Safe injection and infusion practices

Intravenous literature: Dolaon, S.A., Barnes, S., Cox, T.R., Felizardo, G., Patrick, M. and Ward, K.S. (2009) APIC Position Paper: Safe Injection, Infusion and Medication Vial Practices in Healthcare. APIC.

Introductory text:

“The transmission of bloodborne viruses and other microbial pathogens to patients during routine healthcare procedures continues to occur due to unsafe and improper injection, infusion and medication vial practices being used by healthcare professionals within various clinical settings throughout the United States.

Breaches in safe injection, infusion and medication vial handling practices continue to result in unacceptable and devastating events for patients. More than 35 outbreaks of viral hepatitis have occurred in the United States in the past 10 years due to these unsafe practices and other breaches of infection prevention procedures. These outbreaks have resulted in the transmission of either hepatitis B or C to more than 500 patients. The unsafe practices that were used by physicians and/or nurses in these outbreaks can be categorized by:

1. syringe reuse between patients during parenteral medication administration to multiple patients;
2. contamination of medication vials or intravenous (IV) bags by accessing them with a used syringe and/or needle;
3. failure to follow basic injection safety practices when preparing and administering parenteral medications to multiple patients;
4. inappropriate use of fingerstick devices and glucometer equipment between patients”.

Click here for the full position statement.

IV pump conference

Intravenous conference: The MHRA have announced the ‘Pumps in Practice’ one day conference in London, UK. This event will feature presentations from clinicians using infusion pumps every day, advisory bodies and the medical device regulator, the MHRA. There will also be breakout sessions giving delegates the opportunity to consider some issues in greater depth and to interact with a range of different pumps.

Topics covered include:

• Managing medical infusion devices
• Patient perspective
• Problems with IV connectors
• Common problems with pumps
• Safer medication delivery
• Ensuring safe intravenous infusions

Fees:

• Early bird fee – register on or before 5 August – £145.00
• Standard fee – register on or after 6 August – £165.00

The venue for this event is:

Holiday Inn Kings Cross Bloomsbury, 1 Kings Cross Road, London. WC1X 9HX

Click here to view the agenda.

Online registration.

BD Nexiva closed IV update

Intravenous products: PRNewsWire.co.uk report “BD Medical, a segment of BD (Becton, Dickinson and Company), announced today the UK launch of the latest BD Nexiva(TM) Closed IV Catheter System designed to reduce healthcare workers’ risk of needlestick injuries and minimise exposure to blood. The system includes the BD Q-SyteTM Luer Access Split Septum to help reduce catheter-related bloodstream infections (CRBSIs).

The new version of the BD Nexiva(TM) system introduces key developments, including:

• New non-removable pinch clamp for easy, one-handed activation
• Soft stabilisation platform designed to decrease catheter movement and associated complications, whilst providing greater patient comfort
• New catheter grip design which accommodates the various insertion techniques employed by clinicians
• Larger bore extension tubing on 18G and 20G cannulas for improved flow rates”

Click here for the full press release.

IV closed‐hub systems reduce CRBSI

Intravenous literature: Ivy, D.D., Calderbank, M., Wagner, B.D., Dolan, S., Nyquist, C., Wade, M., Nickels, W.M. and Doran, A.K. (2009) Closed‐Hub Systems with Protected Connections and the Reduction of Risk of Catheter‐Related Bloodstream Infection in Pediatric Patients Receiving Intravenous Prostanoid Therapy for Pulmonary Hypertension. Infection Control & Hospital Epidemiology. 30.

Abstract:

Background: Intravenous prostanoids (epoprostenol and treprostinil) are effective therapies for pulmonary arterial hypertension but carry a risk of catheter‐related bloodstream infection (CR‐BSI). Prevention of CR‐BSI during long‐term use of indwelling central venous catheters is important.

Objective: To evaluate whether using a closed‐hub system and waterproofing catheter hub connections reduces the rate of CR‐BSI per 1,000 catheter‐days.

Design: Single‐center open observational study (January 2003–December 2008).

Patients: Pediatric patients with pulmonary arterial hypertension who received intravenous prostanoids.

Methods: In July 2007, CR‐BSI preventive measures were implemented, including the use of a closed‐hub system and the waterproofing of catheter hub connections during showering. Rates of CR‐BSI before and after implementing preventive measures were compared with respect to medication administered and type of bacterial infection.

Results: Fifty patients received intravenous prostanoid therapy for a total of 41,840 catheter‐days. The rate of CR‐BSI during the study period was 0.51 infections per 1,000 catheter‐days for epoprostenol and 1.38 infections per 1,000 catheter‐days for treprostinil, which differed significantly ( ). CR‐BSIs caused by gram‐negative pathogens occurred more frequently with treprostinil than with epoprostenol (0.91 infections per 1,000 catheter‐days vs 0.08 infections per 1,000 catheter‐days;  ). Patients treated with treprostinil after the implemented changes had a significant decrease in CR‐BSI rate (1.95 infections per 1,000 catheter‐days vs 0.19 infections per 1,000 catheter‐days;  ).

Conclusion: The closed‐hub system and the maintenance of dry catheter hub connections significantly reduced the incidence of CR‐BSI (particularly infections caused by gram‐negative pathogens) in patients receiving intravenous treprostinil.

Monitoring of peripheral IV catheters

Intravenous literature: Van Donk, P., Rickard, C.M., McGrail, M.R. and Doolan, G. (2009) Routine Replacement versus Clinical Monitoring of Peripheral Intravenous Catheters in a Regional Hospital in the Home Program: A Randomized Controlled Trial. Infection Control & Hospital Epidemiology. 30.

Abstract:

This randomized, controlled trial involving 316 patients in the home setting found no difference in the rate of phlebitis and/or occlusion among patients for whom a peripheral intravenous catheter was routinely resited at 72–96 hours and those for whom it was replaced only on clinical indication (76.8 events per 1,000 device‐days vs 87.3 events per 1,000 device‐days). There were no bloodstream infections.

Peripheral IV dwell-time indicator

Intravenous products: Timestrip.com report “Timestrip’s newly-launched Timestrip I.V. product has achieved positive feedback from its recent trials at the Whittington Hospital in London, at the same time as the company has announced the appointment of a UK distributor for the product. Timestrip I.V. is designed to enable quick assessment of how long an intravenous cannula has been in place, ensuring hospitals comply with infection control procedures. Existing policy directives stipulate that Peripheral Intravenous Cannulae (PVCs) must be changed every 72 hours.

The Whittington introduced Timestrip I.V. to a pilot medical ward between 1st May and 13th June, during which routine inspection of Timestrip I.V. was incorporated into the Trust’s existing cannula inspection policy. During the trial period, the ward maintained a 100% compliance rate with the inspection policy and positive feedback was received from nursing staff and patients alike about the information offered by Timestrip I.V.. The Trust believes that nursing time could be saved by using Timestrip I.V., avoiding the need for staff to compile and refer to written records. The trial concluded that co-locating Timestrip I.V. with the cannula would offer the greatest benefits, allowing both the cannulated site and the Timestrip I.V. display to be checked in a single observation.

In the meantime, Timestrip has appointed Vygon (UK) Ltd as its main distributor for Timestrip I.V. products in the UK and Ireland. Vygon is a leading supplier of single-use medical and surgical products, including intravenous access devices, to the NHS. In the UK alone there are over 40 million venepuncture and cannulation procedures a year and Vygon will make Timestrip I.V. available to hospitals through the NHS Supply Chain from the end of July”.

Click here for the full press release.

For more product information email caroline.redmond@vygon.co.uk

IM injection – needle length

Intravenous literature: Stecher, D., Bulloch, B., Sales, J., Schaefer, C. and Keahey, L. (2009) Epinephrine Auto-injectors: Is Needle Length Adequate for Delivery of Epinephrine Intramuscularly? Pediatrics. 124(1), p. 65-70.

Abstract:

OBJECTIVE: Studies show that intramuscular epinephrine results in peak plasma concentrations of epinephrine faster than the subcutaneous route, and therefore, epinephrine is recommended to be administered intramuscularly. The objective of this study was to determine if the needle length on epinephrine auto-injectors is adequate to deliver epinephrine intramuscularly in children.

METHODS: Patients between the ages of 1 and 12 years who presented to a children’s hospital were enrolled in the study. Ultrasound was used to determine the depth from the skin to the vastus lateralis muscle. The patient’s body mass index was recorded. The data were analyzed using simple descriptive statistics, and logistic regression was used to identify variables that might predict whether or not the needle length was exceeded.

RESULTS: A total of 256 children were enrolled. Of these, 158 children weighed less than 30 kilograms and would be prescribed the 0.15mg epinephrine auto-injector. Nineteen of these children (12%) had a skin to muscle surface distance of >” and would not receive epinephrine intramuscularly from current auto-injectors. There were 98 children weighing 30 kilograms who would receive the 0.3 mg epinephrine auto-injector. Of these 98 children, a total of 29 (30%) had a skin to muscle surface distance of >” and would not receive epinephrine intramuscularly.

CONCLUSION: The needle on epinephrine auto-injectors is not long enough to reach the muscle in a significant number of children. Increasing the needle length on the auto-injectors would increase the likelihood that more children receive epinephrine by the recommended intramuscular route.

