IV cannula dwell time
May 29, 2009
Intravenous news: NewBritainHerald.com report “The state Department of Public Health has fined the Hospital of Central Connecticut $2,500 after inspections found violations that might have led to the death of a patient”.
The report continues “The violations include a patient who died after an intravenous catheter designed for two days’ use was left in 11 days”.
Click here to read the full the story.
IV drip trial ended
May 28, 2009
Intravenous news: “Officials at the National Heart, Lung, and Blood Institute (NHLBI) have halted a multicenter clinical trial of concentrated saline administered to patients who have experienced trauma and go into shock as a consequence of blood loss while they are en route to a hospital.
Last August, when the trial’s data and safety monitoring board found evidence that patients who received the concentrated saline were no more likely to survive than those who received a standard saline solution, it suspended enrollment in the trial. Patients in this study who received the concentrated solution were more likely to die in the emergency department or before reaching the hospital than were patients who received the standard saline solution. Both groups experienced a similar death rate during the 28-day period after treatment; however, deaths occurred later in the normal saline group” (Kuehn 2009).
Reference
Kuehn, B.M. (2009) Saline Trial Ended. JAMA. 301(20), p.2085.
Intravenous (IV) nursing
May 27, 2009
Intravenous literature: Tromp, M., Natsch, S. and Van Achterberg, T. (2009) The preparation and administration of intravenous drugs before and after protocol implementation. Pharmacy World & Science. 31(3), p.413-20.
Abstract:
OBJECTIVES: This paper reports on a pilot study examining the incidence of nurses’ errors in preparation and administration of intravenous drugs. Furthermore, the study aimed to evaluate the short-term effects of implementation of a new protocol for preparation and administration of intravenous drugs.
SETTING: Two nursing departments of internal medicine at a 953 beds University Medical Centre in The Netherlands.
METHODS: By means of a prospective, quasi-experimental design, nurses were observed during the process of preparation and administration of intravenous drugs. Observation was performed before and after the implementation of a new protocol. Seventy-two nurses at two nursing departments were observed during the study.
MAIN OUTCOME MEASURE: A mean pre-test and post-test quality score at two departments of internal medicine.
RESULTS: At baseline, average quality scores for nurses at the two departments were 64 (intervention ward) and 67 (control ward) on a 0-100 quality scale. The pre-test quality scores were not statistically significant for the two nursing wards (T = 1.36, df = 55, P = 0.18). After the implementation of the new protocol, nurses at the intervention ward scored better (72) than nurses at the control ward (69). The mean score at the intervention ward was significantly higher than the score in nurses of the control ward (T = -2.20, df = 53, P = 0.04).
CONCLUSIONS: The number of errors in the preparation and administration of intravenous drugs is high. This study shows that implementing a protocol for the preparation and administration of these drugs can reduce the number of errors.
Identifying medication errors
May 27, 2009
Intravenous literature: Sheu, S.J., Wei, I.L., Chen, C.H., Yu, S. and Tang, F.I. (2009) Using snowball sampling method with nurses to understand medication administration errors. Journal of Clinical Nursing. 18(4), p.559-69.
Abstract:
AIMS AND OBJECTIVES: We aimed to encourage nurses to release information about drug administration errors to increase understanding of error-related circumstances and to identify high-alert situations.
BACKGROUND: Drug administration errors represent the majority of medication errors, but errors are underreported. Effective ways are lacking to encourage nurses to actively report errors.
METHODS: Snowball sampling was conducted to recruit participants. A semi-structured questionnaire was used to record types of error, hospital and nurse backgrounds, patient consequences, error discovery mechanisms and reporting rates.
RESULTS: Eighty-five nurses participated, reporting 328 administration errors (259 actual, 69 near misses). Most errors occurred in medical surgical wards of teaching hospitals, during day shifts, committed by nurses working fewer than two years. Leading errors were wrong drugs and doses, each accounting for about one-third of total errors. Among 259 actual errors, 83.8% resulted in no adverse effects; among remaining 16.2%, 6.6% had mild consequences and 9.6% had serious consequences (severe reaction, coma, death). Actual errors and near misses were discovered mainly through double-check procedures by colleagues and nurses responsible for errors; reporting rates were 62.5% (162/259) vs. 50.7% (35/69) and only 3.5% (9/259) vs. 0% (0/69) were disclosed to patients and families. High-alert situations included administration of 15% KCl, insulin and Pitocin; using intravenous pumps; and implementation of cardiopulmonary resuscitation (CPR).
CONCLUSIONS: Snowball sampling proved to be an effective way to encourage nurses to release details concerning medication errors. Using empirical data, we identified high-alert situations. Strategies for reducing drug administration errors by nurses are suggested.
RELEVANCE TO CLINICAL PRACTICE: Survey results suggest that nurses should double check medication administration in known high-alert situations. Nursing management can use snowball sampling to gather error details from nurses in a non-reprimanding atmosphere, helping to establish standard operational procedures for known high-alert situations.
Rituximab infusion-related reactions
May 27, 2009
Intravenous literature: Graham, A. (2009) Administering rituximab: infusion-related reactions and nursing implications. Cancer Nursing Practice. 8(2), p.30-5.
Abstract:
Use of intravenous rituximab, a monoclonal antibody, as a treatment for non-Hodgkin’s lymphoma. Common infusion-related reactions and toxicities to the drug are described together with precautions that nurses should take and management of adverse reactions.
Blood cultures in PICU
May 23, 2009
Intravenous literature: Kiragu, A.W., Zier, J. and Cornfield, D.N. (2009) Utility of blood cultures in postoperative pediatric intensive care unit patients. Pediatric Critical Care Medicine. 10(3), p.364-8.
OBJECTIVE: To determine the frequency of positive blood cultures in patients with fevers in the initial 48-hour postoperative period.
STUDY DESIGN: All patients who had blood cultures drawn during the initial 48 hours postoperatively while in the pediatric intensive care unit (PICU) at the University of Minnesota Children’s Hospital-Fairview during an 18-month period were included in the current study. Six hundred two postoperative patients were admitted to the PICU during the study period. Patients with a temperature >100.4 degrees F and who had blood cultures drawn were identified. Patients for whom the operative procedure was not the first in that admission, those discharged in <48 hours, and those with an indwelling central venous catheter for >24 hours before their admission were excluded.
RESULTS: Sixty-six of these patients were febrile and had blood cultures drawn in the initial 48 hours postoperatively. One hundred eleven blood cultures were obtained. A single (0.9%) blood culture was positive. The cost per positive culture was estimated at $23,532.
CONCLUSIONS: Even in patients admitted to the PICU, fever in the initial 48-hour postoperative period is unlikely to represent bacteremia in low-risk pediatric patients. Blood cultures in these patients are, therefore, unlikely to yield positive results. Procurement of blood cultures in this patient population is not justified. Cessation of the practice of blood culture procurement in this patient population may both focus care and provide enable meaningful cost savings.
