Novel PICC coating

Intravenous products: News-Medical.net report “A novel coating being used on a new peripherally inserted central catheter (PICC) from r4 Vascular mimics the cell layer found on natural tissue surfaces.

r4 Vascular designed the catheter to have a biomimetic surface that mimics the natural glycocalyx layer on endothelial tissues. Laboratory tests prove that mimicking the glycocalyx layer can dramatically reduce thrombus formation on the catheter surfaces. r4 Vascular recently gained FDA clearance to launch their first catheter based on this Biomimetic technology. It will be available beginning June 30, 2009 as the Zeus Coated CT PICC”.

Click here for the full item.

Needlefree injection FDA approval

Intravenous products: MedGadget.com report “The FDA issued approval for Antares Pharma’s (Ewing, New Jersey) needle-free injection device for use with Tev-Tropin brand human growth hormone (hGH) from Teva out of Petach Tikva, Israel. The device will be marketed under the name Tev-Tropin Tjet Injector system”.

Teva will market the Antares needle-free device as the Tev-Tropin Tjet Injector system.

“We are pleased to add this new technology to our growing portfolio through our successful partnership with Antares, and to offer patients a less invasive delivery system,” stated Larry Downey, head of Teva`s North America Brand Pharmaceuticals division. “This significant achievement demonstrates our ability to leverage our leadership in the pharmaceutical industry, and our ongoing commitment to utilize our global strengths in innovative activities.”

Click here for the story on MedGadget.

Click here for the full press release.

Lyme disease research

Intravenous literature: InfectionControlToday.com report “Lyme disease in the U.S. is caused by the tickborne bacteria Borrelia burgdorferi and usually begins with a skin lesion, after which the bacteria spread throughout the body to the nervous system, heart or joints. About 60 percent of untreated individuals develop arthritis, which affects the knees in particular. Lyme disease usually responds well to antibiotic therapy, but in rare cases arthritis can persist for months or years after treatment, a rare condition known as antibiotic-refractory Lyme arthritis. Joint fluid usually tests negative for B burgdorferi after treatment, indicating that joint inflammation may persist even after the bacteria has been eradicated.

Two genetic marker systems are used to correlate the variation of this bacterial strain with clinical outcomes: OspC typing divides B burgdorferi strains into 21 types, while the ribosomal RNA intergenic spacer type (RST) system divides them into just three groups, with certain RST groups corresponding uniquely to specific OspC types.

A new study led by Allen Steere of Massachusetts General Hospital and Harvard Medical School analyzed joint fluid samples from 124 patients with Lyme arthritis who were seen over a 30-year period. It identified B. burgdorferi strains in the joints of patients with Lyme arthritis and found that the genotype frequencies in joints reflected those in skin lesions. However, RST1 strains were the most frequent in patients with antibiotic-refractory arthritis. The study was published in the July issue of Arthritis & Rheumatism”.

Click here for the full review on ICT.

Lyme disease legislation

Intravenous news: InfectionControlToday report “Sen. Christopher Dodd (D-CT), a senior member of the Senate Health, Education, Labor and Pensions Committee and Chairman of its Subcommittee on Children and Families, along with Sen. Susan Collins (R-ME), have introduced the Lyme and Tick-Borne Disease Prevention, Education, and Research Act of 2009. The bill is co-sponsored by Sen. Jack Reed (D-RI), Sen. Joe Lieberman (ID-CT), Sen. Sheldon Whitehouse (D-RI), and Sen. Benjamin Cardin (D-MD)”.

“Every year, tens of thousands of Americans working or playing outdoors are bitten by ticks. For most, it is nothing more than a minor annoyance. But approximately 20,000 Americans contract Lyme disease each year, and the numbers are rising,” said Dodd. “And because Lyme disease is difficult to diagnose, many experts believe the true number of cases each year could be as much as 12 or 12 times the reported number. Worst of all, it’s our children who are most at risk.”

Click here for the full story.

Zero central line infections

Intravenous news: Tim Royer, BSN, CRNI completed prospective surveillance at the VA Puget Sound Healthcare System in Seattle, Washington and presented his findings as an Oral Abstract titled “Using Clear Valves and Flushing with 20ml in the Adult Population to Attain Zero Central Line Associated Bloodstream Infection (CLABSI) Rate: A Prospective Surveillance.”