Intravenous drug mixing robot

Intravenous products: MedGadget.com report “Intelligent Hospital Systems, a company out of Winnipeg, Canada, has developed a robotic system for precise preparation of syringes and IV bags for busy hospital pharmacies. We discovered the Robotic IV Automation (RIVA) device when we read the announcement of the firm receiving the 21st Century Achievement Award from the Computerworld Honors Program”.

Click here for the full story.

ICU Medical profit growth

Intravenous products: The Wall Street Journal report “ICU Medical Inc.’s (ICUI) second-quarter profit grew by 20% as demand for the company’s disposable medical products was stable despite the economic downturn. The company also raised its full-year earnings, revenue and margins targets, due to improvements in its existing businesses as well as its acquisition of Hospira Inc.’s (HSP) critical-care product line, which is expected to close in the third quarter. The $35 million acquisition is expected to add 1 cent to 2 cents a share in the second half of the year”.

Click here for the full story.

Hand hygiene guidelines revised

Intravenous news: InfectionControlToday.com report “The Association of periOperative Registered Nurses (AORN)  announces that it has revised terminology in its recently published “Recommended Practices for Hand Hygiene in the Perioperative Setting” to account for the multiple regulatory paths related to hand hygiene products. The following terminology revising recommendation III of this recommended practice was submitted and approved by AORN’s board of directors on July 17, 2009: “A surgical hand scrub should be performed by healthcare personnel before donning sterile gloves for surgical or other invasive procedures. Use of either an antimicrobial surgical scrub agent intended for surgical hand antisepsis or an alcohol-based antiseptic surgical hand rub with documented persistent and cumulative activity that has met U.S. Food and Drug (FDA) regulatory requirements for surgical hand antisepsis is acceptable.”

Click here for the full story.

IV device contamination

Intravenous literature: Rothwell, M., Pearson, D., Wright, K. and Barlow, D. (2009) Bacterial contamination of PCA and epidural infusion devices. Anaesthesia. 64(7), p.751-753.

Abstract:

We prospectively audited the bacterial contamination of re-useable analgesia infusion pumps. In a one-month period, 112 samples from the handset and keypads of our analgesia infusion pumps were cultured for bacterial contamination. Forty-five percent of handset swabs and 46% of keypad swabs grew bacteria; the commonest organism being coagulase-negative staphylococcus. An additional cleaning step using 70% isopropyl alcohol wipes was introduced and the contamination rate was re-audited in 100 samples. The contamination rate was reduced to 6% of handset swabs and 4% of keypad swabs. A high initial rate of bacterial contamination of re-useable analgesia infusion pumps was significantly reduced by the implementation of a simple, additional cleaning procedure.

Intravenous litigation

Intravenous literature: Cook, T.M., Bland, L., Mihai, R. and Scott, S. (2009) Litigation related to anaesthesia: an analysis of claims against the NHS in England 1995–2007. Anaesthesia. 64(7), p.706-718.

Abstract:

The distribution of medico-legal claims in English anaesthetic practice is unreported. We studied National Health Service Litigation Authority claims related to anaesthesia since 1995. All claims were reviewed by three clinicians and variously categorised, including by type of incident, claimed outcome and cost. Anaesthesia-related claims account for 2.5% of all claims and 2.4% of the value of all claims. Of 841 relevant claims 366 (44%) were related to regional anaesthesia, 245 (29%) obstetric anaesthesia, 164 (20%) inadequate anaesthesia, 95 (11%) dental damage, 71 (8%) airway (excluding dental damage), 63 (7%) drug related (excluding allergy), 31 (4%) drug allergy related, 31 (4%) positioning, 29 (3%) respiratory, 26 (3%) consent, 21 (2%) central venous cannulation and 18 (2%) peripheral venous cannulation. Defining which cases are, from a medico-legal viewpoint, ‘high risk’ is uncertain, but the clinical categories with the largest number of claims were regional anaesthesia, obstetric anaesthesia, inadequate anaesthesia, dental damage and airway, those with the highest overall cost were regional anaesthesia, obstetric anaesthesia, and airway and those with the highest mean cost per closed claim were respiratory, central venous cannulation and drug error excluding allergy. The data currently available have limitations but offer useful information. A closed claims analysis similar to that in the USA would improve the clinical usefulness of analysis.

Laboratory tests in hepatic failure

Intravenous literature: Agarwal, M. and Cottam, S. (2009) Laboratory tests in hepatic failure. Anaesthesia and intensive care medicine. 10(7), p.326-327.

Abstract:

Laboratory tests of liver function are widely used and often poorly understood. As in any field of medicine, they should be used as part of a diagnostic process involving history-taking and clinical examination. Interpretation of tests will depend on the situation in which they are used: to obtain a diagnosis, to assess prognosis in acute or chronic liver failure or to monitor disease progression and response to treatment.

Laboratory tests of renal function

Intravenous literature: McWilliam, A. and Macnab, R. (2009) Laboratory tests of renal function. Anaesthesia and intensive care medicine. 10(6), p.296-299.

Abstract:

The human kidney provides essential regulatory and excretory functions. Body water content, plasma electrolyte composition and plasma pH are all under the regulatory control of the kidney. In addition, the kidney provides a path of excretion for blood-borne, water-soluble, low-molecular-weight compounds. These include the end-products of protein metabolism, such as urea and creatinine, as well as foreign compounds with similar physicochemical characteristics and their metabolites. Endocrine activity of the human kidney includes the secretion of the hormones erythropoietin and renin and the activation of vitamin D by hydroxylation to its 1,25-dihydroxycholecalciferol form. The renal blood flow is immense, constituting 25% of resting cardiac output. The glomeruli form 170–200 litres of ultrafiltrate per day and the selective reabsorption of water and solutes results in the final formation of approximately 1.5 litres of urine for excretion. Here, commonly used laboratory tests of renal function are discussed, including glomerular filtration rate (GFR), creatinine clearance, serum creatinine concentration estimation of GFR, cystatin C assay, serum urea concentration, urinalysis, free water clearance and endocrine changes in renal disease. It must be noted, however, that these tests require a clinical assessment of the patient to allow meaningful interpretation.

Acid-base balance

Intravenous literature: Atherton, J.C. (2009) Role of the kidney in acid–base balance. Anaesthesia and intensive care medicine. 10(6), p.276-278.

Abstract:

Correction of disturbances in acid–base balance is achieved by: physicochemical buffering by extracellular and intracellular buffer systems (instantaneous), alveolar ventilation to control pCO2 (rapid), and renal compensation (long term). Buffering and changes in ventilation limit changes in pH but cannot return acid–base status to normal. The kidney has a pivotal role: disturbances can be completely corrected through changes in H+ secretion and HCO3− reabsorption and production. HCO3− reabsorption is modified by changes in GFR (filtered load), changes in extracellular volume and by hormones which modify Na+ reabsorption via the Na+–H+ exchanger in renal tubular cells. Changing the activity of this exchanger influences H+ secretion and, hence, HCO3− reabsorption. Chronic (but not acute) changes in pCO2 influence HCO3− reabsorption through changes in the filtered load and, in chronic acidosis, by the insertion of more H+ transport proteins in renal tubular cells. Renal HCO3− production is linked to H+ excretion: acid buffer salts (phosphate, creatinine), their availability and pK and tubular fluid pH. Formation and excretion of NH4+ buffer salts are important – acidosis stimulates secretion of NH4+ (proximal tubule) and NH3 (collecting duct). There is a reciprocal relationship between extracellular K+ and NH4+ excretion, hence HCO3− production.

Regulation of fluid and electrolyte balance

Intravenous literature: Louden, J.D. (2009) Regulation of fluid and electrolyte balance. Anaesthesia and intensive care medicine. 10(6), p.279-285.

Abstract:

The three fluid compartments of the body are interdependent. Their homeostasis relies on systems that regulate water balance and, as the principal extracellular solute, sodium balance. Maintenance of plasma volume is essential for adequate tissue perfusion. Regulation of plasma osmolality, which is determined primarily by the serum sodium concentration, is essential for the preservation of normal cell volume and function. The importance of osmoregulation is best illustrated by the consequences of a rapid fall or rise in serum osmolality, which can cause permanent neurological damage and death through shrinkage or swelling of cells. It is tempting to attribute control of plasma sodium concentration to sodium balance, but there is no direct relationship between plasma sodium and renal sodium excretion. Osmolality and volume are, therefore, regulated by separate mechanisms. It is important to recognize that osmoregulation occurs through changes in water balance, whereas volume regulation is principally determined by changes in sodium excretion.

Drug calculation problems

Intravenous literature: Wright, K. (2009) Resources to help solve drug calculation problems. British Journal of Nursing. 18(14), p.878 – 883.

Abstract:

This article is the third in a series of articles discussing drug calculations and discusses the resources, in terms of knowledge and skills, that are required to support the use of methods for solving calculation problems (Wright, 2009). The main resources discussed are clinical practice, numeracy knowledge (including number patterns), proportions and factors, and clinical tools such as syringes. These resources can be used as part of formal teaching sessions, or can be developed and practised by individual nurses to improve knowledge and confidence in solving drug calculations. The most important resource for developing drug calculation skills is regular exposure to drug calculations in clinical practice. Any drug calculation teaching and assessing, therefore must have clinical practice as the starting point, with numeracy knowledge not extracted and taught separately, but developed as a resource from within practice, for the purpose of supporting practice.