Stuck Seldinger guidewire
May 23, 2009
Intravenous literature: Araki, Y., Fukuda, I., Hirano, M., Matsuoka, N. and Kazama, T. (2009) [Central venous catheterization complication by a guide wire]. Masui – Japanese Journal of Anesthesiology. 58(3), p.354-6.
Abstract:
Central venous catheterization using the Seldinger technique is a well known and often used method. On the other hand, there are also well known complications by needle puncture or by indwelling catheter, there are few reports about a guide wire which got hung up around the tricuspid valve. We report a case in which a guide wire got hung up to the chordae tendineae of the tricuspid valve. To insert the AVA 3Xi (Edwards life science Co. Iervine) from the right internal jugular vein, we inserted a guide wire without ease. Resistance appeared when we tried to remove the wire for 20 cm from the inserted state. The X-ray and the transesophageal echocardiography, showed the guide wire in the right ventricle. As actions to be taken, we advanced the central vein catheter of the EXCV catheter kit (Nippon Sherwood Medical Industries Co., Ltd.) to the tip, and a the guide wire was easily removed. There are many reports of the complication by the central venepuncture, but there are few reports about the guide wire which was entrapped in the vicinity of a tricuspid valve. The tip of the guide wire in this case was bent excessively, but the cause of the damage did not become clear by investigation. When a guide wire became hard to withdraw, we should never withdraw a guide wire blindly, but should search a cause and we should use the material which was matched with the cause.
Blood sampling in infants
May 23, 2009
Intravenous news: Kapellou, O. (2009) Blood sampling in infants (reducing pain and morbidity). Clinical Evidence.
Abstract:
INTRODUCTION: Preterm or ill neonates may undergo 1-21 heel punctures or venepunctures per day. These punctures are likely to be painful. Heel punctures comprise 61-87% and venepunctures comprise 8-13% of the invasive procedures performed on ill infants. Analgesics are rarely given specifically for blood sampling procedures, but 5-19% of infants receive analgesia for other indications.
METHODS AND OUTCOMES: We conducted a systematic review and aimed to answer the following clinical question: What are the effects of interventions to reduce pain-related distress and morbidity during venepuncture in preterm or term babies aged under 12 months in a neonatal unit? We searched: Medline, Embase, The Cochrane Library, and other important databases up to July 2007 (Clinical Evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA).
RESULTS: We found 16 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions.
CONCLUSIONS: In this systematic review we present information relating to the effectiveness and safety of the following interventions: oral sweet solutions, pacifiers, and topical anaesthetics (lidocaine-prilocaine cream, tetracaine).
Central Venous Catheter tip position
May 23, 2009
Intravenous literature: Na, H.S., Kim, J.T., Kim, H.S., Bahk, J.H., Kim, C.S. and Kim, S.D. (2009) Practical anatomic landmarks for determining the insertion depth of central venous catheter in paediatric patients. British Journal of Anaesthesia. 102(6), p.820-3.
Abstract:
BACKGROUND: Various methods have been recommended to decide a proper insertion depth of central venous catheter (CVC). The carina is recommended as a useful target level for the CVC tip position. We evaluated the sternal head of a right clavicle and the nipples as anatomic landmarks for determining the optimal depth of CVC in paediatric patients.
METHODS: Ninety children, <5 yr, undergoing catheterization through the right internal jugular vein were enrolled. The insertion depth was determined as follows. The insertion point was designated as ‘Point I’. The sternal head of the right clavicle was called ‘Point A’ and the midpoint of the perpendicular line drawn from Point A to the line connecting both nipples was called ‘Point B’. The insertion depth of CVC was determined by adding the two distances (from I to A and from A to B) and subtracting 0.5 cm from this. A chest radiography was taken and the distance of the CVC tip from the carina level was measured by the Picture Archiving and Communicating System.
RESULTS: The mean distance of the CVC tip from the carina level was 0.1 (1.0) (P=0.293) cm above the carina (95% CI 0.1 cm below the carina-0.3 cm above the carina). There was no specific relationship between the distance of the CVC tip from the carina level and the patients’ age, height, and weight.
CONCLUSIONS: The CVC tip could be placed near the carina by using the external landmarks without any formulae, images, and devices in children in our study.
NICU zero CLABSI
May 23, 2009
Intravenous literature: Curry, S., Honeycutt, M., Goins, G. and Gilliam, C. (2009) Catheter-associated bloodstream infections in the NICU: getting to zero. Neonatal Network – Journal of Neonatal Nursing. 28(3), p.151-5.
Abstract:
The neonatal population is at a particularly high risk for catheter-associated bloodstream infections (CABSI). Chlorhexidine for skin antisepsis is well documented to effectively decrease the incidence of bloodstream infections associated with central venous catheters in other populations. The project described in this article demonstrates that chlorhexidine for central venous catheter insertion and line maintenance in the neonatal population safely and effectively reduces CABSI.
Central venous line complications
May 23, 2009
Intravenous literature: Milbrandt, K., Beaudry, P., Anderson, R., Jones, S., Giacomantonio, M. and Sigalet, D. (2009) A multiinstitutional review of central venous line complications: retained intravascular fragments. Journal of Pediatric Surgery. 44(5), p.972-6.
Abstract:
BACKGROUND: There have been many reports of complications of central venous lines in children but limited discussion of the specific problem of retained intravascular fragments after attempted removal. We report on a series of 6 patients from 2 tertiary pediatric hospitals that had intravascular segments of long-term central venous lines that could not be removed and so were left in situ.
METHODS: We conducted a retrospective multiinstitutional review of long-term central venous lines (Broviacs, Port-A-Caths, and Hickmans) removed in the operating room with a focused chart review and prospective follow-up of those patients that had a failed attempt at removal.
RESULTS: A total of 299 central venous lines were removed with 6 patients identified as having fragments of lines left behind (2%). The lines had been in place for an average of 37 +/- 12 months. The average follow-up period is now 5.4 +/- 3.9 years; none of the patients have developed any symptoms, evidence of thrombus, infection, or catheter migration.
CONCLUSION: Given the 2% incidence rate, the issue of managing a stuck long-term central venous line will face most individuals who place these lines. We have demonstrated that simply ligating the catheter and leaving the fragment in place appears to be a safe option with minimal risk to the patient.
Complication of implanted port
May 23, 2009
Intravenous literature: Bass, J., and Halton, J.M. (2009) Skin erosion over totally implanted vascular access devices in children. Seminars in Pediatric Surgery. 18(2), p.84-6.
Abstract:
Erosion of the skin over a totally implanted vascular access device (TIVAD) is a rare event that may lead to life-threatening sequelae. From 1994 to 2007, we reviewed the medical records and central line database of 960 central line insertions for the complication of skin erosion over the TIVAD. Outcome measures included age, gender, and nutritional status, number of days until complication, insertion site, and attending surgeon. A total of 540 of the 960 central lines were TIVAD. Skin erosion occurred in 9 patients for an incidence of 1.67%. Average age at insertion was 51 months (range 25-116.5 months). The average catheter duration use in days was 335 with a range of 39-1575 days. Malnutrition defined as BMI <5% or a decrease in BMI percentiles occurred in 2 and 4 patients, respectively, and contributed to the thinning of the subcutaneous fat. Skin erosion over TIVAD is a rare complication. Most cases can be prevented by inserting the device in a subfacial location in the very young child or in the child with expected weight loss. Furthermore, the device should be placed at a fair distance from the skin incision to prevent early skin erosion through the wound.
