ANTT conference 09 programme

Intravenous conference: Stephen Rowley, ANTT UK Director has informed IVTEAM of the 2009 ANTT conference programme. Read more

SCOTVAN IV conference

Intravenous conference: The Scottish Vascular Access Network (SCOTVAN) have announced that Andrew Jackson, Rotherham, Read more

Saving lives support material

Intravenous news: Saving IVs is an implementation package for the peripheral IV elements of Saving Lives (DH Read more

IV luer disinfection cap

Intravenous products: Excelsior Medical, one of the leading manufacturers of pre-filled catheter flush syringes and syringe pump Read more

Contaminated needle prosecution

Intravenous news: The New York Times report “A former hospital surgical technician who may have infected dozens of surgical p Read more

Central venous catheter BSI risk

Intravenous literature: AL‐Rawajfah, O.M., Stetzer, F. and Hewitt, J.B. (2009) Incidence of and Risk Factors for Nosocomial Read more

Chlorhexidine prevents CLABSI

Intravenous literature: Popovich, K.J., Hota, B., Hayes, R., Weinstein, R.A. and Hayden, M.K. (2009) Effectiveness of Routine Read more

Voice assisted IV documentation

Intravenous products: Informationweek.com report “Butler Memorial Hospital recently completed a pilot project where three IV Read more

Promethazine FDA Boxed Warning

Intravenous news: FDA is requiring a Boxed Warning for promethazine hydrochloride injection, USP products to better Read more

Heparin label confusion

Intravenous news: Attorneyatlaw.com report “Hollywood actor Dennis Quaid and his wife have asked the Illinois Supreme Court to order a state court to hear their lawsuit blaming confusing labeling on the blood-thinning drug Heparin for causing a medical mishap that nearly killed the couples infant twins.

The Quaids accuse Baxter Healthcare Corp., the maker of Heparin, of negligence for packaging the full-strength form of Heparin similarly to a diluted form of the drug, called Hep-Lock, which is designed for use in pediatric patients.

Heparin and Hep-Lock are both anticoagulants commonly used to prevent clogging blockages in intravenous lines. In November 2007, a nurse at Cedars-Sinai Medical Center in Los Angeles mistakenly administered full-strength Heparin to the Quaid twins, causing near fatal internal bleeding to occur. It was later learned that by using Heparin instead of Hep-Lock, the nurse had administered doses that were 1,000 times greater than the recommended dose.

The hospital agreed to pay the Quaids $750,000 in damages after admitting mistakes were made.”

Click here for the full story.

Venous Assessment Tool

Intravenous news: A former Birmingham-based nurse has come up with an innovative idea that is set to benefit chemotherapy patients – or anyone who needs intravenous treatment.

Sara Wells (pictured) developed two assessment tools for health care professionals to use while working as a sister on the haematology day unit at University Hospitals Birmingham (UHB) NHS Foundation Trust.

MidTECH, the West Midlands NHS Innovation Hub, has now helped Sara to find a company to develop, print and distribute VAT and DIVA commercially. The Venous Assessment Tool (VAT) and the Deciding on Intravenous Access (DIVA) were developed by Sara as part of her research for a Masters thesis.

Sara’s paper-based assessment tools help nurses to assess patients for the most appropriate device to deliver medication directly into each patient’s veins. Sara, who started a new job as a bone marrow transplant coordinator for Southampton University Hospitals NHS Trust in August, said the tools would primarily be used for chemotherapy patients.

“When a patient is admitted to hospital with haematological problems, they may need to have a range of treatments delivered into their veins,” she said. “VAT and DIVA aim to help nurses make a proactive assessment when a patient arrives to ensure the most appropriate venous access device is used. “The tools not only enable healthcare staff do a better job, by assisting in decision making, but they also help patients by reducing the risk of problems developing in relation to their intravenous treatment as their treatment progresses.

Sara, who has worked in the NHS for seven years, said she hoped her tools would be adopted by nurses across the country.

MidTECH approached 3M Health Care, of Loughborough, Leicestershire, for support and, in line with its aims, the company agreed to fund the development through an educational grant, through Tegaderm I.V. Dressings, a part of its healthcare division.