Closed IV systems study (COSMOS)

Intravenous literature: López, J.L.G, del Palacio, E.F., Marti, C.B., Corral, J.O., Portal, P.H. and Vilela, A.A. (2009) COSMOS – a study comparing peripheral intravenous systems. British Journal of Nursing. 18(14), p.844-853.

Abstract:

In many areas of the world, safety peripheral intravenous systems have come into widespread use. The Madrid region was the first in Spain to adopt such an approach. These systems, though initially introduced to protect users from sharps injuries, have now evolved to include patient protection features as well. Patient protection, simply stated, means closing the system to pathogen entry. The authors’ purpose was to investigate, in a prospective and randomized study, the clinical performance of a closed safe intravenous system versus an open system (COSMOS – Compact Closed System versus Mounted Open System). COSMOS is designed to provide definitive answers, from a nursing perspective, to many topics related to peripheral venous catheterization, which have important implications in intravenous therapy and which have not been validated scientifically. Furthermore, it forms pioneering research in that it is the first clinical trial on medical devices in a legislated environment carried out entirely by nurses and whose promoter and principal investigator is a nurse. The objectives of COSMOS are to compare the effectiveness (as defined by time of survival without complications) and rates of catheter-related complications, such as phlebitis, pain, extravasation, blockage and catheter-related infections. It also looks at rates of catheter colonization, the ease of handling of both systems and overall costs. This article outlines the authors’ approach, both in preparing hospital units for such an evaluation as well as in the choice of parameters and their method of study. Further articles will detail the results and findings of the study.

Nurse-led ultrasound cannulation

Intravenous literature: Walker, E. (2009) Piloting a nurse-led ultrasound cannulation scheme. British Journal of Nursing.  18(14), p854-859.

Abstract:

Intravenous therapy has evolved to form a fundamental cornerstone of modern health care, but there are significant groups of patients in whom obtaining peripheral venous access is a difficult and drawn out process. An ultrasound guided peripheral venous access service could potentially stop multiple ‘blind’ attempts, and subsequent damage. A pilot scheme to look at nurse-led ultrasound cannulation was established, and its early results are presented in this article. In addition, a one-operator technique of peripheral ultrasound guided cannulation is described. A total of 28 different patients were referred on 34 occasions for ultrasound guided peripheral cannulation. A total of 33 cannulae were inserted with an overall success rate of 97%. An average of 6.4 attempts at cannulation were undertaken prior to referral and an average of 1.3 attempts were needed to place a cannula under ultrasound guidance. Sixty-nine percent of the cannulae were inserted into the veins of the anterior forearm and 12% into the basilic veins. Overall, 2D ultrasound guided peripheral cannulation is a reliable technique for obtaining vascular access on any adult patients who have already undergone multiple cannulation attempts or in those who it is thought cannulation may be difficult.

Sharps management and disposal

Intravenous literature: Blenkharn, J.I. (2009) Sharps management and the disposal of clinical waste. British Journal of Nursing. 18(14). p.860-864.

Abstract:

Dangerous errors in clinical waste management continue to occur and inappropriate items find their way into clinical waste sacks that are not designed to hold sharp or heavy items, or fluids. Although great attention is given to the safe use of sharps, needles still find their way into waste sacks instead of a sharps bin. Sharps injuries among ancillary and support staff, and waste handlers working in the disposal sector, can occur at a rate greater than for health-care staff. Blood and body fluid exposures from carelessly packaged clinical waste are similarly common, with almost 100% of waste handlers having blood splashes on their clothing within four hours of starting a shift. Blood splashes are also common on the outside surfaces of sharps bins and on the frames supporting clinical waste sacks. Using forensic techniques, blood residues invisible to the naked eye can be detected on all surfaces of most sharps bins and on the bench top, walls and floor where the bins were positioned. Care is required when disposing of clinical waste, to protect and maintain the immediate environment from contamination, and to ensure the safety of those who come into contact with waste as it passes along the disposal chain.

Weight gain following IV fluids

Intravenous news: wvrecord.com report “A Boone County woman says a Charleston hospital gave her too much intravenous fluids and caused her to gain 20 pounds. Cynthia Gay filed a lawsuit June 18 in Kanawha Circuit Court against Charleston Area Medical Center, the West Virginia University Board of Governors and Dr. Damian Maxwell.

Maxwell performed an exploratory laparotomy and ileocecectomy on Gay, the complaint says. After the procedures, Gay was started on intravenous fluids as she convalesced. Gay says staff at the hospital was negligent and didn’t monitor how much IV fluids she was being given. As a result, on Nov. 3, 2007, Gay says she weighed 124 pounds”.

Click here for the full story.

IV conference application

Intravenous conference: The IV conference application is now available online (click here) for the IPS IV Forum Conference. A one- day conference for professions with responsibility for vascular access and IV therapy as well as anyone with an interest in this area of therapy which is playing an increasingly pivotal role in the hospital and community.

• Venue: Harrogate International Centre, Harrogate, UK.
• Date: 22nd September 2009

Click here for the conference flyer.

Online registration at www.ips.uk.net and follow the link to infection prevention 09.

HAI virtual symposia

Intravenous conference: INS is offering a complimentary Virtual Symposia for continuing education credit. The second of two units is “Healthcare-associated Infections: Using Evidence-based Research to Prevent Infections in All Healthcare Settings”, sponsored by a continuing nursing education grant from Cook Medical, was presented by Michelle (Mickey) Hawes, MSN, RN, CRNI®, at the 2009 INS Annual Meeting and Industrial Exhibition.

Click here to view the featured session.

Immunoglobulin virtual symposia

Intravenous conference: INS is offering a complimentary Virtual Symposia for continuing education credit. The first of two units is “Immunoglobulin Replacement Therapy in Adults and Children: A Guide to Treatment Management and Case Studies” this session was originally co-presented by Kristin Epland, MSN, FNP-C, and M. Elizabeth Younger, PhD, CRNP, at the 2009 INS Annual Meeting and Industrial Exhibition, and sponsored by a continuing nursing education grant from CSL Behring.

Click here to view the featured session.

Quality review into IV syringe use

Intravenous news: The Canadian Press report “A quality review says isolation and old habits were the main reasons that a northern Alberta hospital recycled syringes that were meant to be used only once. The government asked the Health Quality Council of Alberta to investigate after it was discovered last year that the High Prairie Health Complex was reusing syringes to inject medicine into intravenous lines.

The council says isolated medical staff in the reasonably remote community were not being kept up to date on new developments”.

Click here for the full story.

New Zealand IV conference 2010

Intravenous conference: IVNNZ Inc. invites you to Christchurch NZ to join them as they celebrate this 12th national conference. The keynote speech will be delivered by Mary Alexander INS (USA).

Details:

• 17th March 2010 – Registration & Welcome
• 18th -19th March 2010 – Conference
• Venue: Hotel Grand Chancellor, Christchurch

Further details from the conference organiser: Elizabeth Culverwell conference@ivnnz.co.nz

Click here for the conference website.

Post PICC arrhythmia

Intravenous literature: Elsharkawy, H., Lewis, B.S., Steiger, E. and Farag, E. (2009) Post placement positional atrial fibrillation and peripherally inserted central catheters. Minerva Anestesiologica. 75(7-8), p.471-4.

Abstract:

Arrhythmias are common in hospitalized patients and during surgery. We present a case of positional atrial arrhythmia related to a peripherally inserted central catheter (PICC). There are other documented case reports of ventricular tachycardia precipitated by body position changes with a PICC. The immediate correction of the arrhythmia with repositioning of the PICC strongly points to the PICC as the cause. This highlights the potential seriousness of cardiac arrhythmias precipitated by PICCs as well as the need for careful catheter placement and perioperative maintenance. Practitioners should consider PICC line tip position as a rare cause of positional atrial arrhythmias.

Imaging PICC complications

Intravenous literature: Amerasekera, S.S., Jones, C.M., Patel, R. and Cleasby, M.J. (2009) Imaging of the complications of peripherally inserted central venous catheters. Clinical Radiology. 64(8), p.832-40.

Abstract:

Peripherally inserted central catheters (PICC) are widely used to provide central venous access, often in chronically ill patients with long-term intravenous access requirements. There are a number of significant complications related to both insertion and maintenance of PICC lines, including catheter malposition, migration, venous thrombosis, and line fracture. The incidence of these complications is likely to rise as the number of patients undergoing intravenous outpatient therapy increases, with a corresponding rise in radiologist input. This paper provides an overview of the relevant peripheral and central venous anatomy, including anatomical variations, and outlines the complications of PICC lines. Imaging examples demonstrate the range of radiological findings seen in these complications.

Central line complications

Intravenous literature: Worth, L.J., Seymour, J.F. and Slavin, M.A. (2009) Infective and thrombotic complications of central venous catheters in patients with hematological malignancy: prospective evaluation of nontunneled devices. Supportive Care in Cancer. 17(7), p.811-8.

Abstract:

GOALS: Central venous catheter (CVC)-related bloodstream infection (CR-BSI) is a significant complication in hematology patients. A range of CVC devices may be used, and risks for the development of complications are not uniform. The objectives of this study were to determine the natural history and rate of CVC-related complications and risk factors for CR-BSI and to compare device-specific complications in a hematology population.