Inadvertent carotid artery puncture
May 23, 2009
Intravenous literature: Bouzas-Mosquera, A., Mosquera, V.X., Portela, F., Cuenca, J.J., Alvarez-Garcia, N. and Castro-Beiras, A. (2009) Extrinsic compression of the left atrium by a mediastinal hematoma secondary to inadvertent carotid puncture. Echocardiography. 26(5), p.586-8.
Abstract:
We present the case of a 63-year-old man who underwent surgical closure of a paravalvular mitral leak. Immediately after surgery, transesophageal echocardiography revealed the appearance of a mediastinal hematoma encroaching on the left atrium and separating the esophageal probe from the posterior left atrial wall. The cause was an inadvertent puncture of the carotid artery, presumably during central venous line insertion prior to surgery.
Care bundles to prevent neonatal infection
May 23, 2009
Intravenous literature: Lachman, P. and Yuen, S. (2009) Using care bundles to prevent infection in neonatal and paediatric ICUs. Current Opinion in Infectious Diseases. 22(3), p.224-8.
Abstract:
PURPOSE OF REVIEW: Quality and safety of care are national priorities. Healthcare-acquired infections are now considered preventable and unacceptable. Care bundles are used to prevent and treat health-care acquired infections in adults. This paper considers the evidence and context for their use in children.
RECENT FINDINGS: There is evidence that care bundles are effective in the adult literature. There have been few reports in the paediatric literature on the implementation of care bundles in children. Paediatric reports focus on the impact of interventions to reduce ventilator-associated pneumonia and central line infections. Recent articles suggest that care bundles are beneficial as part of a comprehensive improvement programme in the ICU. Other papers confirm that ventilator-associated pneumonia bundles can be translated from adults to children, supporting the business case for improving quality.
SUMMARY: The adult and paediatric literature agree that care bundles are valuable tools for ensuring that evidence-based medicine is delivered reliably. Care bundles should be adopted in paediatric and neonatal units. In particular, if applied correctly, they are likely to significantly reduce certain health-care acquired infections. Further research is needed to refine the individual elements of the bundles and to evaluate new applications for them.
Complications of central line insertion
May 23, 2009
Intravenous literature: Askegard-Giesmann, J.R., Caniano, D.A. and Kenney, B.D. (2009) Rare but serious complications of central line insertion. Seminars in Pediatric Surgery. 18(2), p.73-83.
Abstract:
Discussions on the complications of central venous catheterization in children typically focus on infectious and the more common mechanical complications of pneumothorax, hemothorax, or thrombosis. Rare complications are often more life-threatening, and inexperience may compound the problem. Central venous catheter complications can be broken down into early or late, depending on when they occur. The more serious complications are typically mechanical and occur early, but delayed presentations of pericardial effusions, cardiac tamponade, and pleural effusions may be of equal severity, and delay in diagnosis can be catastrophic. Careful insertion techniques, as well as continued vigilance in the correct position and function of central venous catheters, are imperative to help prevent serious complications.
Vascular access device prevalence
May 23, 2009
Intravenous literature: Voges, K.A., Webb, D., Fish, L.L. and Kressel, A.B. (2009) One-day point-prevalence survey of central, arterial, and peripheral line use in adult inpatients. Infection Control & Hospital Epidemiology. 30(6), p.606-8.
Abstract not available.
IV administration set replacement
May 23, 2009
Intravenous literature: Labeau, S., Vandijck, D., Lizy, C., Piette, A., Verschraegen, G., Vogelaers, D. and Blot, S. (2009) Replacement of administration sets used to administer blood, blood products, or lipid emulsions for the prevention of central line-associated bloodstream infection. Infection Control & Hospital Epidemiology. 30(5), p.494.
Abstract not available.
Sharp safety poll
May 23, 2009
Intravenous news: New IVTEAM Poll launched “Should the mandatory use of sharps safety devices be made European law?”
Please vote in the IVTEAM poll box shown at the bottom right of every IVTEAM page.
SCOTVAN launch IV network
May 22, 2009
Intravenous news: The Scottish Vascular Access Network was launched on the 18th May 2009. The Scottish Vascular Access Network have come together to establish a collaborative group which will develop credibility by terminating the unknowns, discrepancies and misunderstandings surrounding the use of Vascular Access in Scotland. This will ultimately benefit patients and health-care professionals across the country as SCOTVAN aim to involve every Health Board in Scotland. Their aim is to promote sharing best practice and provide a platform for discussion and debate. This will be achieved by IV Therapy Nursing Staff, Educators and Infection Control Nurses networking with other IV therapy Specialists across Scotland.
Click here to visit the SCOTVAN website.
Click here for details of the SCOTVAN IV conference.
Needlestick personal account
May 22, 2009
Intravenous news: “I felt a sharp sting. Looking down, I saw a small scarlet drop emerging from the tip of my left index finger. I had stabbed my finger against the needle I had just used to anesthetize Jean’s skin, a needle I still held in my right hand.
I stared at the tiny red bloom on my fingertip. And for a moment, I felt the floor beneath my feet give way, pulling everything — Jean, my heart, my work, my life — down with it. I stood there paralyzed, staring at the puncture wound on my fingertip and unable to stop the movie playing in my mind’s eye, a movie of a future like Jean’s”.
Click here for the full article from Dr Chen following a needlestick injury.
Read the comments on this story on the Tara Parker-Pope on Health blog.
Scottish Vascular Access Network
May 22, 2009
Intravenous conference: SCOTVAN – Call for papers - Scottish Vascular Access Network First Annual Conference, Thursday 12th and Friday 13th November 2009. The venue is The Beardmore Hotel and Conference Centre, Clydebank, Glasgow.
SCOTVAN are pleased to invite abstracts for Presentation and Poster Exhibition at their Inaugural 2 day Conference.The conference will be the beginning of a National Vascular Access Network establishing a collaborative group which will develop credibility by terminating the unknowns, discrepancies and misunderstandings surrounding Vascular Access in Scotland. This will ultimately benefit patients and health-care professionals across the country. Our aim is to promote sharing best practice and provide a platform for discussion and debate.
Guidance for Submission:
- Submissions should be summarised in no more than 250 words
- Authors should indicate their preference for Poster or Oral Presentation
- Submissions should not contain diagrams or references
- All places, organisations and people should anonymised
Conditions of Submission:
- The presenter author must register to attend the conference prior to submitting an abstract(s). Payment is not required until confirmation of acceptance.
- Abstracts will only be accepted if received online in the requested format by Friday 21st August 2009. An email confirmation of receipt will be sent within 48 hours.
- The first Author will receive all correspondence.
