinson, Jr., Baxter’s chairman and chief executive officer. “Whether through monetary and product donations, or by volunteering our time, Baxter is committed to making a positive impact on the health and well-being of our local and global communities.”
Click here for the full story on EarthTimes.org
Safe transfusion practice
March 9, 2009
Intravenous literature: Oldham, J., Sinclair, L. and Hendry, C. (2009) Right patient, right blood, right care: safe transfusion practice. British Journal of Nursing, 18(5), p.312-320.
Blood transfusion therapy can save and enhance patients’ lives but careful consideration must be given to the associated dangers. Nurses must have the skills and knowledge required to care for patients receiving blood components. It is important for nurses to understand the correct and safe way to approach transfusion practice as it is a constant and central component of modern health care. The number of people eligible to donate blood is reducing and each blood component comes from a donation given in good faith: it is given voluntarily with the expectation that it will be used effectively for the benefit of patients. Therefore at every stage of the transfusion process the nurse is responsible for the part they play in making sure that the correct patient receives the correct blood and also that blood components are used and handled with care. This article examines the key principles and practicalities to be considered in day-to-day practice. Areas covered include legal obligations, appropriate handling of blood components, the different elements of the transfusion process, recognition and management of transfusion reactions and education. A key theme running throughout is the management of clinical risk.
Vacuette safety needle system
March 8, 2009
Intravenous products: MedPro Safety Products Inc. is undergoing safety testing for a product known as the Vacuette Premium Safety Needle System, a self-capping needle used for drawing blood. The goal of the system is to eliminate accidental sticks with a used needle by eliminating any chance of human error.
Walter Weller, president and chief operating officer of MedPro, said he thinks Vacuette Premium Safety needles have several aspects that make them stand out from existing blood collection systems.
The first is what he describes as “passive” technology — that is, the needle cover deploys on its own. “What’s unique about it is that we don’t require interaction from the phlebotomist. We don’t ask them to push buttons or snap clips,” Weller said. Weller estimates that 35 percent of needle-stick injuries occur from the time the needle leaves the arm to transportation to a container or destructive device.
Click here for the full story on Kentucky.com
More IV news at IVTEAM
Extravasation injury compensation
March 7, 2009
Intravenous news: A Lancashire hospital has paid out £90,000 to a man who sued them after doctors saved his life. Michael Dexter, 58, was taken to Blackburn Royal Infirmary in December 2002, after swallowing pills washed down with rum and cola.
Doctors at Blackburn Royal Infirmary saved his life but gave him an excessive amount of neutralising drugs which left his right arm damaged. He has now been given damages in an out-of-court settlement.
Mr Dexter had to have plastic surgery and skin grafts to the tissue on his arm after suffering burn-like symptoms.
Click here to read the full story on BBC news.
Click here to view a video of the story.
Positive‐pressure mechanical valves
March 5, 2009
Intravenous literature: Edgar, K. (2009) Letter to the Editor: Does the Evidence Support the SHEA‐IDSA Recommendation on the Use of Positive‐Pressure Mechanical Valves? Infection Control and Hospital Epidemiology. 30(4), p.402-403.
Click here to view the letter page.
Click here to view the full text of the original article.
Marshall, J. et al (2008) Supplement Article: SHEA/IDSA Practice Recommendation. Strategies to Prevent Central Line–Associated Bloodstream Infections in Acute Care Hospitals. Infection Control and Hospital Epidemiology. 29:S22–S30.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line–associated bloodstream infection (CLABSI) prevention efforts.
Click here for the full text version of this document.
Baxter webinar
March 5, 2009
Intravenous conference: Baxter Healthcare Corporation via the TargetBSI website announces it will present the Webinar, “CDC’s National Healthcare Safety Network (NHSN): What Are We Learning?” on Tuesday, March 17 at 12 p.m. ET and on Thursday, March 19 at 2 p.m. ET.
The speaker is Mary Andrus, BA, RN, CIC, of Surveillance Solutions, who has worked with both the National Nosocomial Infections Surveillance (NNIS) System and the National Healthcare Safety Network (NHSN) as a subject matter expert.
Click here to register for the Webinar.
Needlestick reduction
March 4, 2009
Intravenous products: A Sheffield-based healthcare company, B Braun Medical, is helping to prevent needlestick injuries to NHS staff. The company’s patented safety device, which eliminates the risk of being accidentally stuck or scratched by needles when delivering medication through a cannula, has already been snapped up by more than 70 UK NHS trusts.
And those who have adopted the technology say they are cutting down on injuries as a result. At Manchester Royal Infirmary, for example, there was an average of 19 needlestick injuries every year, but there have been none since the introduction of the Vasofix and Introcan safety devices.
Click here for the full press release.
Alteplase dosing error
March 4, 2009
Intravenous products: The FDA state that in a recent report, the Institute for Safe Medication Practices warned about the possibility of prescribing and administering the wrong dose of alteplase when the indication for the drug is not specified.