PATIENTS AND METHODS: An observational cohort of patients with hematologic malignancy was prospectively studied following CVC insertion. Participants were reviewed until a CVC-related complication necessitated device removal, completion of therapy, death, or defined end-of-study date. The National Nosocomial Infection Surveillance definition for CR-BSI was used. Overall and device-specific rates of infective and noninfective complications were calculated and potential risk factors were captured.

MAIN RESULTS: One hundred six CVCs (75 peripherally inserted central venous catheters [PICCs], 31 nontunneled CVCs) were evaluated in 66 patients, over 2,399 CVC days. Thrombosis occurred in 16 cases (15.1%), exit-site infection in two (1.9%), and CR-BSI in 18 (7.5 per 1,000 CVC days). No significant differences were found when complication rates in PICC and nontunneled devices were compared. An underlying diagnosis of acute myeloid leukemia was negatively associated with CR-BSI (odds ratio (OR) 0.14, p = 0.046), and a previous diagnosis of fungal infection was associated with infection (OR 22.82, p = 0.031).

CONCLUSIONS: CR-BSI rates in our hematology population are comparable to prior reports. A low rate of exit-site infection and high proportion of thrombotic complications were observed. No significant differences in thrombotic or infective complications were evident when PICC and nontunneled devices were compared. PICC devices are a practical and safe option for management of hematology patients.

INS IV conference 2010

Intravenous conference: INS have announced the date for the 2010 Annual INS Meeting! More information, including details on the educational sessions and registration, will be available early Fall.

Details:

May 15-20, 2010
Greater Fort Lauderdale/Broward County Convention Center
Ft. Lauderdale, FL

Click here for the INS IV conference web page.

Oxford IV conference 2009

Intravenous conference: The dates for the 8th International IV therapy conference has be announced. The theme for this conference is ‘patient Safety-minimising risk in IV Therapy’.

• Dates:  1st & 2nd October 2009
• Venue: The Oxford Centre, Oxford. OX2 7PL.

Click here for registration details.

Saline drip – suspected overdose

Intravenous news: The Sun report “Police are probing the death of a baby who died after being given a suspected salt overdose in hospital. The tiny boy, who had been born prematurely, had been on a saline solution drip.

Horrified nurses realised his sodium levels had suddenly rocketed and he was acutely dehydrated. Medics desperately fought to save him but he lost his fight for life three days later. Last night, sources said early investigations showed the death had probably been caused by a blunder at the Queen’s Medical Centre in Nottingham. A hospital insider said: “It very much looks like there has been a huge mistake with the dosage quantities.”

Click here for the full story.

Hemodialysis linked to infection

Rao, C.Y., et al (2009) Contaminated Product Water as the Source of Phialemonium curvatum Bloodstream Infection among Patients Undergoing Hemodialysis. Infection Control & Hospital Epidemiology. 30.

Abstract:

Objective: We investigated a cluster of cases of bloodstream infection (BSI) due to the mold Phialemonium at a hemodialysis center in Illinois and conducted a cohort study to identify risk factors.

Design: Environmental assessment and cohort study.

Setting: A hemodialysis center in a tertiary care hospital.

Methods: A case patient was defined as a person who underwent dialysis at the center and had a blood sample that tested positive for Phialemonium curvatum on culture. We reviewed microbiology and medical records and tested water, surface, and dialysate samples by culture. Molds isolated from environmental and clinical specimens were identified by their morphological features and confirmed by sequencing DNA.

Results: We identified 2 case patients with BSI due to P. curvatum. Both became febrile and hypotensive while undergoing dialysis on the same machine at the same treatment station, although on different days. Dialysis machines were equipped with waste handling option ports that are used to discard dialyzer priming fluid. We isolated P. curvatum from the product water (ie, water used for dialysis purposes) at 2 of 19 treatment stations, one of which was the implicated station.

Conclusion: The source of P. curvatum was likely the water distribution system. To our knowledge, this is the first report of patients acquiring a mold BSI from contaminated product water. The route of exposure in these cases of BSI due to P. curvatum may be related to the malfunction and improper maintenance of the waste handling option ports. Waste handling option ports have been previously implicated as the source of bacterial BSI due to the backflow of waste fluid into a patient’s blood line. No additional cases of infection were noted after remediation of the water distribution system and after discontinuing use of waste handling option ports at the facility.

MicroEye blood biosensor

Intravenous products: Reported on theengineer.co.uk “Doctors could continuously monitor the characteristics of a critically ill patient’s blood using a new device being developed in the UK.

The MicroEye, from Bedfordshire-based Probe Scientific, would fit inside traditional IV catheters inserted into the veins of intensive-care patients. The device incorporates a semi-permeable membrane, which sits in the vein of a patient, and a biosensor located outside the body to measure blood characteristics such as glucose, potassium and urea levels.

The technology, which is still under development, recently received £1m worth of venture capital funding to bring it closer to commercialisation.

Click here for the full story.

Pocket guide to diagnostic tests

Intravenous literature: Pocket Guide to Diagnostic Tests provides quick, evidence-based information on the selection and interpretation of common laboratory tests. Including more than 350 diagnostic tests, this handy reference is ideal for answering questions encountered daily by physicians, nurses, students and other healthcare professionals, such as:

• Which test is best to diagnose, screen, or follow a patient’s condition?
• What is the correct interpretation of an abnormal diagnostic test?
• How do I collect the appropriate specimen or prepare the patient for testing?
• Where can I find more information on this test in the medical literature?

Click here for more information.

Nurse-led vascular access team

Intravenous literature: Beerman, L.A. (2009) Making the case for a nurse-led vascular access team utilizing a quality assurance conceptual framework. JAVA. 14(2), p.77-82.

Abstract:

The cost of complications of Central Venous access Devices (CVADs) in today’s health care setting is creating financial buden, increasing the expenditures of resources, and consuming the time of health care providers to resolve. As the roles of nurses continue to evolve, nurses may be in a position to recognize and prevent many of these complications. This paper proposes a conceptual model to address the issues related to caring for and monitoring CVADs, while reducing complications and increasing quality of patient care.

Pediatric ultrasound PICC placement

Doellman, D. and Nichols, I. (2009) Modified Seldinger technique with ultrasound for PICC placement in the pediatric patient: A precise advantage. JAVA. 14(2), p.93-99.

Introduction:

For pediatric patients requiring infusion therapy, several challenges exist for the clinician who will be inserting a vascular access device (Lininger, 2003). Some of the challenges include the varied size and age range of the pediatric patient. The age range of the pediatric patient is from 1 month of age to 18 years. Co-morbidities such as obesity or history of prematurity have a direct effect on the size of the patient…

Positive pressure needlefree research

Intravenous literature: Khalidi, N., Kovacevich, D.S., Papke-O’Donnell, L.F. and Btaiche, I. (2009) Impact of the positive pressure valve on vascular access device occlusions and bloodstream infections. JAVA. 14(2), p.84-91.

Abstract:

Background/Purpose: The use of needleless positive pressure connector valves (PPVs) on venous access devices (VADs) has been shown to have possible benefits in decreasing VAD occlusion rates. catheter-related bloodstream infections (CRBSI) rates, however; have been variable. With this potential for improving patient outcomes, decreasing costs, and facilitating nursing care and catheter management, the use of PPV devices becomes both advantageous and desirable.

Methodology: This was a randomized, prospective, parallel clinical study of 160 medical and surgical step-down unit patients requiring parenteral therapies. Patients were equally randomized to two study groups to assess the impact on occlusion and CRBSI rates, using a PPV versus a standrad cap without PPV. VADs included both peripherally inserted catheters (PICCs) and midlines.

Results: Seven VAD occlusions occurred; six in the experimental group, one in the control group (p = 0.43). Also, two CRBSIs occurred in the experimental group, with none in the control group (p = 0.497). All incidents occurred in double lumen PICCs. The lack of statistical difference between the two groups for occlusion and CRBSIs indicates that the use of PPVs had no impact on preventing such outcomes. However, it was observed that the number of double-lumenn PICCs and their dwelling time in the experimental group was significantly higher (p = 0.003).

Conclusion: There was no difference in the rate of catheter occlusions or CRBSIs when using PPVs or standard caps. We consider that the study outcomes may be due to the study’s small sample size, and we speculate that longer dwell time of double lumen catheters may have contributed to these outcomes. These observations deserve further investigation. However, the use of PPVs may still be advantageous from a nursing process perspective.

RCN comments on sharps injury agreement

Intravenous news: The Royal College of Nursing today welcomed the signing of a joint agreement by European Federation of Public Service Unions (EPSU) and the European Hospital and Healthcare Employers Association (HOSPEEM). This is an EU-wide agreement which the RCN has played a key role in bringing about to prevent one million medical sharps injuries per year. Dr Peter Carter, Chief Executive of the Royal College of Nursing (RCN), said:

“Around half of nurses in the UK have been injured by a needle or sharp and we are delighted that the voice of our members has been heard in Europe on this issue. Nurses work in fear of needlestick injuries and, while the deal is welcome, we are concerned that it might take a number of years to be implemented in the UK. We are calling for speedy implementation of these measures in order to end the stress, trauma and serious medical consequences of these preventable accidents. It is vital that more people are not injured while we wait for safer practices to reach the workplace.”

Dr Carter continues “It is very clear – needle policies, training and investment in safer needles can help prevent these accidents from happening in the first place. Nurses must also receive proper support from their employers when they sustain an injury to prevent the feelings of stress and isolation that often accompany such trauma. By making these changes and safeguarding the health of all staff, we can improve patient care in the UK and throughout Europe.”