- If selected for Oral or Poster presentation, authors are required to make their presentation available as a pdf file for posting on the SCOTVAN conference webpage.
- The first author will be notified of the decision of the selection panel via email by Friday 18th September 2009. The Panel’s decision is final.
- Accepted abstracts will be reproduced in the printed and online programme.
Submissions should be sent to: Linda.kelly3@ggc.scot.nhs.uk with ‘SCOTVAN Call for papers’ in the subject line
For more information go to: www.scotvan.com
IV pole redesigned
May 19, 2009
Intravenous products: Core77.com report “Every research project is a journey. This one started in Basingstoke, England, a small city 50 miles southwest of London in a hospital run by the National Health Service. I was there for Modo to think about IV poles—an ordinary piece of healthcare furniture. Modo researches, designs and builds carts and trolleys for medical devices and customers like Herman Miller, Steelcase and Philips. This project was for Cardinal Health, a $60 billion company”.
Click here for the full story.
Parenteral nutrition complication
May 18, 2009
Intravenous literature: Jardine, L.A., Inglis, G.D.T. and Davies, M.W. (2009) Aspiration of parenteral nutrition–a previously unreported complication of central venous access in an infant: a case report. Neonatal Intensive Care. 22(2), p.18-19.
Abstract:
Introduction The insertion of percutaneous central venous catheters is a common procedure in neonatal intensive care nurseries. Placement of the catheter tip in a large central vein is most desirable. Occasionally, due to difficult venous access, catheter tips are left in places that are less than ideal. Case presentation A female infant with a complicated gastroschisis developed signs of short bowel syndrome post surgery. She was treated with a combination of parenteral nutrition and enteral feeds. A central venous line was inserted through a scalp vein. The tip was noted to be in a vessel at the level of the mandible. She subsequently became unwell with large milky pharyngeal aspirates and episodes of bradycardia. Chest radiography revealed aspiration. The central venous line was removed because of presumed extravasation. This is the first reported case of parenteral nutrition extravasation into the pharynx causing aspiration in an infant. Conclusion This complication may have been prevented by recognising that the tip of the catheter was not correctly placed. When catheters are in unusual positions it may be useful to obtain a second radiograph from a different angle or an ultrasound scan to confirm the positioning of the catheter tip.
Management of extravasation
May 18, 2009
Intravenous literature: Schulmeister, L. (2009) Vesicant chemotherapy – the management of extravasation. Cancer Nursing Practice. 8(3), p.34-37.
Example of text shown below:
The Joint Commission National Patient Safety Goal #13 is to encourage patients’ active involvement in their own care as a patient safety strategy (Joint Commission, 2009). The U.S. Department of Health and Human Services, Agency for Health Care Research and Quality (2009) agrees that the single most important way to prevent errors is for patients to be active members of the healthcare team. For patients receiving vesicant chemotherapy, playing an active role in promoting safety can help prevent chemotherapy extravasation.
Extravasation of Epirubicin
May 18, 2009
Intravenous literature: Vano-Galvan, S. and Jaen, P. (2009) Images in clinical medicine. Extravasation of epirubicin. New England Journal of Medicine. 360(20), p.2117.
Example of text shown below:
A 63-year-old woman with a diagnosis of infiltrative ductal carcinoma of the breast (stage T2N1M0[IIB], according to the tumor–node–metastasis staging system) that was estrogen receptor–negative and HER2-negative was referred for adjuvant chemotherapy after undergoing modified radical mastectomy and axillary lymph-node dissection. Epirubicin, at a dose of 90 mg per square meter of body-surface area, was infused at 21-day intervals, along with fluorouracil and cyclophosphamide. During the third period of administration, the patient reported having excruciating pain in the left wrist, near the intravenous-catheter site (arrow). The infusion was stopped, and a diagnosis of extravasation of epirubicin was made.
Community IV waste management
May 18, 2009
Intravenous literature: Blenkharn, I. (2009) Waste management requirements of community i.v. therapy services. British Journal of Community Nursing. 14(1), p.38-9.
Abstract:
Healthcare professionals carry a legal and professional responsibility for the safe disposal of clinical wastes. Sharps safety is paramount, and though this is a well-recognized hazard there remains an unacceptably high incidence of sharps injury and of blood and body fluid exposures that are particularly frequent among ancillary and support staff and waste handlers. Statutory Local Authority waste collection and disposal services generally provide the most convenient and cost-effective approach to community-generated clinical wastes though there remains much room for improvement. Special arrangements will be necessary for the careful collection, packaging and disposal of not only cytotoxic and cytostatic drug wastes, and of items contaminated with these drug substances, and of controlled drugs, but of all other prescription and many non-prescription pharmaceutical products.
Cost of occupational sharps injuries
May 18, 2009
Intravenous literature: Glenngård, A.H. and Persson, U. (2009) Costs associated with sharps injuries in the Swedish health care setting and potential cost savings from needle-stick prevention devices with needle and syringe. Scandinavian Journal of Infectious Diseases. 41(4), p.296-302.
Abstract:
The number and costs associated with reported sharps injuries in Swedish hospitals and the potential cost offset by introducing safety devices with needle and syringe was estimated from a health care perspective. Data about reported sharps injuries were collected from infection control nurses at 18 Swedish hospitals and information about the procedures following such injuries from doctors at Swedish hospitals and published articles. Unit costs were derived from the Southern Regional Health Care Board, SEK 2007. On average, 3.14 injuries per 100 full-time equivalent positions are reported annually in Swedish health care. Approximately 60% involves hollow-bore needles. The cost of occupational sharps injuries in Sweden was estimated at euro1.8 million (SEK 16.3 million) or euro272 (SEK 2513) per reported injury, of which euro1 million was for hollow-bore sharps injuries. The expected number of injuries that could be avoided by introducing safety devices was estimated at 3125 injuries and the corresponding expected cost offset at euro850,000. Most costs are associated with investigation as opposed to treatment. The cost per reported injury in Sweden seems to be lower than in other EU countries and the US, due to more thorough investigation and treatment procedures in countries with confirmed transmission of pathogens to healthcare workers.
Assessment and care of intravenous lines
May 18, 2009
Intravenous news: Lawsuits involving problematic intravenous lines are the third most common cause of medical malpractice litigation in the United States, so nurses who maintain IVs must take personal accountability when managing complications, says an internationally known expert in infusion therapies.
Because most complications from peripheral IVs are considered preventable and thus indefensible to the courts, the best defense a nurse can present is vigilant assessment and care of intravenous lines, says Sue Masoorli, RN, founder and president of Philadelphia-based Perivascular Nurse Consultants.
Click here for the full news item.
Click here to check the VIP score for IV site checks.
AccuVein locate hard-to-find veins
May 18, 2009
Intravenous products: AccuVein LLC today announced the launch of AccuVein AV300, the world’s first hand-held, non-contact vein illumination device that helps healthcare professionals locate hard-to-find veins. IV starts and blood draws (venipuncture) can be a source of patient anxiety and discomfort, and accessing veins in difficult patients can take up to 10 minutes and require multiple needle sticks.