The data presented consisted of six years of surveillance data spanning from January 2003 to December 2008. The abstract presentation and research was awarded first place in its category by the Infusion Nursing Society.

Click here to view the poster.

Peripheral IV placement study

Intravenous products: GetTheWordOut.com report “University Hospitals Case Medical Center has been selected by Telesso Technologies Limited, a global healthcare company, as the second site to enroll patients in a head-to-head trial evaluating its FDA-approved guide wire-assisted peripheral IV catheter versus the industry’s gold standard device for peripheral IV placement.

A peripheral vein is the most common site for insertion of a catheter for short-term diagnostic or therapeutic use. The catheter is placed into the peripheral vein in the arm, below the elbow and is typically passed up inside the vein to a length of 2-3 inches.

Telesso’s uniquely-designed guide wire-assisted peripheral IV catheter device uses a retractable guide wire system that is believed to enable easier IV access, reduce common safety risks, significantly lessen patient pain and discomfort, and provide cost savings to facilities by lowering administrative costs associated with failed IV starts”.

Click here for the full story.

IV ultrasound support on iPhone

Intravenous products: The SonoAccess™ application is your direct link to SonoSite. They have designed this medical iPhone® app to give you helpful resources such as videos that demonstrate techniques for specific scanning procedures, quick guides for reimbursement information, and more.

At the tap of a finger, a portable, on-demand library of high quality clinical and system instructional videos, case studies, clinical image gallery and reference guides on point-of-care ultrasound applications is available to any medical professional or student.

SonoAccess™ for the iPhone™ is available downloadable for free from iTunes – click here to download

IV containers and pumps win award

Intravenous products: InfectionControlToday.com report “Medical Device and Diagnostic Industry magazine has recognized three medical devices manufactured by B. Braun Medical Inc. as being among the most influential medical devices of the last 30 years. B. Braun’s Outlook® Safety Infusion System, PINNACLE® TPN Management System and EXCEL® and PAB® IV Containers were all recognized in the magazine’s 30 Years, 30 Devices special commemorative issue”.

“It truly is a great honor that B. Braun has contributed to the industry’s advancement in infusion therapy,” said Eric Steen, senior vice president and chief marketing officer for B. Braun Medical Inc. “In developing these and all other B. Braun products, we continuously seek innovative ways to translate our customer’s needs into products with unmatched quality, cost-effectiveness, environmental responsibility and safety.”

Click here for the full story.

Vascular access devices & Biofilm

Intravenous conference: TargetBSI.com are presenting a webinar on why are Vascular Devices Prone to Biofilm Contamination? The session will enable clinicians to understand biofilm contamination in vascular devices. In addition, speakers will discuss the obstacles to preventing, managing and eradicating biofilms in vascular access devices. Clinical strategies will be identified to reduce the impact of biofilm.

The webinars will take place on:

• Tuesday, July 28th at 1pm Eastern
• Thursday, July 30th at 2pm Eastern

The expert speakers who will discuss this topic are:

• Garth James, PhD, BS. Medical Projects Manager, Center for Biofilm Engineering.
• Marcia Ryder PhD, MS, RN. Ryder Science, Medical Biofilm Research.

Click here to register for the Webinar.

Central venous catheter care

Intravenous literature: Zingg, W., Imhof, A., Maggiorini, M., Stocker, R., Keller, E. and Ruef, C. (2009) Impact of a prevention strategy targeting hand hygiene and catheter care on the incidence of catheter-related bloodstream infections. Critical Care Medicine. 37(7), p.2167-73.

Abstract:

OBJECTIVES: To study the impact of a teaching intervention on the rate of central venous catheter-related bloodstream infections (CRBSI) in intensive care patients.

DESIGN: Prospective before/after interventional cohort study on medical and surgical intensive care units.

SETTING: University hospital with five adult intensive care units.

PATIENTS: All patients with a central venous catheter on the five ICUs from September to December 2003 (baseline period) and from March to July 2004 (intervention period).

INTERVENTIONS: Educational program with teaching of hand hygiene, standards of catheter care, and preparation of intravenous drugs.