EU sharps safety agreement signed

Intravenous news: The European Hospital and Healthcare Sector Social Partners – The European Federation of Public Service Unions (EPSU) represented by the President of EPSU health Committee, Karen Jennings and the European Hospital and Healthcare Employers’ Association (HOSPEEM) represented by General Secretary, Godfrey Perera today signed a European agreement, which is set to prevent medical sharps injuries for the whole health workforce in Europe.

Click here for the full press release.

Click here to view the agreement text.

Click here to view a video of the signing.

Novel approach to distraction during venipuncture

Intravenous literature: Tufekci, F.G., Celebioglu, A. and Kucukoglu, S. (2009) Turkish children loved distraction: using kaleidoscope to reduce perceived pain during venipuncture. Journal of Clinical Nursing. 18(15), p.2180-6

Abstract:

AIM: To assess the effect of distraction (looking through kaleidoscopes) to reduce perceived pain, during venipuncture in healthy school-age children.

BACKGROUND: Distraction has been noted to be an effective method to help children cope with painful procedures. In the studies carried out, although it was found out that distraction made with different distracters reduced the pain of venipuncture, there is only one study confirming analgesic effect of distracters.

DESIGN: The study was carried out as an intervention-control group design.

METHOD: Children (n = 206), in whom venipuncture was applied in a laboratory for examination between the dates January-September 2006, were included in the study. The data were obtained by a form determining introductory features of the children and Wong-Baker FACES Pain Rating Scale and Visual Analogue Scale evaluating the pain. Descriptive statistics was used in the assessment of the data and t-test was used in comparisons of dependent-independent groups.

RESULTS: Pain levels of the children according to both scales in intervention group were lower than those of control group. But, it was detected that the distinction between score averages of intervention and control group of Wong-Baker FACES Pain Rating Scale, not Visual Analogue Scale, was statistically significant (p < 0.001).

CONCLUSION: It was detected that the distraction made with kaleidoscope effectively reduced the pain related to venipuncture in healthy school children and that some features of the children influenced the perception of pain.

RELEVANCE TO CLINICAL PRACTICE: Distraction with kaleidoscope is a method, which the nurse will be able to use for venipuncture to obtain optimal pain control. In addition, it is important for a nurse to know some features about the children for a pain free and positive experience.

Tourniquet application time

Intravenous literature: Cengiz, M., Ulker, P., Meiselman, H.J. and Baskurt, O.K. (2009) Influence of tourniquet application on venous blood sampling for serum chemistry, hematological parameters, leukocyte activation and erythrocyte mechanical properties. Clinical Chemistry & Laboratory Medicine. 47(6), p.769-76.

Abstract:

Background: Venous blood sampling is usually performed using a tourniquet to help locate and define peripheral veins to achieve successful and safe venipuncture. Despite widespread usage of tourniquets for venipuncture by medical and laboratory staff, very few are aware of the effects of tourniquet application on laboratory parameters. In addition, definitive guidelines regarding when and how to use a tourniquet for blood sampling are lacking. The aim of the present study was to define the optimal sampling time after tourniquet removal to avoid adverse impact on laboratory analytes.

Methods: Blood oxygen and carbon dioxide partial pressure, pH, oxyhemoglobin saturation (satO(2)), hematological parameters, serum electrolyte concentrations, erythrocyte, deformability and aggregation, leukocyte activation and nitrite/nitrate concentrations obtained 180 s after tourniquet release were compared with baseline values for 10 healthy subjects.

Results: Blood gases, hematological parameters and serum electrolyte levels were not affected by the application and removal of a tourniquet. However, there were significant decreases in erythrocyte deformability at 90, 120, 180 s, and increases in erythrocyte aggregation at 5 and 30 s following removal of the tourniquet. A significant increase in granulocyte respiratory burst at 60 s was observed, confirming leukocyte activation due to application of the tourniquet. There were no significant alterations of blood nitrite/nitrate levels.

Conclusions: Our blood sampling technique which mimicked the application and release of a tourniquet indicated unaltered values for routine blood gases, hematological testing and serum electrolyte levels. Conversely, hemorheological measurements can be affected. Therefore, it is strongly recommended that tourniquet application should be avoided during blood sampling or, if this is not possible, the procedure should be well standardized and details of the sampling method should be reported.

Central venous catheters in prehospital use

Intravenous literature: Fyntanidou, B., Fortounis, K., Amaniti, K., Katsanoulas, K., Mouloudi, E., Grosomanidis, V. and Boutlis, D. (2009) The use of central venous catheters during emergency prehospital care: a 2-year experience. European Journal of Emergency Medicine. 16(4), p.194-8.

Abstract:

OBJECTIVE: Evaluation of the efficacy and safety of central venous catheter (CVC) use during prehospital emergency care.

METHODS: All prehospital patients who underwent CVC positioning by emergency medical services physicians in the greater area of Thessaloniki during a 2-year period were included. A two-lumen indwelling polyurethane 8F catheter was inserted using the Seldinger technique in all cases. Patients’ demographics and underlying diseases, site of access, number of attempts, time spent for catheter placement, and insertion-related complications were recorded.

RESULTS: Four hundred and ninety-seven CVCs were inserted by emergency medical services physicians during the study period in patients with various underlying diseases [cardiac arrest (35.4%), other cardiac emergencies (16.3%), trauma (30.0%), coma (7.7%)]. Subclavian and internal jugular veins were accessed in 55.3 and 44.15% of patients, respectively. The mean number of attempts was 1.3 and the mean time spent for insertion was 2.0+/-0.5 min. Eleven (2.2%) hematomas at the insertion site of minor clinical importance and five (1.0%) uncomplicated arterial punctures were found. All of the 378 patients referred alive for admission in hospitals after prehospital resuscitation had radiological detection of their CVCs. Catheter malposition occurred in 11 (2.9%) cases. Three pneumothoraces were also detected (0.8%), but only one required chest tube placement.

CONCLUSION: Insertion of CVCs during prehospital emergency care is effective in providing intravenous access, thus facilitating the delivery of fluids and medications in unstable patients. It is safe, as associated with a low incidence of complications in experienced hands.

Hepatitis – IV contamination

Intravenous news: LoHud.com report “A surgical technician addicted to painkillers who has been jailed in Colorado on accusations of injecting herself with syringes used for surgery may have also exposed Northern Westchester Hospital patients to hepatitis C, officials said yesterday.

“If there was a moment when she could get her hands on a syringe filled with the painkiller fentanyl, she would grab it and she would inject herself, then put it back without anyone seeing her. That was her MO, if you will,” said Joel Seligman, president and chief executive officer at Northern Westchester Hospital, referring to the Colorado case”.

Click here for the full story.

Hand hygiene guidelines from WHO

Intravenous news: The final, revised and updated version of the World Health Organization (WHO) Guidelines on Hand Hygiene  is now available online.

Introduction:

“The WHO Guidelines on Hand Hygiene in Health Care provide health-care workers (HCWs), hospital administrators and health authorities with a thorough review of evidence on hand hygiene in health care and specific recommendations to improve practices and reduce transmission of pathogenic microorganisms to patients and HCWs. The present Guidelines are intended to be implemented in any situation in which health care is delivered either to a patient or to a specific group in a population. Therefore, this concept applies to all settings where health care is permanently or occasionally performed, such as home care by birth attendants. Definitions of health-care settings are proposed in Appendix 1. These Guidelines and the associated WHO Multimodal Hand Hygiene Improvement Strategy and an Implementation Toolkit (http://www.who.int/gpsc/en/) are designed to offer health-care facilities in Member States a conceptual framework and practical tools for the application of recommendations in practice at the bedside. While ensuring consistency with the Guidelines’ recommendations, individual adaptation according to local regulations, settings, needs, and resources is desirable. (WHO 2009)”

Click here for the full document.

Fifty percent of injections unsafe

Intravenous news: PlusNews.org report “Injections and needles are still not being used properly in African health Read more

ANTT conference 2009

Intravenous conference: Stephen Rowley has announced the second national conference for ANTT. “Building upon the success of last years two national conferences, this years conference will provide new Master Classes in ANTT theory, practice and implementation”.

Stephen continues “This will be complemented by expert speakers of national repute, providing updates in important practice issues relating to safe aseptic practice in healthcare organisations”.

Conference details:

Friday 27th November 2009
The Wellcome Collection Conference Centre,
183 Euston Rd. NW1 2BE
London

Click here for more information.

Mobile chemotherapy clinic

Intravenous news: HealthExec.tv Report “Cancer charity Tenovus is revolutionising the care of patients in Wales with a hi-tech mobile chemotherapy clinic that delivers treatment in the heart of local communities.

The mobile clinic, provided by specialist supplier EMS, is cutting hospital waiting times and improving patients’ access to vital services – removing the cost and strain of travel.

Click here to view the video review on HealthExec.tv

Enteral feed given intravenously

Intravenous news: TypicallySpanish.com report “A premature baby who lost his mother to Swine Flu dies in Spanish hospital from a dreadful medical error. Rayan was said to be progressing well when, on Sunday evening, a nurse from another department, who El País said was on duty for the first time in the hospital’s neonatal ICU, mistakenly administered premature baby formula into a vein. It should have been delivered by tube to the baby’s stomach”.