Venipuncture is the most common invasive medical procedure with an estimated 2.7 million procedures conducted every day in the United States alone. The AV300 can help reduce the need for multiple needle sticks, with the goal of improving patient care and the time to access veins.
Product video shown below:
Click here for the full press release.
Errors in central line placement
May 17, 2009
Intravenous literature: Kilbourne, M.J., Bochicchio, G.V., Scalea, T. and Xiao, Y. (2009) Avoiding Read more
Needlestick injury claims
May 17, 2009
Intravenous literature: Symon, A. (2009) Needlestick injuries: the practitioner as the claimant. British Journal of Midwifery. 17(3), p.192.
Sample text:
“There is a current tension in society regarding health and safety issues. Criticisms of safety notices (‘Warning contents may be hot’, etc) reflect the view that contemporary society has become over-concerned with removing every aspect of risk from our lives. There is a corresponding view that such approaches are less to do with ensuring individual or group safety and more to do with protecting institutions from possible litigation. Nevertheless, we should not forget that the Health and Safety at Work Acts originated in the laudable aim of minimizing the risk of death or severe injury among the workforce”.
Frequency of needlestick injuries
May 17, 2009
Intravenous literature: Talas, M.S. (2009) Occupational exposure to blood and body fluids among Turkish nursing students during clinical practice training: frequency of needlestick/sharp injuries and hepatitis B immunisation. Journal of Clinical Nursing. 18(10), p.1394-403.
Abstract:
AIM AND OBJECTIVE: To describe the rate of needlestick/sharp injuries in nursing students, to estimate the rate of vaccination administration and to define nursing students’ status using universal precautions for protecting from blood-borne infections.
BACKGROUND: Nursing students have a high risk of occupational exposure to bloodborne pathogens because they may have insufficient background knowledge to recognise the level of risk posed by a particular patient and their inexperience with procedural skills and infection control procedures.
DESIGN: This study was designed as a retrospective and descriptive survey.
METHODS: The frequency and mechanism of needlestick/sharp injuries and hepatitis B immunisation were determined retrospectively by surveying students in three nursing schools. In November 2004, 473 students were questioned about needlestick/sharp injuries that they had sustained during their clinical practice and hepatitis B immunisations.
RESULTS: Forty-nine per cent of the students who responded sustained injuries; of these 74% were injured while on wards. The highest number (72.2%) had been injured by hollow-bore needles; 65.2% who were injured were not wearing gloves at the time of injury; 27% of injuries were associated with recapping the needle; 43.9% reported their injuries to administrators and the rate of those receiving medical assistance after needlestick/sharp injuries was less than not seeking assistance; 67.7% had been vaccinated against hepatitis B.
CONCLUSION: This study showed that nursing students frequently sustain needlestick/sharp injuries and hepatitis B immunisation rate was low.
RELEVANCE TO CLINICAL PRACTICE: Findings will help in designing more intensive education programs directed at the students to increase their awareness of and compliance with Universal Precautions and in instituting policies so that they are fully immunised against hepatitis B before beginning clinical practice.
Vascular access training phantom
May 17, 2009
Intravenous products: CIRS is pleased to introduce the Model 072 Vascular Access Training Phantom Kit. The Model 072 was designed to provide a realistic training medium for needle insertion. It is made from a durable elastometric compound mimicking the tactile feel and puncture resistance of soft tissue. This self-healing material has realistic acoustic properties allowing imaging of the simulated palpable vessels under ultrasound. The phantom includes one bifurcated vessel and 2 straight walled vessels at a variety of depths and diameters to simulate a range of challenges often encountered in the clinical environment. The phantom can be easily replenished without leakage using a syringe (included) and a stopcock enables increased vessel pressure for more realistic simulation. The kit also includes needles and a supply of simulated blood. The phantom requires no special handling and will not dry out.
Click here for the full press release.
US contact admin@cirsinc.com
UK contact phil@imagingequipment.co.uk
Prehospital vascular access
May 17, 2009
Intravenous literature: Ezingeard, E., Coudrot, M., Guyomarc’h, S., Aubert, G., Blanc, J.L., Bertrand, J.C., Tardy, B. and Zeni, F. (2009) Evaluation of colonisation of peripheral venous catheters inserted by prehospital emergency service teams (SMUR) in France. Journal of Hospital Infection. 72(2), p.169-75.
Abstract:
There are no data in the literature on colonisation of peripheral venous catheters (PVCs) inserted by French prehospital emergency and resuscitation service teams (SMUR). In a descriptive and prospective study we evaluated colonisation of PVCs inserted and managed solely by a SMUR team. A total of 171 PVCs were analysed. Bacteriological results were positive for seven catheters (4.09%/threshold=10(2)cfu/mL). Our analyses of the characteristics of patients and interventions show a significantly higher number of elderly patients among those colonised (P=0.02) with less satisfactory venous access (P=0.006) and smaller catheter bores (P=0.009). No differences were seen regarding the other evaluation criteria: gender, aetiology, site of intervention, number and site of venepuncture procedures, blood pressure and duration of catheterisation. The absolute value of colonisation seen in our study appears consistent with those reported in the literature, but no comparisons are possible due to widely divergent catheterisation times between published work (days) and our own data (minutes). Our results suggest a reassessment of current recommendations of routine changeover of these catheters, with the attendant discomfort for patients and cost in terms of time and money. We recommend a randomised study comparing catheter colonisation levels associated with routine catheter replacement with targeted replacement based on risk factors.
Distraction techniques for venepuncture
May 17, 2009
Intravenous literature: Murphy, G. (2009) Distraction techniques for venepuncture: a review. Paediatric Nursing. 21(3), p.18-20.
Abstract:
Venepuncture is one of the most feared hospital procedures for children and inadequate pain management has the potential to affect future care. Distraction has been shown to help to reduce procedural distress in children. A thematic analysis of relevant literature on distraction techniques revealed that passive distraction is more effective than active distraction during venepuncture and that the effectiveness of a particular technique depends on the attention capacity of the child and their engagement in the distraction activity.
Haemolysis during venepuncture
May 17, 2009
Intravenous literature: Saleem, S., Mani, V., Chadwick, M.A., Creanor, S. and Ayling, R.M. (2009) A prospective study of causes of haemolysis during venepuncture: tourniquet time should be kept to a minimum. Annals of Clinical Biochemistry. 46(Pt 3), p.244-6.
Abstract:
BACKGROUND: Haemolysis is defined as the release of cellular components of erythrocytes and other blood cells into the extracellular space of blood. These cellular components can cause interference in laboratory measurements, potassium being a commonly measured analyte to be affected. A number of factors have been implicated in the aetiology of haemolysis. We undertook this study to enable us to identify and hence rectify causes of haemolysis in samples from patients on acute medical and surgical wards.
METHODS: We performed a prospective study of 353 blood sampling events during February and March 2007. A proforma was used to obtain detailed information of each blood-taking episode. Information from the proforma was linked to the incidence of haemolysis obtained from the hospital computer system.