MEASUREMENTS AND MAIN RESULTS: The primary outcome variable was the rate of CRBSIs per 1000 catheter days during a baseline period of 4 months and an intervention period of 5 months. The secondary outcome variable was compliance with hand hygiene. Of the patients, 499 patients with 6200 catheter days in the baseline period and 500 patients with 7279 catheter days were monitored in the intervention period. The incidence density of CRBSI decreased from 3.9 per 1000 catheter days in the preintervention phase to 1.0 per 1000 catheter days in the intervention phase (p < 0.001). The risk for CRBSI was significantly higher in the baseline period in both univariate and multivariate analysis. Other independent risk factors were hospitalization in the medical ICU and male gender. Time to CRBSI was significantly longer in the intervention period (median 9 days vs. 6.5 days, respectively; p = 0.02). Compliance with hand hygiene improved slightly from 59% in the baseline period to 65% in the intervention period, but the rate of correct performance of the practice increased from 22.5% to 42.6% (p = 0.003).

CONCLUSIONS: Evidence-based catheter-care procedures, guided by healthcare workers’ perceptions and including bedside teaching, reduce significantly the CRBSI rate and demonstrate that improving catheter care has a major impact on its prevention.

Inotrope infusion

Intravenous literature: de Barbieri, I., Frigo, A.C. and Zampieron, A. (2009) Quick change versus double pump while changing the infusion of inotropes: an experimental study. Nursing in Critical Care. 14(4), p.200-6.

Abstract:

BACKGROUND: Quick change (QC) and double pumping (DP) are common methods of substituting the infusion of inotropes given through intravenous pump.

AIMS: The aim of the study was to compare two methods in respect with the variation in mean arterial pressure (MAP). The hypothesis was that the DP method could be the most effective in achieving haemodynamic stability.

DESIGN: The study is a randomized research in an open randomized clinical trial.

METHODS: The study took place at the Paediatric Intensive Care Unit of Padua Hospital. It considered patients of 0-36 months, not premature, treated with inotropic infusion with monitoring of blood pressure. The research obtained the approval of the Hospital Research Ethics committee and parents signed informed consent. Comparison of the two groups made use of the Wilcoxon test for the continuous variables and the Fisher’s exact test for the comparison of frequencies, at significance value of 5%. The data were registered in an Excel spreadsheet and analysed with SAS.

RESULTS: The sample comprised 30 patients of age between 1 and 27 months, of whom 13 (43%) were male. They were all affected by cardiac, respiratory or infective pathology, all of them intubated and on artificial respiratory support, sedated and infused with dopamine. The characteristics of the patients of the two groups did not differ significantly. The percentage variation of the baseline value of MAP after 30 min from starting the treatment between the two methods was not statistically significant (p = 0.85). The 95% confidence interval for the difference in the percentage variation of MAP between the two groups was (-3.1, +3.7). From a clinical perspective, the methods are to be considered equivalent.

CONCLUSIONS: The study was conducted on a limited sample; no statistically significant differences were detected; QC is the quickest and more cost-effective method.

Paediatric IV therapy conference

Intravenous conference: Alder Hey Children’s NHS Foundation Trust are hosting a conference focussed upon paediatric IV therapy and patient safety.

Speakers include:

• Dr Sasse, Hanover Medical School. Dept, Pediatric Cardiology and intensive care Medicine, Hanover, Germany.
• Professor Patrick Ball, Foundation Professor of Rural Pharmacy, Charles Stuart University, Australia and international member of the BPNG.
• Professor Bernie Carter, Professor of Children’s Nursing, Alder Hey Children’s NHS Foundation Trust.
• Dr Andrew Riordan, Consultant in Paediatric Infectious Diseases And Immunology.
• Dr Steven Ryan, Consultant Paediatrician and Medical Director, Alder Hey Children’s NHS Foundation Trust.
• Mrs Sara Melville, Paediatric IV nurse Specialist.

Showcase hospital conference

Intravenous conference: Southampton University Hospitals NHS Trust in collaboration with the HCAI Technology Innovation Programme are hosting a free Showcase Hospital One Day Conference. The conference will be held at the Novotel, Southampton, Wednesday 15th July 2009

The aim of the programme is to promote the introduction of new technologies with proven effectiveness that have the potential to make a real difference in the battle against HCAI’s. In addition to a range of other speakers, Sarah Jeremiah, Specialist Practitioner Infection Prevention at Southampton University Hospitals NHS Trust will be talking about reducing infection related to intravenous devices.

Click here for the full programme.

Click here to register for the conference.