Click here for the full story.

Michigan Keystone ICU Project

Intravenous news: HHS Secretary Kathleen Sebelius today released the first in a series of health care “success story” reports that document innovative programs and initiatives that can serve as models for a reformed American health care system. The inaugural report highlights the Michigan Keystone ICU Project. A joint partnership between the Michigan Health & Hospital Association and the Johns Hopkins University, the Michigan Keystone ICU Project helped dramatically reduce the number of health care associated infections in Michigan, saving over 1,500 lives and $200 million.

“We know there are tremendous examples of efficient, high-quality health care in America today. Our challenge is spreading these good examples across the country,” said Sebelius. “Our reports will showcase success stories like the Michigan Keystone ICU Project and highlight how health reform can improve the quality of care for all Americans.”

Medical errors including health care associated infections claim the lives of nearly 100,000 patients in America every year and patient safety measures have worsened by nearly 1 percent each year for the past decade. The Michigan Keystone ICU Project worked to make patient care safer in over 100 ICUs in the state of Michigan. The project targeted a specific type of infection that ICU patients can get while in the hospital: catheter-related bloodstream infections. To help reduce these infections, the project worked to ensure clinicians used a simple checklist when inserting catheters into ICU patients.

Click here for the full press release.

Blood culture contamination

Intravenous news: Bev Bacon and Louise Lowry have submitted a ‘Working together to reduce blood culture contamination rates and MRSA bacteraemia’ poster to the IVTEAM website.

Click here to view the poster.

UCLH injectable medicines guide online

Intravenous literature: The UCL Hospitals Injectable Medicines Administration Guide is now available online and provides access to the key information and advice needed for the safe and effective administration of many injectable medicines.

• Practical  online guide to administering medicines by injection
• Essential resource for nurses and health care professionals
• Authoritative and accurate, written by the Pharmacy Team at UCL Hospitals
• Covers intravenous, intramuscular and subcutaneous methods of administration
• Includes preparative details and compatibility for each medicine
• Powerful searching and browsing capabilities
• Easy-to-navigate

How to get access

The UCLHguide online is available on licence to hospitals, NHS trusts and Primary Care Trusts and Clinical Practice groups. To gain access to the online guide your Hospital, Trust or practice group will need a subscription.

Click www.uclhguide.com to view the website.

IV site and hub disinfection

Intravenous conference: APIC expects to offer more than 25 webinars this year, providing members with free access to the most current, practice-based information.

On July 23 2009, Marcia Ryder, PhD, MS, RN Ryder Science presents ‘Access Site and Hub Disinfection: The Missing Link in the CRBSI Prevention Bundle’

Abstract:

The disinfection of injection ports first appeared in the CDC Guidelines for Prevention of Intravascular Catheter Infection in 1982, however compliance to the recommendation has been since been poor. Colonization of the internal lumen of catheter hubs is the most significant risk factor for CRBSI within one week of insertion. The goal of this presentation is to review existing science and procedure recommendations for access site and catheter hub/stopcock disinfection.

Click here for more information.

Reduction of CLABSI guidelines

Intravenous conference: APIC expects to offer more than 25 webinars this year, providing members with free access to the most current, practice-based information.

On August 27 2009, Mary Ellen Scales, RN, MSN, CIC Baystate Medical Center presents ‘Reduction of Central Line Associated Bacteremia (CLABSI) using the Current Guidelines’

Abstract:

This program is intended for the bedside care provider and those interested in best practices for the prevention of Central line associated bacteremia ( CLABSI). Prevention measures described will include evidence-based activities that decrease or eliminate the risk of infection.  Current literature sources further endorse and support recommendations made by the CDC in 2002 and will be described in this presentation. The Infusion Nurse’s Society (INS) standards will be described as they relate to prevention activities and best practices in the care of the patient with invasive vascular devices. The APIC program,  Eliminating catheter related complications, A Guide for More Effective  Infection Prevention and Control,  will be also be highlighted as a prevention tool for bedside healthcare providers.  Limited discussion will include engagement and empowerment of bedside care staff, utilizing teamwork to prevent and control  infections associated with these invasive devices.

Click here for more information.

Strategies to prevent CRBSI

Intravenous conference: APIC expects to offer more than 25 webinars this year, providing members with free access to the most current, practice-based information.

On September 24 2009, Sophie Harnage RN, BSN Clinical Manager Infusion Services, Sutter Roseville Medical Center presents ‘Strategies to Prevent Catheter Related Bloodstream Infection’

Webinar Description:

Catheter Related Bloodstream Infection (CRBSI) is a major cause of patient morbidity, mortality, and cost. Lower CRBSI rates would decrease inpatient length of stay, and improve patient safety and satisfaction. The importance of reducing CRBSI cannot be overstated. An innovative central line bundle was developed at Sutter Roseville Medical Center to reduce CRBSI. Bundle selection was based on available research, CDC and IHI recommendations, new product technology, the amount of change required by the bedside nurse, and product ease of use. An innovative combination of focused nursing practice and product technologies were selected for the bundle and implemented through a defined educational program. To achieve success with limited personnel resources, a combination of behavioral practices and product technologies associated with lowering CRBSI that supported existing nursing practice were selected. When prevention practice activities and innovative products are combined the synergist effect is greater than when the same strategies and or products are used independently. Having a specialized team at Sutter Roseville Medical Center  has resulted in a Zero CRBSI rate in over 7000 PICC lines inserted and maintained by this team, for the past 40 months. While some of the bundle components have not been widely researched, the early outcome of this bundle provides a basis for additional study and refinement.

Click here for more information.

CareFusion Jazz Festival

Intravenous news: CareFusion Corporation, the company that has been formed from a planned spinoff of Cardinal Health’s clinical and medical products businesses, has launched the CareFusion Jazz Festival Series at an event held at the City Winery in New York. The CareFusion Jazz Festival Series was created to support the launch of its new brand and recognize individuals and organizations working to improve patient care.

“There is a clear connection between jazz and medicine that provides the perfect opportunity to launch our new brand, raise funds for and awareness of patient safety and help support and preserve the arts,” said David Schlotterbeck, CEO of CareFusion. “Both jazz and the practice of medicine embrace innovation, performance and change. Jazz is also used to teach listening skills to medical students and resonates with our customers. In addition, the musicians playing at these festivals are the best and the brightest—a great fit for our company whose products are recognized as leaders in our industry.”

The CareFusion Jazz Festival Series uses jazz to shine a light on healthcare safety and those working to improve care. The best and brightest musicians will be playing at some of the world’s largest and oldest jazz festivals, making it the perfect opportunity to increase awareness, raise funds for worthy charities, and support the festivals—all while enjoying the healing sounds of jazz.

Click here for the full press release.

Click here for the Carefusion Jazz website.

International conference on HAIs

The fifth decennial International Conference on Healthcare-Associated Infections will be held March 18-22, 2010 at the Hyatt Regency Atlanta. The meeting, co-organized by SHEA, the CDC, APIC and IDSA, will set the agenda for healthcare-associated infection (HAI) prevention for the next decade. The meeting will address topics such as:

• New international and domestic perspectives
• Updates on the scientific evidence in such areas as antimicrobial resistance, surveillance strategies, emerging infections, environmental transmission, new technologies
• Translation of research and epidemiologic, organizational, and implementation principles into quality improvement practices

Click here for the conference website.

TimestripIV distributed by Vygon

Intravenous products: ProcativeInvestors.co.uk report “Timestrip PLC said it appointed Vygon (UK) Ltd as the main distributor for TimestripIV products in the United Kingdom and Ireland. TimestripIV is a technology that enables clinicians and patients to quickly assess how long a cannula has been in place and thus take appropriate action in line with hospital infection control procedures.

TimestripIV will be available to hospitals through the NHS supply chain from the end of July. Vygon also intends to include TimestripIV as a component in a new cannulation pack that will be available in the coming months.

Click here for the full story.

Improper IV administration

Intravenous news: TheLocal.se report “A patient at Danderyd hospital in Stockholm was reported dead after having received a nutritional intravenous drip too quickly, reports Radio Stockholm.

According to a report the hospital submitted to the National Board of Health and Welfare (Socialstyrelsen), the patient received a drip that was enough for twelve hours in the span of an hour”.

Survey of PICC use in children

Intravenous literature: Shen, G., Gao, Y., Wang, Y., Mao, B. and Wang, X. (2009) Survey of the long-term use of peripherally inserted central venous catheters in children with cancer: experience in a developing country. Journal of Pediatric Hematology/Oncology. 31(7). p.489-92.

Abstract:
Peripherally inserted central catheters (PICCs) have been used for many years in developed countries, but few studies have been focused on children with cancer in developing countries. In this study, we assessed the feasibility of PICCs and determined the rate of PICC-related complications in children with cancer. We prospectively followed all children with cancer over 3 years of age who received chemotherapy and PICC placement in our cancer center between June 2003 and May 2007. The date of last follow-up was January 31, 2008. A total of 119 PICCs were inserted into 116 patients during the 48-month period. PICCs were placed in 113 of 119 attempts, yielding an insertion rate of 95.0%. The 113 PICCs were in place for a total 26,721 catheter days (median time, 246 d; range, 8 to 455 d). The 113 PICCs had 53 overall complications, for a rate of 1.98/1000 catheter days. Twenty-one (18.6%) PICCs were removed because of complication with a rate of 0.79/1000 catheter days. The most common reason for PICC removal was breakage/leakage. An infection requiring PICC removal occurred in 4 patients. This study demonstrated relatively low complication rate and long duration for PICCs in children with cancer over 3 years of age in our hospital.