ISMP described a case of a patient in an interventional radiology department who suffered respiratory arrest from a pulmonary embolism. The physician in charge of the radiology procedure called a code and requested Activase 100 mg IV. The pharmacist who responded to the code called the IV admixture staff and asked for tPA, or tissue plasminogen activator, a synonym for alteplase.
Because the call came from the radiology department, and because the prescribed dose and the intended use were not communicated, the pharmacy staff did not realize that the drug was intended to treat a pulmonary embolus. Instead, they assumed that the alteplase was intended to restore catheter function, so instead of the 100 mg dose that had been prescribed, they dispensed 2 mg of alteplase.
The physician running the code assumed the syringe he received contained the correct dose and administered it, which gave the patient a 50-fold underdose. The patient died, although it’s not clear what impact, if any, the medication error had on his death.
Click here for the full alert.
Phenergan claim
March 4, 2009
Intravenous news: The US Supreme Court ruled Wednesday that pharmaceutical companies can be sued over serious side effects of drugs even when warning labels have been approved by the Federal Drug Administration.
The 6-3 ruling against the drug maker Wyeth opens the door to litigation in thousands of similar cases, lawyers say.
The high court found in favor of Diana Levine, a musician who was awarded 6.7 million dollars in damages by a Vermont court after she developed gangrene and lost her right forearm because of the anti-nausea drug Phenergan.
The court rejected arguments by Wyeth, the drug’s manufacturer, that the Federal Drug Administration had approved warning labels for the drug and that that took precedence over the state law under which the suit was brought.
Click here for the full story.
Baxa acquired ForHealth Tech
March 4, 2009
Intravenous products: Baxa Corp., involved in packaging and administering medications, said Tuesday it has acquired ForHealth Technologies, Inc., a Florida-based healthcare robotics and software company. Englewood-based Baxa said the acquisition is “a strategic expansion of its focus on health-system pharmacy automation and IV-room productivity.” Terms were not disclosed. The deal brings to Baxa the pharmacy management products IntelliFill i.v. and IntelliFlowRx, devices that automate the preparation of intravenous medications.
Click here for full news story.
Intravenous (IV) conference 2009
March 1, 2009
The IPS have announced the details of the IV Conference that is running in conjunction with the Infection Prevention 09 Conference.
The new IV Forum will be presenting their first full day’s programme in conjunction with the main IPS conference programme on Tuesday 22nd September. This session is aimed primarily at people working in IV therapy but it will also be of interest to anyone working in infection prevention and control. Delegates can either register for the IV track on its own or register as a delegate to the whole IPS conference. Any delegate can select which sessions they attend on each day from the three main tracks in the programme.
The programme includes:
- Dr Thomas Latta Lecture – The father of infusion therapy. Presented by Neil MacGillivray, Honorary Post Doctoral Fellow in Scottish History University of Edinburgh, Royal College of Surgeons of Edinburgh
- Blood, bones and bacteria: The diversity of community IV services. Presented by Alison Smith, Liverpool PCT
- ANTT: Standardised approach to aseptic technique. Presented by Stephen Roley, Clinical Lead for Haematology & Lead Cancer Nurse, University College London Hospitals NHS Foundation Trust
- Building a business case for vascular access teams. Presented by Deborah Bolton, Clinical Nurse Specialsit, IV Therapy, Royal Sussex County Hospital, Brighton
- Microbial biofilms: getting to the source of vascular access in infections. Presented by Marcia Ryder, Research and Consulting, Healthcare Acquired Biofilm Related Infections, San Mateo, California
Click here to view the full programme.
Click here to submit a free paper or poster presentation.
Click here to view the registration page.
Hand washing video
March 1, 2009
Intravenous news: CancerNursing.org have provided a free video on Hand Washing Technique. The video is presented by Charlotte Johnson, Hand Hygiene Facilitator at Cumbria NHS in the UK.
CancerNursing.org also provide a number of free online courses on subjects such as peripheral IV cannulation and Peripherally Inserted CEntral Catheters (PICC).
Click here to view the hand washing video page on CancerNursing.org
Click here to view the CancerNursing.org home page.
Clean your hands campaign video.
Post-insertion central line care
March 1, 2009
Intravenous literature: Shapey, I.M., Foster, M.A., Whitehouse, T., Jumaa, P. and Bion, J.F. (2009) Central venous catheter-related bloodstream infections: improving post-insertion catheter care. Journal of Hospital Infection. 71(2), p.117-22.
Abstract:
Patients with central venous catheters (CVCs) are at increased risk of bloodstream infections and sepsis-related death. CVC-related bloodstream infections (CRBSIs) are costly and account for a significant proportion of hospital-acquired infections. The aim of this audit was to assess current practice and staff knowledge of CVC post-insertion care and therefore identify aspects of CVC care with potential for improvement. We conducted a prospective audit over 28 consecutive days at a university teaching hospital investigating current practice of CVC post-insertion care in wards with high CVC usage. A multiple choice questionnaire on best practice of CVC insertion and care was distributed among clinical staff. Rates of breaches in catheter care and CRBSIs were calculated and statistical significance assumed when P<0.05. Data was recorded from 151 CVCs in 106 patients giving a total of 721 catheter days. In all, 323 breaches in care were identified giving a failure rate of 44.8%, with significant differences between intensive care unit (ICU) and non-ICU wards (P<0.001). Dressings (not intact) and caps and taps (incorrectly placed) were identified as the major lapses in CVC care with 158 and 156 breaches per 1000 catheter days, respectively. During the study period four CRBSIs were identified, producing a CRBSI rate of 5.5 per 1000 catheter days (95% confidence interval: 0.12-10.97). There are several opportunities to improve CVC post-insertion care. Future interventions to improve reliability of care should focus on implementing best practice rather than further education.