Free peripheral IV conference

Intravenous conference: NHS Education South Central (NESC) are offering a free Peripheral Cannulation Conference. The conference will take place on the 9th July 2009 at Newbury Racecourse, Newbury, RG14 7NZ.

Delegates will also receive free copies of the Venepuncture & Cannulation Structured Learning Programme (Vascular Access Network) & South Central SHA Guidelines for Peripheral Cannulation.

This is a free course so book your place early to avoid disappointment. To book your place, please email your details as soon as possible to cannulation.conference@nesc.nhs.uk

Topics and speakers include:

• Safer Peripheral Cannulation & Decreased Infections, Evonne Harding, Department of Health
• Reducing the Effects of Prehospital Cannulation, Mohammed Iqbal, East Midlands Ambulance Service NHS Trust
• Closing the Theory/Practice Gap in Peripheral Cannulation in South Central SHA, Participants from the Peripheral Line Training Project
• Venepuncture & Cannulation Structured Learning Programme, Sarah Phillips, Vascular Access Network
• Paediatric Cannulation, Jo Schofield, Southampton University Hospitals NHS Trust & NESC

To book your place, please email your details as soon as possible to cannulation.conference@nesc.nhs.uk

Sonosite ultrasound remote

Intravenous products: “SonoSite, Inc. the world leader and specialist in hand-carried ultrasound for point-of-care medicine, announced today that it has begun customer shipments of the SonoRemote™ Control, a compact voice or touch activated solution for adjusting ultrasound controls at a distance when using SonoSite M-Turbo® or S Series™ systems.

Approximately the size of an iPhone® and using Bluetooth® technology, the SonoRemote Control is capable of adjusting essential system parameters – Depth, Gain, Freeze and Save – within 10 meters of the ultrasound system. With voice activation or when used in a sterile sheath, the SonoSite remote control eliminates the need to break the sterile field during interventional procedures. And with a tactile reference keypad the user does not have to look at the remote to identify which button to press—even the touchpad has been designed with increased workflow in mind”.

Click here for the full press release.

Detecting intravenous infiltration

Intravenous products: Matthew Alley (CW Optics, Inc) has submitted a poster recently presented at the Infusion Nurses Society 2009 annual meeting.

Abstract:

Intravenous infiltration is a serious problem associated with infusion therapy.  It is usually accompanied by pain, erythema, and swelling at the needle insertion site.  Severe infiltration may lead to necrosis requiring skin debridement, skin grafting, and/or amputation.  Early detection of infiltration prevents the occurrence of serious incidents.  A new device, ivWatch™, was developed to monitor the intravenous infusion site for infiltration.  The results of validation studies on animal and human subjects are presented.  A clinical trial on 800 patients is currently underway to investigate safety and efficacy of the ivWatch™.

Click here to view the poster.

Skin protection under IV dressings

Intravenous literature: ICT report “Medline Industries, Inc. today announced the results of a clinical study demonstrating that the company’s Sureprep No-sting Alcohol-Free Protective Barrier Wipe provides better security against adhesive-derived skin trauma than solvent-containing formulations. The randomized controlled study, recently published in the International Wound Journal, is the first comparison between solvent-free and solvent-containing no-sting barrier formulations as a skin protectant against tape stripping.

The study examined the use of Medline’s Sureprep No-Sting solvent-free formulation and a solvent-containing formulation on the skin of 12 healthy volunteers aged 18 to 55 years. Treatments were applied at baseline to two of the four test sites on the back of each subject and repeated for five days. The study found that the solvent-free formulation product provided significantly greater protection against the skin surface trauma that comes as a result of the repeated application and removal of adhesive tapes and dressings”.

Click here for more information.

Needlestick prevention delay

Intravenous news: The Nursing Times report “NHS Employers is unlikely to recommend that the NHS implement new European guidelines on needlestick injuries until at least 2011″.

“Speaking last week Karen Jennings, Unison’s head of health, called on the NHS to ‘take the initiative’ and ‘start using safer needles and adopting the new prevention guidelines across the UK now’.

“But a spokesperson from NHS Employers told Nursing Times that the NHS was already compliant with high standards of needlestick and sharps usage, and that it would not be taking immediate action following the agreement”.

Click here for the full story.

Intravenous infusion at home

Intravenous news: IrishTimes.com report “A new pilot scheme to treat rheumatoid arthritis sufferers outside the hospital has been hailed as a success by doctors working in the field.