Colonisation of peripheral venous catheters

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.

Hypodermoclysis site hemorrhage

Intravenous literature: O’Hanlon, S., Sheahan, P. and 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.

Venepuncture pain reduction

Intravenous literature: Balan, R., Bavdekar,  S.B. and Jadhav, S. (2009) Can Indian classical instrumental music reduce pain felt during venepuncture?. Indian Journal of Pediatrics. 76(5)p.469-73.

Abstract:
OBJECTIVE: Local anesthetic agent is not usually used to reduce pain experienced by children undergoing venepuncture. This study was undertaken to determine comparative efficacy of local anesthetic cream, Indian classical instrumental music and placebo, in reducing pain due to venepuncture in children.

METHODS: Children aged 5-12 yr requiring venepuncture were enrolled in a prospective randomized clinical trial conducted at a tertiary care center. They were randomly assigned to 3 groups: local anesthetic (LA), music or placebo (control) group. Eutactic mixture of local anesthetic agents (EMLA) and Indian classical instrumental music (raaga-Todi) were used in the first 2 groups, respectively. Pain was assessed independently by parent, patient, investigator and an independent observer at the time of insertion of the cannula (0 min) and at 1- and 5 min after the insertion using a Visual Analog Scale (VAS). Kruskal- Wallis and Mann-Whitney U tests were used to assess the difference amongst the VAS scores.

RESULTS: Fifty subjects were enrolled in each group. Significantly higher VAS scores were noted in control (placebo) group by all the categories of observers (parent, patient, investigator, independent observer) at all time points. The VAS scores obtained in LA group were lowest at all time points. However, the difference between VAS scores in LA group were significantly lower than those in music group only at some time-points and with some categories of observers (parent: 1 min; investigator: 0-, 1-, 5 min and independent observer: 5 min).

CONCLUSION: Pain experienced during venepuncture can be significantly reduced by using EMLA or Indian classical instrumental music. The difference between VAS scores with LA and music is not always significant. Hence, the choice between EMLA and music could be dictated by logistical factors.

Venepuncture and hypnosis

Intravenous literature: Liossi, C., White, P. and Hatira, P. (2009) A randomized clinical trial of a brief hypnosis intervention to control venepuncture-related pain of paediatric cancer patients. Pain. 142(3), p.255-63.

Abstract:
Venepuncture for blood sampling can be a distressing experience for a considerable number of children. A prospective controlled trial was conducted to compare the efficacy of a local anaesthetic (EMLA) with a combination of EMLA with self-hypnosis in the relief of venepuncture-induced pain and anxiety in 45 paediatric cancer outpatients (age 6-16years). A secondary aim of the trial was to test whether the intervention will have a beneficial effect on parents’ anxiety levels during their child’s procedure. Patients were randomized to one of three groups: local anaesthetic, local anaesthetic plus hypnosis, and local anaesthetic plus attention. Results confirmed that patients in the local anaesthetic plus hypnosis group reported less anticipatory anxiety, and less procedure-related pain and anxiety, and were rated as demonstrating less behavioural distress during the procedure than patients in the other two groups. Parents whose children were randomized to the local anaesthetic plus hypnosis condition experienced less anxiety during their child’s procedure than parents whose children had been randomized to the other two conditions. The therapeutic benefit of the brief hypnotic intervention was maintained in the follow-up. The present findings are particularly important in that this study was a randomized, controlled trial conducted in a naturalistic medical setting. In this context, convergence of subjective and objective outcomes was reached with large effect sizes that were consistently supportive of the beneficial effects of self-hypnosis, an intervention that can be easily taught to children, is noninvasive and poses minimal risk to young patients and their parents.

Central venous catheter tip culture

Intravenous literature: Bouza, E., Guembe, M., Gomez, H., Martin-Rabadan, P., Rivera, M. and Alcala, L. (2009) Are central venous catheter tip cultures reliable after 6-day refrigeration? Diagnostic Microbiology & Infectious Disease. 64(3), p.241-6.

Abstract:

Present guidelines recommend culturing only central venous catheter (CVC) tips from patients with suspected catheter-related bloodstream infection (CR-BSI). However, a high proportion of these suspicions are not confirmed. Moreover, CVC tip culture increases laboratory workload, and reports of colonization may be meaningless or misleading for the clinician. Our working hypothesis was that CVC tips should be refrigerated and cultured only in patients with positive blood cultures. We evaluated the effect of 6-day refrigeration of 215 CVC tips. We selected all the catheters with a significant count according to the Maki’s roll-plate technique and randomly assigned them to 2 groups. In group A, the catheters were recultured after 24 h of refrigeration, and in group B, the catheters were recultured after 6 days more of refrigeration, so that the refrigeration time evaluated would be of 6 days. The yield of refrigerated CVC tips that grow significant colony counts of primary culture in group B was compared with the yield of refrigerated catheter tips in group A. The difference showed that 6-day refrigeration reduced the number of significant CVCs by 15.2%. Only 61 CVCs were obtained from patients with CR-BSI, and in most of them, blood cultures were already positive before CVC culture, so only 0.91% of the CR-BSI episodes would have been misdiagnosed as culture negative after refrigeration. Refrigeration of CVC tips sent for culture and culturing only those from patients with positive blood cultures reduce the workload in the microbiology laboratory without misdiagnosing CR-BSI.

Treatment of Multiple Sclerosis

Intravenous literature: Ryan, M. (2009) Drug therapies for the treatment of Multiple Sclerosis. Journal of Infusion Nursing. 32(3), p.137-144.

Abstract:

The name multiple sclerosis (MS) refers to 2 features of the disease: multiple describes the number of central nervous system lesions and sclerosis refers to the demyelinated nature of the lesions. Today, these lesions are usually called plaques rather than scleroses. Multiple sclerosis is a complex inflammatory disease of the central nervous system that is variable in terms of symptoms and presentation. The objectives of this article are to review briefly the epidemiology and pathophysiology of MS and to focus on the major categories of therapies currently in use to treat MS. Research is progressing at a rapid pace. The article also discusses some of the most promising new compounds in clinical trials.

Children’s perspectives of venepuncture

Intravenous literature: Hands, C., Round, J. and Thomas, J. (2009) “When someone stabs you”: children’s perspectives of venepuncture. Archives of Disease in Childhood. 94(6), p.466.

Extract:

“The suffering experienced by children during phlebotomy or cannulation has been well documented from observations of nurses and parents. Despite several proven interventions that reduce the impact of these procedures, such as topical anaesthesia, play therapy and distraction, few specialist trainees are properly trained in venepuncture or know about the use of these interventions…”

Transfusion-related acute lung injury (TRALI)

Intravenous literature: Clark, C.T. (2009) Transfusion-Related Acute Lung Injury: Clinical Features and Diagnostic Dilemmas. Journal of Infusion Nursing. 32(3), p.132-136.

Abstract:

Transfusion-related acute lung injury (TRALI) is recognized as the number-one cause of transfusion-associated death in the United States. Although TRALI was not designated as the number-one cause until 2004, respiratory-related symptoms associated with blood transfusion have been reported for decades. More recently, our understanding of the pathophysiology and clinical significance of TRALI has advanced significantly, and great efforts are being implemented for patient safety. This article reviews the background, history, definitions, clinical features, and pathophysiology of TRALI. It also discusses some of the difficulties in diagnosing TRALI, compares some of the important components in the differential diagnosis, and describes some of the efforts being implemented for patient safety.

Infant painful procedure analgesia

Intravenous literature: Harrison,  D., Loughnan, P., Manias, E. and Johnston, L. (2009) Analgesics administered during minor painful procedures in a cohort of hospitalized infants: a prospective clinical audit. Journal of Pain. 10(7), p.715-22.

Abstract:
A number of evidence-based consensus statements relating to pain in infants include recommendations concerning effective pain management during painful procedures. Yet numerous studies have shown that procedural pain remains poorly managed in neonatal intensive care units. The aim of this prospective clinical audit was to ascertain analgesics administered during skin-breaking, minor painful procedures occurring over the entire course of a hospitalization in a cohort of infants with a length of stay of 28 days or more. Data were collected on aspects relating to utilization of oral sucrose specifically for minor painful procedures as well as administration of opioid analgesics or other strong analgesics on the day the procedures were performed. A total of 3605 minor painful procedures were recorded for 55 infants during the study period, a mean of 65 minor procedures per infant. The majority of procedures recorded were heel lance (71%), followed by intravenous catheter insertion or venepuncture (14%). Either oral sucrose was specifically administered or background opioid analgesics were being administered during 85% of all minor painful procedures. These results show considerably higher frequency of analgesic use during acute minor painful procedures compared with similar studies of pain management practices in neonatal intensive care units.

PERSPECTIVE: This study ascertained analgesics administered to sick infants during minor painful procedures during a prolonged hospitalization. Oral sucrose or morphine was administered during the most painful procedures, whereas 15% of procedures were performed with no analgesics. This illustrates a vast improvement compared with similar studies.