3M Health Care provides world-class innovative products and services to help healthcare professionals improve the practice, delivery and outcome of patient care in medical, oral care, drug delivery and health information markets. Emma Jenkins, Senior Marketing Executive for Tegaderm I.V. Dressings, said:  “The team at 3M felt that the tools developed by Sara provided an innovative way to support clinicians and improve patient outcomes.”

The educational grant provided by 3M covered the design and production of 2,500 laminated cards to be distributed to colleagues at UHB. This will ensure that the tools are widely distributed throughout the Trust, benefiting all clinicians involved in the care of patients receiving long-term intravenous treatment.

David Gleaves, chief executive of MidTECH, said: “We are delighted to have been able to help Sara to turn her well-researched idea into an extremely useful tool that will help healthcare professionals to deliver the best treatment for patients.”

Peripheral IV fluid dynamic properties

Intravenous literature: Weber, P.W., Coursey, C.A., Howle, L.E., Nelson, R.C., Nichols, E.B. and Schindera, S.T. (2009) Read more

Hospital wide CLABSI surveillance

Intravenous news: Sarah Cooper (IV Nurse Specialist) and her surveillance team completed a hospital-wide CLABSI surveillance Read more

Clean hands campaign 2009

Intravenous news: The Clean Hands Coalition (CHC) launches the International Clean Hands Week from September 20th to 26th Read more

Phlebotomy robot

Intravenous products: Mwdgadget.com report “Here is a project from the folks at the Department of Mechanical Engineering at Read more

Infection control and IV therapy

Intravenous literature: Higginson, R. (2009) Infection control and IV therapy in patients with Clostridium difficult. Read more

NxStage System One launched in UK

Intravenous products: Inside-Hospitals.co.uk report “The Lister Hospital in Stevenage, part of East and North Read more

Mixing of medicines

Intravenous news: The MHRA published the outcome of MLX 356 on the mixing of medicines in palliative care together Read more

IV site skin disinfection

Intravenous products: IVTEAM are pleased to announce the publication of our third sponsored product page. This Read more

Blood culture zero false positives

Intravenous literature: Thompson, F. and Madeo, M. (2009) Blood cultures: towards zero false positives. Journal of Infection Read more

CHG IV dressing review

Intravenous literature: Moureau, N.L., Deschneau, M. and Pyrek, J. (2009) Evaluation of the clinical performance of a chlorhexidine gluconate antimicrobial transparent dressing. Journal of Infection Prevention. 10 (Supplement 1), p.S13-S17.

Abstract:

Each year an estimated 250,000 cases of central line associated bloodstream infections occur in the United States (CDC, 2005). Reduction of CRBSI has become a major focus for education and initiatives to improve practice. Various antimicrobial agents and practices are supported with evidence to demonstrate impact on CRBSI. The broad spectrum activity of chlorhexidine as an antibacterial, antiviral, and antifungal agent is well accepted (Denton, 2001).

The purpose of this clinical evaluation was to statistically validate the performance of a new chlorhexidine gluconate (CHG) gel dressing. A fully integrated transparent dressing with a CHG gel pad was evaluated in six different facilities across the United States over a period of 73 days with 64 different clinicians. A total of 500 CHG gel dressings were applied during the evaluation period. The clinicians were asked to evaluate 16 levels of performance  criteria of the new CHG dress dressings and compare these areas of performance to the performance of their current CHG disk plus transparent dressing being used at their facility. Their current dressing was replaced with the new CHG gel dressing. All sites changed dressings at 24-48 hours as needed, and then at seven days. The evaluation questions were striated into four performance groups: ease of application, gel dressing performance, securement function and ‘other’. In all 16 levels of performance ratings, the CHG gel dressing was rated ’same as’, ‘better’, or ‘much better’. In addition to the antimicrobial advantages of a CHG gel dressing, clinical data demonstrates the following benefits: ease of use of a one piece CHG gel dressing, ability to fully visualise the insertion site through the gel, and absorption of fluid under the dressing. The new CHG gel dressing was well tolerated by patients and performed in a manner that equalled or well exceeded the current two step process of antimicrobial dressing application.

More information.

IV team business case

Intravenous literature: Bolton, D. (2009) Writing a business case for the expansion of service: expanding the IV therapy team, Read more

Dr Latta and IV infusion history

Intravenous literature: MacGillivray, N. (2009) Dr Thomas Latta: the father of intravenous infusion therapy. Journal of Infection Prevention. 10 (Supplement 1), p.S3-S6.