Currently most patients who receive expensive mono-clonal antibody treatments intravenously do so in hospitals, but a number of pilot schemes in the Dublin area have found that the drugs can be given efficiently, either in a GP’s surgery or a health centre, with intravenous infusion.

The results of a pilot project in a health clinic in Dundrum Town Centre has been published in The Irish Journal of Medical Science.

Its findings will be revealed at a major conference on arthritis which takes place at the Royal College of Surgeons in Dublin from this Friday, June 19th until Sunday, June 21st”.

Click here for the full story.

Peripheral IV MRSA reduction

Intravenous news: Peter Orsman et al (2009) have submitted a poster that looks at Interventions to Prevent Bloodstream Read more

World Congress on Vascular Access

Intravenous conference: The 1st World Congress on Vascular Acces wil take place in Amsterdam in June 2010.

The congress will run from the 16th to the 18th of June.

The congress will be held in the RAI Amsterdam.

More information on the programme and how to register will be available on the WoCova website as soon as possible.

If you want to attend or be involved, send an email to info@wocova.com

Click here to visit the WoCoVA website.

End of life hydration

Intravenous literature: Schultz, M.A.F. (2009) Helping Patients and Families Make Choices About Nutrition and Hydration at the End-of-Life. Topics in Advanced Practice Nursing eJournal. published 06/04/2009

Example of text:

“Among the many end-of-life issues encountered in long-term care (LTC), one that continually resurfaces is how to manage nutrition and hydration in an individual approaching the end of his or her life. In the course of my career in LTC, I have seen many families struggle with decisions surrounding the withholding of a loved one’s food and fluids. The prevailing question from families, when the loved one no longer wants to eat or drink is, “Are we starving [him or her] to death?”

Click here for the full online article.

Pathology improvement

Intravenous news: NHS Improvement are requesting expressions of interest from potential pathology pilot sites. They are working in partnership with the Department of Health Pathology Team.

The role of the Pathology Improvement Team is to:

• provide service improvement and redesign expertise, including Lean and Six Sigma methodology
• provide clinical and managerial expertise in radiology and pathology
• support the delivery of timely access, high quality and effective patient centered diagnostic services
• support the delivery of NHS guidelines and DH policy.

Click here for more information.

What makes a good nurse

Intravenous literature: Gallagher, A., Horton, K., Tschudin, V. and Lister, S. (2009) Exploring the views of patients with cancer on what makes a good nurse – a pilot study. Nursing Times. 105(23), early online publication.

Abstract:

This article presents and discusses findings from a qualitative pilot study that surveyed patients with cancer to discover their views on what makes a good nurse. Ten outpatients at a UK specialist cancer hospital, who had received inpatient treatment for cancer, were interviewed. The interview data was analysed thematically, and four themes were identified: good nurse virtues, knowledge, skill and organisational culture.

Click here for the online article.

Hand hygiene in Australia

Intravenous news: Australia’s World Health Organization infectious disease expert and Director of Hand Hygiene Australia has urged all health professionals to improve infection control and save lives by adopting the new National Hand Hygiene Initiative.
The world-first Initiative is based on award-winning Australian research that shows using alcohol-based hand rub is the single-most effective way to prevent and control bloodstream infections, such as golden staph.

“This simple 15-second hand rub routine has the potential to save the lives of 1,500 Australians a year,” explains Professor Lindsay Grayson, Director of Hand Hygiene Australia.”

Click here for the full news item on news-medical.net

Click here for the Hand Hygiene Australia webpage.

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Drug dosage calculations

Intravenous literature: Wright, K. (2009) Developing methods for solving drug dosage calculations. British Journal of Nursing. 18(11), p.685-689.

Abstract:

This second part of a three-part series of articles examining drug calculation skills, focuses on the different methods that can be used to solve drug calculations. It builds on Part 1 (Supporting the development of calculating skills in nurses, 18(7): 399-402), and provides examples of different methods that can be used to plan and solve a range of common calculations, such as weight-based calculations and weight and volume calculations. The framework introduced in Part 1 is used to support the planning and solving of drug administration calculations.

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Needle safety legislation for UK

Intravenous news: The Nursing Times report “The European Federation of Public Service Unions and the European Hospital and Healthcare Employers Association yesterday announced an EU-wide agreement on measures to make needles safer, which are expected to become legislation by the end of the year.