RESULTS: The incidence of haemolysis among the samples studied was 6.5%. While staff group, method of sampling, tourniquet time and number of attempts at venepuncture were each univariately associated with haemolysis, stepwise logistic regression resulted in a final model which only included tourniquet time (odds ratio for haemolysis if tourniquet time >1 min was 19.5 [95% confidence interval [CI] 5.6-67.4%]).
CONCLUSION: Tourniquet time of more than a minute is associated with a significant increase in risk of haemolysis. Advice on tourniquet time is included in phlebotomy training within the hospital; hence a campaign of appropriately channelled continuing education on this issue may be successful in reducing the haemolysis rate.
Costs associated with CRBSI
May 17, 2009
Intravenous literature: Tacconelli, E., Smith, G., Hieke, K., Lafuma, A. and Bastide, P. (2009) Epidemiology, medical outcomes and costs of catheter-related bloodstream infections in intensive care units of four European countries: literature- and registry-based estimates. Journal of Hospital Infection. 72(2), p.97-103.
Abstract:
Despite high incidence rates, little information is available on the burden of illness of catheter-related bloodstream infections (CRBSIs) in Europe. A review of the available data was performed to estimate the clinical outcomes and costs associated with CRBSIs during intensive care unit (ICU) stays in four European countries (France, Germany, Italy and the UK). Based on these data we have estimated the CRBSI-related mortality and the annual costs associated with CRBSIs in the aforementioned countries. Results show large variation between countries: 1.12-4.2 CRBSI per 1000 catheter days, 8400-14,400 CRBSIs episodes per year, 1000-1584 deaths per year, 15,960-201,600 ICU days caused by CRBSIs and euro35.9 to euro163.9 million associated costs. Discrepancies are mainly explained by the heterogeneous quality of epidemiological studies, as well as the variety of national clinical practices.
CRBSI diagnosis
May 17, 2009
Intravenous literature: Slobbe, L., El Barzouhi, A., Boersma, E. and Rijnders, B.J. (2009) Comparison of the roll plate method to the sonication method to diagnose catheter colonization and bacteremia in patients with long-term tunnelled catheters: a randomized prospective study. Journal of Clinical Microbiology.47(4), p.885-8.
Abstract:
Diagnosing catheter-related bloodstream infection (CRBSI) still often involves tip culture. The conventional method is the semiquantitative roll plate method. However, the use of a quantitative sonication technique could have additional value, as it may detect endoluminal microorganisms more easily. Because endoluminal infection tends to occur in long-term central venous catheters, we compared both techniques for patients with long-term tunnelled catheters. For 313 consecutive Hickman catheter tips from 279 hematological patients, colonization detection rates were compared by performing both techniques in a random order, using conventional detection cutoffs. Additionally, for the subgroup of patients with clinical suspicion of CRBSI (n = 89), the diagnostic values of both techniques were compared. The overall tip colonization rate was 25%. For each technique, the detection rate tended to be better if that technique was performed first. The diagnostic performance for the subgroup of patients with clinical suspicion of CRBSI was limited and not different for both methods. Sensitivity and specificity were 45% and 84%, respectively, for sonication versus 35% and 90%, respectively, for the roll plate technique. The fact that 35 of 40 patients with CRBSI received antimicrobial therapy before catheter removal and tip culture, in an attempt to salvage the catheter, may partly explain this poor performance. No differences were observed when catheters were stratified according to in situ time below or above the median of 4 weeks. The sonication culture technique was not better than the roll plate method to diagnose tip colonization or CRBSI in patients with long-term tunnelled catheters.
PICC insertion criteria
May 17, 2009
Intravenous literature: Migita, D.S., Postetter, L., Heath, S., Hagan, P. and Del Beccaro, M. (2009) Governing peripherally inserted central venous catheters by combining continuous performance improvement and computerized physician order entry. Pediatrics. 123(4), p.1155-61.
Abstract:
OBJECTIVE: Seattle Children’s in Seattle, Washington sought to establish governance over peripherally inserted central catheters. Preventing overuse and creating an efficient placement process were of paramount importance.
METHODOLOGY: We describe a process by which the marriage of continuous performance-improvement projects and computerized physician order entry has led to a reproducible reduction in peripherally inserted central catheter volumes and an increase in overall provider satisfaction with the ordering process. This was accomplished by increasing daily awareness of central venous catheters, establishing peripherally inserted central catheter-specific insertion criteria, establishing a governing vascular-access service, and creation of a peripherally inserted central catheter-specific computerized order set.
RESULTS: After implementation of these measures, peripherally inserted central catheter insertion volumes decreased by 33.4%; these results have been sustained over a period of 19 months. From August 2006 to October 2006, 48% of peripherally inserted central catheters were placed on the same calendar day of order entry, 37% within 24 hours of order entry, and 15% within 48 to 72 hours. Overall, provider satisfaction with the ordering process improved according to a Likert scale. Scores increased from 2.68 of 5 to 3.55 of 5 over a 9-month period. This result was statistically significant at the 95th percentile level according to the t-test method.
CONCLUSIONS: We conclude that properly constructed computerized order sets can be effective in altering physician ordering practices through standardization.
IV extravasation infection
May 16, 2009
Intravenous news: ConcordMonitor.com report “The family of a Vermont woman who died following complications from her treatment at Dartmouth-Hitchcock Medical Center was awarded nearly $1 million by a federal jury this week in medical malpractice and wrongful death awards. The jury awarded $598,000 to the estate of Katherine Coffey and $385,000 to her surviving husband.
According to court documents, Coffey was admitted to Dartmouth-Hitchcock Medical Center to treat fluid in her lungs shortly after she had received open heart surgery in 2005. While she was there, an IV line placed in her hand leaked medication into the tissue of her hand. The resulting reaction required her to undergo surgery to amputate several fingers.
A few weeks after the amputations, Coffey, 79, died from an infection with Methicillin-resistant Staphylococcus aureus, a drug-resistant type of bacteria often acquired inside of hospitals”.
Click here for the full story.
Incidence of thrombophlebitis
May 14, 2009
Intravenous literature: Cicolini, G., Bonghi, A.P., Di Labio, L. and Di Mascio, R. (2009) Position of peripheral venous cannulae and the incidence of thrombophlebitis: an observational study. Journal of Advanced Nursing. 65(6), p.1268-73.
Abstract:
Aim. This paper is a report of a study conducted to investigate the most suitable location of peripheral venous cannulae to reduce the incidence of thrombophlebitis.
Background. Peripheral intravenous cannulae are used for vascular access, but the site of insertion and size of the cannula could expose patients to local and systemic infectious complications. Small cannula size is an important factor in reducing the incidence of thrombophlebitis, but cannula location has not yet been studied. Evidence-based knowledge on how to prevent these complications is needed.
Method. An observational survey carried out was carried out in 2007 with 427 patients in one Italian hospital. A structured observation protocol was used to survey the frequency of thrombophlebitis and the realtionship of location and size of peripheral intravenous cannulae. The variables evaluated were age, gender, cannula size and site of cannula location. Chi-square or Student t tests were used, and the adjusted odds ratios and relative 95% confidence intervals are reported.