Abstract:

The paper reviews the work of Dr Thomas Latta who during the cholera epidemic of 1831-32 pioneered the use of intravenous saline infusion in the treatment of cholera. The reaction of the medical profession to this new therapy is described and the reasons for the profession’s failure to acknowledge the importance of this advance is analysed. The reasons why the name of Thomas Latta and his contribution did not survive his death in 1833 are discussed and the contributions of the twentieth century scholars in remembering his work are highlighted.

ANTT implementation and review

Intravenous literature: Rowley, S. and Clare, S. (2009) Improving standards of aseptic practice through an ANTT trust-wide implementation process: a matter of prioritisation and care. Journal of Infection Prevention. 10 (Supplement 1), p.S18-S23.

Abstract:

Aseptic technique is a critical last line of defence between patients and clinical staff. Aseptic Non Touch Technique (ANTT) recognises this and is based on the premise that reducing the variables in aseptic practice across  large clinical workforces by standardising aseptic technique will improve quality of practice and subsequently infection rates. The scale of adoption of ANTT in the National Health Service (NHS) continues to grow, with uptake estimated at between 150-250 NHS hospitals using ANTT as a standard aseptic technique. To better understand how effectively the implementation process was working in different trusts a convenience sample of acute trusts (n=7) was reviewed. The trusts used the recommended ANTT implementation framework and applicable audit tools. Feedback was requested regarding the implementation process as well as healthcare associated infection (HCAI) trends mapped before and after ANTT implementation. All seven trusts had found the ANTT implementation process an effective tool for standardising aseptic practices across large clinical workforces. Data reviewed from five of the trusts suggests the process impacted positively on HCAI trends. Limitations include appreciating ANTT implementation alongside other infection control interventions. More controlled studies appear to be warranted, especially now that ANTT is the most common standard aseptic technique in NHS hospitals.

Vascular access device range

Intravenous literature: Kelly, L.J. (2009) The family of vascular access devices. Journal of Infection Prevention. 10 (Supplement 1), p.S7-S12.

Abstract:

Adequate intravenous access is of paramount importance for patients in both acute and community care. Advances in catheter materials and techniques have resulted in a range of vascular access devices being available for use in clinical settings. This article will present an overview of vascular access devices and provide the most relevant information regarding the indications for the use of each device. For the purpose of this article the devices will be divided into short-term, intermediate-term or long-term devices.

IV cannula not removed

Intravenous news: stuff.co.nz report “Two elderly women have been sent home from Taranaki Base Hospital with the Read more

TPN infection reduction

Intravenous news: IMN.ie report ” The introduction of a dedicated total parenteral nutrition (TPN) surveillance clinical nurse Read more

IV pump connectivity

Intravenous products: News-Medical.net report “Arcomed AG, a global provider of IV pumps, and Capsule, the leading provider of Read more

Fluid management in septic shock

Intravenous literature: Murphy, C.V., Schramm, G.E., Doherty, J.A., Reichley, R.M., Gajic, O., Afessa, B., Micek, S.T. and Kollef, M.H. Read more

Wireless insulin pump

Intravenous products: MedGadget.com report “Medtronic has released a new insulin pump/continuous glucose monitoring system, called Read more

IV conference at Harrogate

Intravenous conference: It is now less than three weeks to the IPS IV Forum conference at Harrogate. If you are a professional with Read more

Hydration of terminally ill patients

Intravenous news: OncologyNursingNews.com report “Whether to hydrate terminally ill patients has been debated for decades and there Read more

IV infusion reactions in critical care

Intravenous news: UPI.com report “German researchers suggest some infusion solutions in a common intravenous treatment may cause life-threatening inflammation. The study, published in the Journal of Leukocyte Biology, found a common intravenous treatment used to boost blood pressure in critical patients contains substances called “advanced glycation end products.” This reaction among various proteins occurring after the fluid has been formulated for use is called “post-translational modification.” The researchers suggest screening infusion solutions for post-translational protein modifications and then removing the compounds.”