Karen Jennings, UNISON’s head of health, who led negotiations on behalf of the union federation, said: ‘Subjecting thousands of NHS workers every year to the terror of dirty needles is unnecessary and inhumane, when safer needles are available and cost very little more”.

Click here for the full story.

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Safer needles in the European Union

Intravenous news: The Nursing Times report “UK hospitals will have to introduce self-resheathing needles under European Union health and safety legislation on reducing needlestick injuries. A landmark agreement on the safer use of needles to prevent injury among hospital staff was set to be announced on 9 June at the European Public Services Unions annual congress in Brussels, Belgium.

The agreement has been made between the European Public Services Unions – which represents the majority of health trade unions across the EU including Unison, the RCN and the RCM – and Hospeem which represents hospitals and healthcare employers across Europe, including the NHS Confederation.

It is expected to become EU health and safety legislation before the end of the year. As a result, hospitals across the EU will soon be legally obliged to take action to prevent needlestick injuries to their staff”.

Click here for the full story.

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Infusion containers and CLABSI

Intravenous literature: Franzetti, F., Borghi, B., Raimondi, F. and Rosenthal, V.D. (2009) Impact on rates and time to first central vascular-associated bloodstream infection when switching from open to closed intravenous infusion containers in a hospital setting. Epidemiology & Infection. 137(7), p.1041-8.

Abstract:

SUMMARY: An open-label, prospective cohort, active healthcare-associated infection surveillance sequential study was conducted in four Italian intensive-care units. The aim was to determine the effect of switching from open (glass) to closed fully collapsible plastic intravenous (i.v.) infusion containers (Viaflo(R)) on rate and time to onset of central venous catheter-associated bloodstream infections (CVC-BSI). A total of 1173 adult patients were enrolled. The CVC-BSI rate during the open container period was significantly higher than during the closed container period (8.2 vs. 3.5 BSI/1000 CVC days, relative risk 0.43, 95% confidence interval 0.22-0.84, P=0.01). The probability of developing a CVC-BSI was assessed over time comparing open and closed i.v. infusion containers. In the closed container period, it remained fairly constant (0.8% at days 1-3 to 1.4% at days 7-9) whereas during the open container period it increased (2% at days 1-3 to 5.8% at days 7-9). Overall, the chance of acquiring a CVC-BSI significantly decreased by 61% in the closed container period (Cox proportional hazard ratio 0.39, P=0.004).

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Phenomenological view of IV care

Intravenous literature: Larsson, I., Bergman, S., Fridlund, B. and Arvidsson, B. (2009) Patients’ dependence on a nurse for the administration of their intravenous anti-TNF therapy: A phenomenographic study. Musculoskeletal Care. 7(2), p.93-105.

Abstract:

BACKGROUND: Pain, stiffness and functional restriction of the joints are the main problems for many patients with inflammatory rheumatic conditions. When conventional drugs fail to delay the development of the disease, the patient may require biological treatment such as anti-TNF therapy. Some biological drugs are administered in the form of intravenous infusions and thus the patient is obliged to attend a clinic in order to receive his/her medication, which can affect everyday life as well as independence. It is therefore important to focus on the patient perspective.

AIM: The aim of this study was to describe variations in how patients with rheumatic conditions conceive their dependence on a nurse for the administration of their intravenous anti-TNF therapy.

METHOD: The study had a descriptive qualitative design with a phenomenographic approach. Interviews were conducted with 20 patients.

RESULT: Three descriptive categories and seven sub-categories emerged: Dependence that affords security (encountering continuity, encountering competence and obtaining information); Dependence that creates involvement (being allowed influence and being given freedom); Dependence that invigorates (obtaining relaxation and encountering the environment).

CONCLUSION: The patients had not reflected on the fact that they were dependent on a nurse for the administration of their intravenous anti-TNF therapy, which may be due to their possibility to influence the treatment. The patients’ needs should constitute the basis for the nurse’s role in the provision of care.

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Antibiotic treatment for Lyme disease

Intravenous literature: Cameron, D.J. (2009) Insufficient evidence to deny antibiotic treatment to chronic Lyme disease patients. Medical Hypotheses. 72(6), p.688-91.