Results. The frequency of peripheral intravenous cannulae thrombophlebitis was higher in females (OR:1.91;CI:1.20-3.03;P < 0.006). The highest incidence was found in patients with cannulae inserted in the dorsal side of the hand veins compared to those with cannulae inserted in cubital fossa veins (OR:3.33;CI:1.37-8.07; P < 0.001).
Conclusion. The use of cubital fossa veins rather than forearm and hand veins should be encouraged to reduce the risk of thrombophlebitis in patients with peripheral intravenous cannulae.
Hypodermoclysis site problem
May 14, 2009
Intravenous literature: O’Hanlon S,Sheahan P,McEneaney R (2009) Severe hemorrhage from a hypodermoclysis site. American Journal of Hospice & Palliative Medicine. 26(2), p.135-6.
Abstract:
Hypodermoclysis, or subcutaneous infusion of fluids, is an alternative means of administration of fluid. It is sometimes used in older patients in whom there is difficulty achieving intravenous access, or who are entering the terminal stage. It is considered a relatively low-risk procedure. We report a case where a patient’s death may have resulted from its use.
CLABSI and needleless device use
May 14, 2009
Intravenous literature: Toscano, C.M., Bell, M., Zukerman, C., Shelton, W., Novicki, T.J., Nichols, W.G., Corey, L. and Jarvis, W.R. (2009) Gram-negative bloodstream infections in hematopoietic stem cell transplant patients: the roles of needleless device use, bathing practices, and catheter care. American Journal of Infection Control. 37(4), p.327-34.
Abstract:
BACKGROUND: Between August 1 and October 30, 1998 (outbreak period), an increased incidence of central venous catheter (CVC)-associated gram-negative bacterial bloodstream infection (GN-BSI) was detected in hematopoietic stem cell transplantation (HSCT) candidates and recipients in an outpatient HSCT unit. The objectives of the present study were to determine strategies for controlling the outbreak and identify risk factors for GN-BSI.
METHODS: Two case-control studies, an assessment of infection control practices, microbiologic studies, and water quality analysis were conducted. A case was defined as any outpatient with a CVC and a primary GN-BSI during the outbreak period.
RESULTS: All of the 31 case patients identified had needleless intravenous (IV) access devices. Independent risk factors for CVC-associated GN-BSI were self-administered IV infusion (odds ratio [OR] = 6.2; P = .02), lower frequency of needleless device changes (OR = 15.2; P = .03), and more frequent baths (OR = 1.4; P = .05). Interventions included increased frequency of needleless device change, recommending showers rather than baths, and use of CVC protection during showering/bathing. After these interventions, the CVC-associated GN-BSI rate declined to below the preoutbreak period rate (2.1/1000 vs 0.3/1000 CVC-days; P < .01).
CONCLUSIONS: This study demonstrated an increased risk of CVC-associated GN-BSIs related to self-IV infusion, bathing habits, and frequency of needleless device change. Infection control practices associated with the use of needleless devices may expose susceptible patients to increased risk for BSI.
Cook’s new Spectrum Turbo-Ject PICC
May 14, 2009
With the launch of Cook Medical’s new Spectrum Turbo-Ject PICC, for the first time, the clinical benefits of antibiotic-impregnated catheters—a critical component in eliminating 250,000 potentially fatal catheter-related bloodstream infections (CRBSIs) in the U.S. annually—are now available for peripherally inserted central venous catheters (PICCs) that can also be used for contrast-enhanced CT scans.
The Spectrum Turbo-Ject PICC is the industry’s first antibiotic-impregnated PICC capable of accepting the contrast media injection rates required for CT scans. The ability to power-inject contrast media, combined with the Spectrum technology’s proven ability to prevent CRBSIs, means that patients receiving PICC lines will gain the highest possible protection from deadly CRBSIs, while clinicians will have access to the industry’s best flow rates.
“Cook’s new Spectrum Turbo-Ject PICC lines provide industry-leading technology to interventional radiologists, nurses and other health care professionals in the fight against costly, life-threatening hospital-acquired infections, and also provide industry-best flow rates for contrast media,” said Dan Sirota, global business leader of Cook Medical’s Interventional Radiology division. “This innovation further demonstrates Cook’s commitment to reducing infections by providing a unique Cook technology that is proven to improve patient outcomes.”
Demand for the new PICC is so high, he added, that the first units were shipped to customers even before Cook’s official introduction of the device to key customers at the Society of Interventional Radiology Meeting earlier this year in San Diego.
With the Spectrum Turbo-Ject PICC, clinicians can choose from multiple catheter configurations that offer an industry-best range of flow rates in order to meet patient needs, including:
- Maximum pressure limit settings of 325 psi
- 5 French single and double lumen with a maximum flow rate of 7 and 5 mL/second, respectively
- 4 French single lumen with a maximum flow rate of 4 mL/second
- 50 cm and 60 cm length available
Click here for the full press release.
Handwashing behaviour
May 14, 2009
Intravenous literature: Hanna, D., Davies, M. and Dempster, M. (2009) Psychological processes underlying nurses’ handwashing behaviour. Journal of Infection Prevention. 10(3), p.90-95.
Abstract:
Background: Psychological models of behaviour A change have been found to be useful in predicting health-related behaviour in patients but have rarely been used in relation to the health behaviour of staff. This study explored the association between a range of psychological variables and self-reported handwashing in a sample of nurses who work in a large general hospital.
Method: A questionnaire-based cross-sectional, cor-relational study was used. Questionnaires examining demographics, self-efficacy, perceived importance of handwashing, perception of risk, occupational stress and training related to handwashing were administered to an opportunity sample (n = 76) of nurses drawn from an acute hospital. ANOVAs, correlation and regression analyses were performed to determine significant covariates of handwashing behaviour.
Findings: There was a weak relationship between demographic variables and self-reported handwashing. The degree to which employees perceived their workplace to assist handwashing and the perceived importance of handwashing were related to self-reported handwashing. Accordingly further covariates of these variables were sought. Training received and occupational stress both covaried with nurses’ perceptions of the degree to which their workplace assisted handwashing. Nurses’ beliefs regarding the transmission of infections covaried with perceived importance of handwashing.
Conclusion: Occupational stress was observed to reduce the perception of having a supportive employer: organisations need to facilitate handwashing and protect staff from factors that have a detrimental impact, such as work-related stress. Nurses’ perceived importance of the potential for poor handwashing practice to contribute to the transmission of infections should be highlighted in interventions.
Possible heparin deaths
May 11, 2009
Intravenous news: The Chicago Tribune reports ‘Baxter International Inc. said medical care providers at a hospital in Delaware and U.S. health officials are investigating whether the deaths of two patients are linked to a brand of heparin blood thinner Baxter sells in intravenous bags.
The U.S. Food and Drug Administration said the situation “appears to be an isolated incident,” agency spokeswoman Karen Riley said this afternoon.