Central line dwell time
March 1, 2009
Intravenous literature: Mer, M., Duse, A.G., Galpin, J.S. and Richards, G.A. (2009) Central venous catheterization: a prospective, randomized, double-blind study. Clinical & Applied Thrombosis/Hemostasis. 15(1), p.19-26.
Abstract:
Central venous catheters (CVCs) are extensively used worldwide. Mechanical, infectious and thrombotic complications are well described with their use and may be associated with prolonged hospitalization, increased medical costs and mortality. CVCs account for an estimated 90% of all catheter-related bloodstream infections (CRBSI) and a host of risk factors for CVC-related infections have been documented. The duration of use of CVCs remains controversial and the length of time such devices can safely be left in place has not been fully and objectively addressed in the critically ill patient. Antimicrobial-impregnated catheters have been introduced in an attempt to limit catheter-related infection (CRI) and increase the time that CVCs can safely be left in situ. Recent meta-analyses concluded that antimicrobial-impregnated CVCs appear to be effective in reducing CRI. The authors conducted a prospective, randomized, double-blind study at Johannesburg Hospital over a 4-year period. The study entailed a comparison of standard triple-lumen versus antimicrobial impregnated CVCs on the rate of CRI. Our aim was to determine whether we could safely increase the duration of catheter insertion time from our standard practice of seven days to 14 days, to assess the influence of the antimicrobial impregnated catheter on the incidence of CRI, and to elucidate the epidemiology and risks of CRI. One hundred and eighteen critically ill patients were included in the study which spanned 34 951.5 catheter hours (3.99 catheter years). It was found that antimicrobial catheters did not provide any significant benefit over standard catheters, which the authors feel can safely be left in place for up to 14 days with appropriate infection control measures. The most common source of CRI was the skin. The administration of parenteral nutrition and the site of catheter insertion (internal jugular vein vs subclavian vein) were not noted to be risk factors for CRI. There was no clinical evidence of thrombotic complication in either of the study groups. This study offers direction for the use of CVCs in critically ill patients and addresses many of the controversies that exist.
CRBSI treatment
March 1, 2009
Intravenous literature: Wilcox, M.H., Tack, K.J., Bouza, E., Herr, D.L., Ruf, B.R., Ijzerman, M.M., Croos-Dabrera, R.V., Kunkel, M.J. and Knirsch, C. (2009) Complicated skin and skin-structure infections and catheter-related bloodstream infections: noninferiority of linezolid in a phase 3 study. Clinical Infectious Diseases. 48(2), p.203-12.
Abstract:
BACKGROUND: Catheter-related bloodstream infection (CRBSI) causes substantial morbidity and mortality, but few randomized, controlled studies have been conducted to guide therapeutic interventions. METHODS: To determine whether linezolid would be noninferior to vancomycin in patients with CRBSI, we conducted an open-label, multicenter, comparative study. Patients with suspected CRBSI were randomized to receive linezolid or vancomycin (control group). The primary end point was microbiologic outcome at test of cure 1-2 weeks after treatment, as assessed by step-down procedure. The first analysis population was complicated skin and skin structure infection (cSSSI) in patients with suspected CRBSI; patients with CRBSI were analyzed if noninferiority criteria (lower bound of the 95% confidence interval [CI] not outside -15%) were met. RESULTS: Noninferiority criteria were met for cSSSI (microbiologic success rate for linezolid recipients, 89.6% [146 for 163 patients]; for the control group, 89.9% [134 of 149]; 95% CI, -7.1 to 6.4) and CRBSI (for linezolid recipients, 86.3% [82 of 95]; for the control group, 90.5% [67 of 74]; 95% CI, -13.8 to 5.4). The frequency and severity of adverse events were similar between groups. Mortality rates were 10.4% for linezolid recipients (28 of 269 patients) and 10.1% for control subjects (26 of 257) in the modified intent-to-treat population (i.e., all patients with gram-positive baseline culture) through test of cure, and they were 21.5% for linezolid recipients (78 of 363) and 16.0% for the control group (58 of 363; 95% CI, -0.2 to 11.2) for all treated patients through poststudy treatment day 84. CONCLUSIONS: Linezolid demonstrated microbiologic success rates noninferior to those for vancomycin in patients with cSSSIs and CRBSIs caused by gram-positive organisms. Patients with catheter-related infections must be carefully investigated for the heterogeneous underlying causes of high morbidity and mortality, particularly for infections with gram-negative organisms.