Abstract:

BACKGROUND: The severity, length of illness, and cost of chronic Lyme disease (CLD) have been well described. A number of oral, intravenous, and intramuscular antibiotics have been prescribed for CLD. Surprisingly few antibiotic schedules prescribed for the treatment of CLD have been evaluated in randomized double-blind placebo-controlled clinical trials (RCTs). Physicians have increasingly turned to clinical treatment guideline (CPG) panels to judge the mixed results of the evidence. Two CPG panels have looked at the evidence only to reach opposite conclusions: (1) antibiotic therapy for CLD is not effective and (2) antibiotic therapy for CLD is effective. Physicians have been advised by guideline developers to use clinical discretion in diagnosing and treating CLD. Nevertheless, many health insurers – relying exclusively upon only one CPG – have a policy of automatically denying antibiotics to CLD patients regardless of the specifics of each case or the recommendations of the patient’s physician.

HYPOTHESES: This paper examined the eight limitations of the evidence used to conclude that antibiotics therapy for CLD is not effective in forming the following hypothesis: insufficient evidence to deny antibiotic treatment to CLD patients.

EVIDENCE FOR THE HYPOTHESIS: There are eight limitations that support the hypothesis: (1) the power of the evidence is inadequate to draw definite conclusions, (2) the evidence is too heterogeneous to make strong recommendations, (3) the risk to an individual of facing a long-term debilitating illness has not been considered, (4) the risk to society of a growing chronically ill population has not been considered, (5) treatment delay has not been considered as a confounder, (6) co-infections have not been considered as a confounder, (7) the design of RCTs did not address the range of treatment options in an actual practice, and (8) the findings cannot be generalized to actual practice.

IMPLICATIONS OF THE HYPOTHESES: This hypothesis suggests that physicians should consider the limitations of the evidence before denying antibiotic treatment for CLD. Physicians who deny antibiotic treatment to CLD patients might inform their patients that there are some clinicians who disagree with that position, and then offer to refer them for a second opinion to a doctor who could potentially present a different point of view. The hypothesis also suggests that health care insurers should consider the limitations of the evidence before adopting policies that routinely deny antibiotic treatment for CLD patients and should expand coverage of CLD to include clinical discretion for specific clinical situations.

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Misuse of IV fluid bags

Intravenous news: The Jamaica Gleaner reports “A nurse, who was attached to the May Pen Hospital, is facing a six-month suspension after a baby - born prematurely – died while under her care in August 2008″.

They continue “At one point, the child’s body temperature began to fall. It is alleged that the nurses used a microwave oven to heat bags containing intravenous fluid. These were then wrapped in towels and blankets before the child was placed on top of them… It is further alleged that at least one of the bags burst and the hot content burnt the child, resulting in its death”.

Click here for the full story.

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Contaminated heparin syringes

Intravenous news: chicagotribune.com report on a personal account of the tragic impact of contaminated heparin syringes on one family “Natalie Fullerton’s parents were thrilled to watch their year-old daughter bounce back from a double-lung transplant. Within months, she was mimicking her sister’s ballet poses and gleefully repeating the word “purple.”

Her father, Leslie, carefully tended to Natalie, following an intricate regimen to keep her healthy. After doctors implanted a tube in Natalie’s chest to give her intravenous medication, he dutifully used fluid-filled syringes to clean it.

Days later, the 29-month-old was back in a Texas hospital, breathless and feverish. Bacteria had infected her blood, the first in a cascade of complications over four months. In the end, Natalie died in her mother’s arms on March 12, 2008″.

Click here for the full story.

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Incidence of CRBSI

Intravenous literature: Bezzio, S. et al (2009) Prospective Incidence Study of Bloodstream Infection in Infants and Read more

Prevention of pediatric CLABSI

Intravenous literature: Jeffries, H.E. et al (2009) Prevention of Central Venous Catheter–Associated Bloodstream Infections in Pediatric Intensive Care Units: A Performance Improvement Collaborative. Infection Control and Hospital Epidemiology. Link to full abstract.

Objective.The goal of this effort was to reduce central venous catheter (CVC)–associated bloodstream infections (BSIs) in pediatric intensive care unit (ICU) patients by means of a multicenter evidence‐based intervention.