Use of Baxter’s heparin, a diluted form in pre-mixed bags used for a variety of blood thinning purposes, has been suspended by officials at Beebe Medical Center in Lewes, Del. since Friday. Adverse reactions were reported in five patients who had problems that included internal bleeding in the brain”.
Click here for the full news story.
Infusion Nursing text from INS
May 6, 2009
Intravenous literature: The Infusion Nurses Society (INS) has announced that the 3rd edition of its authoritative textbook, Infusion Nursing: An Evidence-Based Approach, is now available to order… click here to order!
This comprehensive resource brings you practical coverage of every aspect of infusion therapy. Completely updated content helps you stay informed of the latest advances in equipment, technology, best practices, guidelines, and patient safety.
One of the most significant changes in this 3rd edition is in its evidence-based approach. A new chapter has been added to address Evidence-Based Practice, and Focus on Evidence boxes throughout the text emphasize the importance of research in achieving the best possible patient outcomes.
Timestrip IV hospital order
May 5, 2009
Intravenous products: TradingMarkets.com report ‘Timestrip PLC, a UK-based smart label company, declared on 5 May that the company has secured an order with Luton & Dunstable Hospital, which has become the second hospital to place an order for the newly launched TimestripIV product, designed to help hospitals comply with existing policy directives that stipulate the need to change Peripheral Intravenous Cannulae (PVCs) every three days, as part of infection control protocols”.
Click here for the full news item.
Home intravenous (IV) therapy
May 4, 2009
Intravenous conference: Alison Smith, IV lead at Liverpool PCT (UK), will present at the IPS IV conference in September. The Aim of the presentation is to discuss the diversity of a community intravenous therapy service.
The Liverpool PCT home IV service provides gold standard Intravenous Therapies to patients in the community whether it is in their own homes or in community NHS clnics thereby reducing the need for hospitalisation and increasing patient ability to return to their preferred place of care.
Alison sates “We are commissioned to provide IV antibiotics, Blood Product Transfusion, Intravenous Iron, Care and maintanence of Vascular accesss Devices and insertion of Midlines plus IV support for patients with long term conditions and Bronchiectasis”. Alison continues “The service provides clinical leadership, education, assessment and support to the PCT District Nursing and Community Matrons and partnership working with GPs and secondary care in the management of patients requiring intravenous therapy”.
Click here for conference details.
Free injectable medicines course
May 3, 2009
Intravenous training: NHS Education South Central have developed an eLearning programme that examines the issue ‘compatibility of injectable medicines’. The programme was developed by Dr Simon Wills, Head of Wessex Drug & Medicines Information Centre at Southampton University Hospitals NHS Trust and Alison Wright, E-learning Programme Manager at NHS Education South Central.
To register for this free online resource please click the following link www.learning.nesc.nhs.uk/course/view.php?id=59
eLearning for IV cannulation training
May 3, 2009
Intravenous training: New eLearning peripheral IV cannulation training programme from Vygon. Healthcare practitioners need to be updated constantly with high quality education and training, and evidence-based practice relevant to their role.
The programme:
- Can be run on a stand-alone computer.
- Can be accessed over a local network or the internet for hospital Trusts and Boards that have a SCORM compliant e-Learning management system.
- Acts as a clinical resource, refresher update andaudit tool.
- Monitors and tracks individual learner progress.
- Supports your continuing professional development (CPD) portfolio with appraisal and certification of study hours.
- Gives healthcare professionals the opportunity to access education and training programmes 24/7.
- Reduces time away from the clinical area.
Contact the programme author for more information ran.kurvits@vygon.co.uk
Canadian CLABSI rates published
May 2, 2009
By April 2009, Ontario hospitals will be reporting on eight patient-safety indicators that can provide valuable data on which to base effective benchmarks, best practices and foster patient safety improvements across the province’s health care system :
- Clostridium Difficile Associated Disease (CDAD)
- Methicillin Resistant Staphylococcus Aureus (MRSA)
- Vancomycin Resistant Enterococcus (VRE)
- Hospital Standardized Mortality Ratio (HSMR)
- Ventilator-Associated Pneumonia (VAP)
- Surgical Site Infection Prevention
- Hand Hygiene Compliance
- Central-Line Primary Blood Stream Infection (CLI)
Public reporting of central line associated blood stream infection rates in intensive care units (ICU) of Ontario hospitals is now posted on the Ministry of Health and Long-Term Care website. In addition, hospitals will post quarterly rates and case counts of central line infection (CLI) that developed in the ICUs of each hospital site on their website.
The most recent figures published demonstrate a CLABSI rate of 1.56 per thousand catheter days.
Click here for the main CLABSI page on the Ministry of Health and Long-Term Care website.
Click here for a presentation that includes a definition of CLABSI.
Click here for a CLABSI patient fact sheet.
IV catheter insertion attempts
May 2, 2009
Intravenous news: WVrecord.com report that “A Fayette County woman says a nurse’s fumbling with an intravenous needle caused her daughter’s death.
The complaint says that Amber, who was 6 years old, was brought to CAMC Women and Children’s Hospital for suspected meningitis on Sept. 21, 2007. Physicians advised Amber’s parents that the girl should not become excited or agitated, as it might hamper her recovery.
During the evening of Sept. 22 and early morning of Sept. 23, a nurse at CAMC attempted to put an IV needle into Amber 11 times, the complaint says. The complaint says Amber’s parents gave “strenuous protest” while this was going on”.
Click here for the full story.
Extravasation pictures and treatment
May 1, 2009
Intravenous literature: IVTEAM do not regularly publish ‘old’ articles. However, this article has a number of very interesting extravsation pictures and treatment options.
Click here to view the full pdf of article.
Sarovath, A. and Kruavit, A. (2006) Extravasation Injury: What is the Appropriate Management of Extravasated Skin Ulcer? The THAI Journal of SURGERY. 27(1), p.19-25.
Abstract:
Background: Extravasation injury can cause a serious problem from significant soft tissue necrosis. The proper treatment is always being delayed before being referred to surgeons.
Objective: To study the appropriate surgical management of the extravasated skin ulcer.
Patients and Methods: During August 2001 and January 2003, there were seven patients (5 males, 2 females) suffering from extravasation injuries; 5 cases from chemotherapeutic agents (Doxorubicin HCL, Epirubicin) and 2 cases from calcium. Early radical debridement of necrotic tissues and either immediate or delayed reconstruction were successfully performed using either skin flaps or skin grafts if direct closure is impossible.
Results: There were one partial flap necrosis and one minimal wound dehiscence. They healed after secondary minor surgery.
Conclusions: Prevention of extravasation injury is the best policy because once this serious injury develops it will be difficult to heal by conservative treatment. Early radical debridement of the necrotic or non-healthy tissues with immediate or delayed skin coverage is recommended.
Click here to view the full pdf of article.
Hand hygiene online game
May 1, 2009
Intravenous news: The National Patient Safety Agency have launched ‘Wi-Five’ an online game to raise awareness of the five moments of hand hygiene.