Click here to read the full story on UPI.com

NICU CLABSI reduction collaborative

Intravenous literature: Schulman, J., Stricof, R.L., Stevens, T.P., Holzman, I.R., Shields, E.P., Angert, R.M., Wasserman-Hoff, R.S., Nafday, S.M., Saiman, L., New York State Regional Perinatal Centers and New York State Department of Health (2009) Development of a statewide collaborative to decrease NICU central line-associated bloodstream infections. Journal of Perinatology. 29(9), p.591-9.

Abstract:

OBJECTIVE: To characterize hospital-acquired bloodstream infection rates among New York State’s 19 regional referral NICUs (at regional perinatal centers; RPCs) and develop strategies to promote best practices to reduce central line-associated bloodstream infections (CLABSIs).

STUDY DESIGN: During 2006 and 2007, RPC NICUs reported bloodstream infections, patient-days and central line-days to the Department of Health, and shared their results. Aiming to improve, participants created a central line-care bundle based on visiting a potentially best performing NICU and reviewing the literature.

RESULT: All 19 RPCs participated in this quality initiative, contributing 218,096 patient-days and 56,911 central line-days of observation. Individual RPC nosocomial sepsis infection (NI) rates ranged from 1.0 to 5.8 NIs per 1000 patient-days (2006), and CLABSI rates ranged from 2.6 to 15.1 CLABSIs per 1000 central line-days (2007). A six-fold rate variation among RPC NICUs was observed. Participants unanimously approved a level-1 evidence-based central line-care bundle.

CONCLUSION: Individual RPC rates and consequent morbidity and resource use attributable to these infections were substantial and varied greatly. No center was without infections. It is hoped that the cooperation and accountability exhibited by the RPCs will result in a major network for characterizing performance and improving outcomes.

PICC reduces femoral and subclavian CVC

Intravenous literature: Akers, A.S. and Chelluri, L. (2009) Peripherally inserted central catheter use in the hospitalized patient: is there a role for the hospitalist? Journal of Hospital Medicine (Online). 4(6)(E1-4).

Abstract:

BACKGROUND: Peripherally-inserted central venous catheters (PICCs) are frequently used in hospitals for central intravenous access. These catheters may offer advantages over traditional central catheters with respect to ease of placement and decreased complication rates. However, hospital physicians have not traditionally been trained to place PICCs.

METHODS: We trained 3 of 5 hospitalists to place PICCs in our small university-affiliated community hospital as we converted from a house physician model to a hospitalist model for inpatient care. We then looked retrospectively at the rates of all PICC and other central catheter placements as well as the number of femoral and nonfemoral catheter days for the 18-month period prior to and after the inception of the hospitalist program.

RESULTS: Comparing the periods prior to and after the inception of the hospitalist program, the total number of central catheter placements doubled and the PICC rate rose from 20% to 80% of all central catheters. The rate of femoral and subclavian catheter placements decreased by approximately 50% and the rate of internal jugular catheter placement was roughly unchanged. There was also a fall in the number of femoral catheter days and a great increase in the number of total nonfemoral catheter days. The rate of catheter-related bacteremia remained low and did not appear to increase.

CONCLUSIONS: PICCs may be a safe and easy alternative to centrally placed catheters for the hospital physician attempting to secure central intravenous access and may lead to a decrease in the need for more risky central venous catheter (CVC) insertions.

Topical epinephrine injection death

Intravenous news: FDA report “The Institute for Safe Medication Practices (ISMP) recently cited a report from the ISMP Canada Safety Bulletin about the death of a patient who was accidentally injected with topical epinephrine. The attending surgeon and nurse mistakenly thought the syringe they were using contained lidocaine with epinephrine 1:100,000.

ISMP noted an earlier case in which a child died from cardiac arrest after his ear was infiltrated with a syringe containing epinephrine 1:1,000 that had been filled from an open cup. The physician mistakenly assumed that the solution in the cup contained lidocaine with epinephrine 1:100,000.”

Click here for the full report.

Insulin pump alert from FDA

Intravenous products: FDA report “In July, Medtronic recalled certain infusion sets which are used with the company’s Mini-Med Paradigm insulin pumps to deliver insulin to diabetic patients. Because of a manufacturing error, the vents on these sets may clog and then fail to equalize the air pressure in the reservoir compartment with the surrounding atmosphere. If this happens, the pump could deliver too much or too little insulin to the patient, and that could lead to serious injury or death.”

Click here for the full report.