Endovascular Port-a-cath Insertion

Intravenous literature: Ali, A., Zayed, H., Wilkins, J., Wyatt, H. and Rashid, H. (2009) Endovascular Port-a-cath Insertion in a Patient With Cystic Fibrosis and Occluded Superior Vena Cava. Vascular & Endovascular Surgery. 43(3),p.280-3.

Abstract:

Introduction: Port-a-cath insertion, for long-term intravenous antibiotic therapy, is an ideal solution for patient with cystic fibrosis. However, indwelling lines are liable to many complications including catheter thrombosis especially in patients having cystic fibrosis with hypercoagulable state.

Methods: An endovascular technique for insertion of a port-a-cath in a patient having cystic fibrosis with occluded superior vena cava is reported. The technique is described in detail. In addition, a review of literature for the various methods of saving a failed central venous access in these patients was performed.

Results: The line was successfully inserted and remained patent without need of any further intervention for 20 months.

Conclusion: In this report, several endovascular skills were used for central venous access salvage that can be used in similar situations with chronic superior vena cava occlusion, which may not be suitable for thrombolysis or stenting.

Chemotherapy and biotherapy-induced hypersensitivity reactions

Intravenous literature: Van Gerpen, R. (2009) Chemotherapy and Biotherapy-Induced Hypersensitivity Reactions. Journal of Infusion Nursing. 32(3), p.157-165.

Abstract:

Nearly all chemotherapy and biotherapy drugs used in cancer treatment today can cause hypersensitivity reactions. Certain groups of drugs frequently associated with these reactions include the asparaginases, taxanes, platinum compounds, epipodophyllotoxins, and the monoclonal antibodies. Recognizing and managing hypersensitivity reactions are critical when caring for patients receiving these drugs because the reactions are potentially life-threatening. A thorough understanding of the drugs is necessary to assist the nurse in prevention, early recognition, and timely management.

Complication rate reduction in Peripherally Inserted Central Catheter (PICC) Insertions

Intravenous literature: Stokowski, G., Steele, D. and Wilson, D. (2009) The Use of Ultrasound to Improve Practice and Reduce Complication Rates in Peripherally Inserted Central Catheter Insertions: Final Report of Investigation. Journal of Infusion Nursing. 32(3), p.145-155.

Abstract:

The risk of thrombosis related to peripherally inserted central catheters (PICCs) is a well-known complication. A study was conducted to compare thrombosis rates associated with the old technique of inserting PICCs by visualizing veins in the antecubital fossa, using anatomical landmarks and palpation versus using ultrasound guidance to locate veins in the upper arm. The findings from data collected on 538 patients included a significant decline in the thrombosis rates, as thrombosis decreased from 9.3% with the palpation method to 1.9% with the ultrasound method, and successful PICC placements by registered nurses increased from 76.9% when using the old method to 98.9% when using ultrasound guidance.

Effectiveness of venepuncture and cannulation study days

Intravenous literature: Wright, J. (2009) A quantitative pilot study evaluating the effectiveness of a venepuncture and cannulation study day. Nurse Education Today. 29(5), p.555-60.

Abstract:
Continuing education for nurses is an expensive commodity. In order to justify its expense employers must experience tangible benefits to nursing practice. This paper describes a quantitative study carried out in an in-service training organisation in Northern Ireland. The aim of this study was to pilot a tool, which considered factors associated with successful completion of the record of practice documentation following training in peripheral intravenous cannulation. The questionnaire was sent to all course participants for a single year (n=344). The response rate of was 28% (n=97). Seventy two percent of nurses successfully cannulated on at least five occasions with most completing the record of practice form within one month. There were no significant differences found between nursing grades in relation to the time taken to complete the record of practice document (p=0.395, Kruskal-Wallis, chi(2)=1.860, df=2). There was highly statistically significant correlation found in relation to highest academic grade and the time taken to complete the record of practice (p<0.001, r=0.121) as illustrated in Fig. 3. However, the strength of the relationship was weak as the two variables only shared 1.4% of their variation in common. The difference between the grades achieved by hospital and community nurses in time taken to complete the record of practice was statistically significant (p=0.003, Mann Whitney U=470.000, Z=-3.023) with hospital nurses more likely to complete their supervised practice and to do so more quickly.

Ultrasonographically guided peripheral intravenous cannulation

Intravenous literature: Stein, J., George, B., River, G., Hebig, A. and McDermott, D. (2009) Ultrasonographically guided peripheral intravenous cannulation in emergency department patients with difficult intravenous access: a randomized trial. Annals of Emergency Medicine. 54(1), p.33-40.

Abstract:

STUDY OBJECTIVE: We seek to compare ultrasonographically guided peripheral intravenous access to a non-ultrasonographically guided method in a randomized trial of emergency department patients with difficult intravenous access.

METHODS: A prospective cohort of patients with difficult intravenous access was established. Patients were randomized to 2 groups: (1) intravenous access obtained through an ultrasonographically guided technique or (2) intravenous access obtained through non-ultrasonographically guided methods. Outcomes measured were number of attempts after enrollment, time to cannulation from enrollment, and patient satisfaction. Groups were compared with nonparametric analysis.

RESULTS: Fifty-nine patients were randomized. Twenty-eight patients were randomized to the ultrasonography group and 31 to the no ultrasonography group. A median of 2 further intravenous attempts was required in each group before successful cannulation, corresponding to a difference of 0 attempts (95% confidence interval [CI] 0 to 1 attempts). Time to cannulation showed a median of 39 minutes in the ultrasonography group compared with 26 minutes for the no ultrasonography group, giving a median increase of 13 minutes for the ultrasonographically guided group (95% CI -5 to 28 minutes). Patients in the ultrasonography group had a median Likert satisfaction score of 8 compared with 7 for the no ultrasonography group, giving a median increase of 1 on this scale in the ultrasonography group (95% CI 0 to 2).

CONCLUSION: Ultrasonographically guided peripheral intravenous cannulation did not decrease the number of attempts or the time to successful catheterization, nor did it improve patient satisfaction compared with the group that did not use ultrasonography. Superiority of ultrasonographically guided peripheral intravenous cannulation is not supported by this study.

CLABSI and RN ratio

Intravenous news: MedicalNewsToday.com report “The public was well-served today with the release of a report by the New York State Department of Health (DOH) about hospital-acquired infection rates at specific facilities in New York State.

But more information is needed about how to correct these problems, such the high rate of central line-associated bloodstream infections identified in the report. These types of infections are directly related to the number of patients assigned to each registered nurse”.

Click here for the full story.

Infusion fluid settlement

Intravenous news: MSN Money report “Kentucky Attorney General Jack Conway has reached a $2 million settlement with Baxter International Inc., one of the world’s largest manufacturers of intravenous solutions and products used in delivery of fluids and drugs to patients.

Conway said in a news release that Deerfield, Ill.-based Baxter published inflated average prices for its IV solutions, at times exceeding 1,300 percent more than the real price, which caused Kentucky Medicaid to pay substantially more than it should have.”

Click here for the full story.

Intravenous interaction

Intravenous news: The FDA has issued an update on earlier recommendations about the interaction between the antibiotic ceftriaxone and intravenous products that contain calcium.

“In certain circumstances, this interaction can cause dangerous precipitates to form. Ceftriaxone is sold as Rocephin and also as a generic. Products that contain calcium include Ringer’s solution, Hartmann’s solution and parenteral nutrition formulations that contain calcium. FDA had previously recommended that ceftriaxone and calcium-containing IV products not be administered within 48 hours of one another for patients of all ages. This has now changed. It is no longer necessary to wait 48 hours in patients over 28 days old, provided that certain precautions are followed. And FDA is still stressing that ceftriaxone must not be used in neonates if they are receiving or will receive calcium-containing IV products.

Ceftriaxone and products that contain calcium may now be administered sequentially to patients older than 28 days of age, as long as the infusion lines are thoroughly flushed between infusions with a compatible fluid. However, ceftriaxone must not be administered simultaneously with intravenous calcium-containing solutions through a Y-site. FDA also continues to advise practitioners not to reconstitute or mix ceftriaxone with products that contain calcium.

There are no data on whether ceftriaxone might interact with calcium-containing products that are given orally. It’s also not clear whether intramuscular ceftriaxone might interact with calcium-containing products, either IV or oral”.

Click here for the full report from the FDA.

FDA insulin pump alert

Intravenous products: The July FDA Patient Safety News Alert describes that “Disetronic Medical Systems is notifying healthcare professionals and patients about a possible defect with the some of the company’s ACCU-CHEK Spirit insulin pumps. The defect can cause the “up” and “down” buttons on these pumps to stop working, either completely or intermittently. These buttons are used to change the pump programming or to administer additional insulin through a bolus delivery. So if they do not work, pump users may not be able to change any of the pump’s programmed settings.

When the buttons are pushed, the pump normally responds with a confirmation signal: a sound, a vibration, or both. If the buttons stop working, the signal will not occur, and the pump display will not change. If pump users cannot confirm that a change was made, they should disconnect the pump and switch to a back-up pump or other insulin delivery method. Then they should immediately contact the company’s hotline to get a replacement pump. If the buttons on the pump continue to work, the company says the pumps can still be used, but users should make sure the “up” and “down” buttons are working, by verifying that they get a confirmation signal after each pump operation”.

For more information call the ACCU-CHEK Spirit hotline. That number is 1-800-778-5095.

Click here for the full FDA alert.