Results.The collaborative median CVC‐associated BSI rate decreased from 6.3 CVC‐associated BSIs per 1,000 CVC‐days at the start of the collaborative to 4.3 CVC‐associated BSIs per 1,000 CVC‐days at the end of the collaborative. Sixty‐five percent of all participants documented a decrease in their CVC‐associated BSI rate. Sixty‐nine CVC‐associated BSIs were prevented across all teams, with an estimated cost avoidance of $2.9 million. Hospitals were able to sustain their improvements during a 12‐month sustain period and prevent another 198 infections.

Link to full abstract.

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Bloodstream infections – 14% HAIs

Lanini, S. et al (2009) Healthcare‐Associated Infection in Italy: Annual Point‐Prevalence Surveys, 2002–2004. Infection Control and Hospital Epidemiology. Link to full abstract.

Objective.Healthcare‐associated infections (HAIs) are an important cause of morbidity and mortality worldwide. During the period from 2002 through 2004, a group of Italian hospitals was recruited to conduct HAI point‐prevalence surveys.

Results.The overall frequency of HAI was 6.7% (645 infections among the 9,609 surveyed patients). The most frequent HAIs were lower respiratory tract infections, which accounted for 35.8% (231 of 645 HAIs) of all HAIs, followed by urinary tract infections (152 [23.6%] of 645 HAIs), bloodstream infections (90 [14.0%] of 645 HAIs), and surgical site infections (79 [12.2%] of 645 HAIs). In both multivariate and univariate analysis, invasive procedures, duration of stay, chemotherapy, trauma, coma, and the location of the hospital were all factors statistically significantly associated with the occurrence of an HAI. Enterobacteriaceae were the most common isolates recovered in medical and surgical wards, whereas gram‐negative aerobic bacilli were the most common isolates recovered in intensive care units. Approximately one‐half of all of the patients surveyed were receiving antibiotics at the time of our study; the most used antibiotic classes were fluoroquinolones in medical wards, cephalosporins in surgical wards, and penicillins and glycopeptides in intensive care units.

Link to full abstract.

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Needlestick reference list

Intravenous literature: IVTEAM would like to present a ‘Needlestick Reference List‘. The list consists of references of Read more

Central line contamination

Intravenous news: Keyetv.com report “A Manor woman is accused of putting fecal matter into her 3-year-old daughter’s IV line. Emily McDonald, 23, is charged with a single count of injury to a child”. 

“According to the affidavit, video surveillance was set up in the girl’s room and McDonald was allegedly caught on camera taking fecal matter from her daughter’s soiled diaper and placing it in the cap to a intravenous central line that ran into the girl’s bloodstream”.

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Surveillance of infections

Intravenous literature: Surveillance of healthcare-associated infections (HAI) is the cornerstone of an effective infection prevention program.  By definition, surveillance is a comprehensive method of measuring  outcomes and related processes of care, analyzing the data, and providing information to  members of the healthcare team to assist in improving those outcomes and processes.

Click here for the full position statement from APIC.

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Leaking IV (intravenous) bags

Intravenous news: The Timesonline report “A nurse is being questioned by detectives investigating the suspected sabotage of intravenous drip bags used on a children’s ward.

The 21-year-old woman from Wickford, Essex, was arrested this morning on suspicion of criminal damage and an offence under the public order act – contamination of goods. A batch of more than 30 intravenous bags, which contained sugars and salts to hydrate young patients, were seized by police from a store room at Basildon University Hospital, Essex, in April after they were discovered to be wet.

Of the batch 21 were found to have been punctured and detectives are waiting for the results of tests to see if they have been spiked with any dangerous substances”.

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UPDATE: Nurse bailed 3rd June 2009.

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Injection video

Intravenous training: Free Injection and IV placement videos from the Medical College of Georgia on iTunes.

NOTE: Particular procedural activities in these videos may be different to that of your organization and may require further consideration before the video is used for teaching. 

Free videos available include:

• Venipuncture Intravenous Placement
• Subcutaneous Injection
• Injectable Medication Preparation
• Intramuscular

Click here to view the video download page on iTunes.

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Intravenous (IV) drip rate calculator

Intravenous products: Drug Infusion: An IV Med Drip Rate Calculator App by iAnesthesia LLC on for the iPhone iTunes.

Drug infusion was designed specifically for the ICU nurse or anesthesia provider as a quick reference to ensure accurate calculations for dose, concentration or IV rate.

Designed by anesthesiologists, this IV Med Drip Rate Calculator is quick and easy to use in point-of-care environments.

Click here to view the Apps page on iTunes.

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