Failure to monitor fluid balance

NHS Tayside has agreed to apologise to the family of a 79-year-old man who died in Ninewells Hospital Read more

Urokinase meta-analysis

The authors completed a meta-analysis of prospective randomized trials that examine the use of Urokinase Read more

Heparin update New Zealand

Stewart Jessamine, Group Manager, Medsafe in conjunction with the Ministry of Health (NZ)  are continuing to monitor the situation with respect to the global problem of heparin contaminated with over-sulphated chondroitin sulphate (OSCS) entering the market.

Medicines regulators around the world have taken a number of different approaches to managing this issue.  In New Zealand, Medsafe requires all manufacturers of heparin-based products to test for the presence of OSCS in products supplied to the market. To date all of the manufacturers of heparin and low molecular weight heparin products supplied to New Zealand have reported that OSCS has not been detected in the products used by patients.

Click here for the full update.

Barcode medication system

Actor Dennis Quaid, whose twins were given an overdose of a blood thinner as newborns at a California hospital, toured a Dallas hospital on Tuesday to learn about a system to prevent such errors.

Officials at Children’s Medical Center Dallas showed Quaid and his wife, Kimberly, the hospital’s system of bar-coding medications to allow the drugs to be tracked electronically from the point of dispensing until being administered to the patient.

“This system here at Children’s Medical Center, I’m really amazed … it’s beyond cutting edge,” Quaid said at a news conference after the tour.

Click here to view the full story.

 

MedPro and Greiner

MedPro Safety Products, has entered into two medical supply manufacturing agreements with Greiner Bio- Read more

Venepuncture practice

Irene Lavery and Emma Smith from the Western General Hospital, Edinburgh contrast and compare the skill of venepuncture against the 2008 Nursing and Midwifery Council Code.

Lavery, I. and Smith, E. (2008) Venepuncture practice and the 2008 nursing and Midwifery Council Code. British Journal of Nursing. 17(13), p.824-828.

Abstract:

This article explores the new Nursing and Midwifery Council Code (2008) in relation to venepuncture and, through analysing each clause, will present key considerations for good practice. The skill of venepuncture is discussed and, using a scenario, will review the technique and the impact of the Code on the practitioner. Any clinical skill requires safe and competent practice; it is hoped that this article will aid practitioners involved in undertaking venepuncture to reflect on their skills and knowledge, and to review best practice.

Safe transfusion

The authors examine issues that impact upon the successful implementation of national guidance such as the NHS better blood transfusion programme and the NPSA safer practice notice 14, right patient, right blood.

Gray, A., Hart, M., Dalrymple, K. and Davies, T. (2008) Promoting safe transfusion practice: right blood, right patient, right time. British Journal of Nursing. 17(13), p.812-817.

Abstract:

Despite an array of initiatives designed to support the delivery of safe and appropriate transfusion practice, incidences of patients receiving the wrong blood continue to be reported. Nurses play a key role in delivering safe and appropriate transfusion care and have a responsibility to support national initiatives, such as the NHS Better Blood Transfusion programme of action and the National Patient Safety Agency Safer Practice Notice 14, Right Patient, Right Blood. This article examines factors, which impact on the successful implementation of a programme aimed at promoting best transfusion practice, such as organizational support, leadership, education and competency assessment, and the role of audit and feedback. By championing the  systematic assessment of transfusion procedures, the implementation of education and guidelines and the use of innovative approaches, such as care bundles, we can ensure that nurses have the appropriate knowledge, skills and understanding to provide the highest standards of transfusion care to our patients.

 

Systematic review anti-infective CVC

These two recently published systematic reviews consider the impact of anti-infective-treated central Read more

Medical Device Alert MDA/2008/051

The MHRA have issued  a medical device alert (MDA/2008/051) which concerns the Kimal safety fistula needle. Kimal is aware of the potential for the unintentional retraction of the cannula into the protection sheath, which can result in exsanguination.  As a result, Kimal is recalling all lots of the device. 

 Click here to view the alert. 

 

Intraosseous access in children

This article reviews the safety of powered intraosseous devices in pediatric patients. The authors state that ”the rare and minor complications suggest that the powered IO device is a safe and effective means of achieving vascular access in the resuscitation and stabilization of pediatric patients” (Horton and Beamer 2008).

Horton, M.A. and Beamer, C. (2008) Powered intraosseous insertion provides safe and effective vascular access for pediatric emergency patients. Pediatric Emergency Care. 24(6), p.347-350.

Abstract:

OBJECTIVE: For decades, intraosseous (IO) access has been a standard of care for pediatric emergencies in the absence of conventional intravenous access. After the recent introduction of a battery-powered IO insertion device (EZ-IO; Vidacare Corporation, San Antonio, TX), it was recognized that a clinical study was needed to demonstrate device safety and effectiveness for pediatric patients.

METHODS: We measured the insertion success rate, patient pain levels during insertion and infusion, insertion time, types of fluid and drugs administered, device ease of use on a scale of 1 (easy) to 5 (difficult), and complications.

RESULTS: There were 95 eligible patients in the study; 56% were males. Mean patient age was 5.5 +/- 6.1 years. Successful insertion and infusion was achieved in 94% of the patients. Insertion time was 10 seconds or less in 77% of the one-attempt successful cases reporting time to insertion. There were 4 minor complications (4%), but none significant. For patients with a Glasgow Coma Scale (GCS) score >8, mean insertion pain score was 2.3 +/- 2.8, and mean infusion pain score was 3.2 +/- 3.5. The device was rated easy to use 71% of the time (n = 49) and the mean score was 1.4.

CONCLUSIONS: The results of this study support the use of the powered IO insertion device for fluid and drug delivery to children in emergency situations. The rare and minor complications suggest that the powered IO device is a safe and effective means of achieving vascular access in the resuscitation and stabilization of pediatric patients.

Fist clenching during phlebotomy

The authors describe the potential impact of fist clenching during blood sampling upon the incidence of pseudohyperkalaemia.

Bailey, I.R. and  and Thurlow, V.R. (2008) Is suboptimal phlebotomy technique impacting on potassium results for primary care? Annals of Clinical Biochemistry. 45(3), p.266-269.

Abstract:

Background: Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local phlebotomy clinics optimized their technique.

Methods: The effect of improving phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive.

Results: Primary care population serum potassium was inversely related to ambient temperature. Following the change in phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%.

Conclusions: Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during phlebotomy to pseudohyperkalaemia has been underestimated.

Epidural and IV confusion

In 2006 Jasmine Gant, 16, died following a mistake by nurse Julie Thao. Jasmine died following an inadvertent disconnection of her epidural during childbirth. Thao mistakenly attached the epidural to the IV device.

The Wisconsin State Journal state that progress has been made to increase the safety associated with tubing connections, but obstacles continue.

“It’s inching along,” said Rod Hicks, a professor at Texas Tech University and former research manager at U.S. Pharmacopeia, a nonprofit organization that sets standards for the drug industry. “But these errors can still occur. We have not made the world a safer place yet.”

This article calls for industry to provide the solution to safer tubing connections in healthcare.

Click here to read the full story.

Revised EU monographs for heparin

The MHRA have reported a revision of European Pharmacopoeia monographs for heparin.

“Following increased reports of adverse events associated with heparin preparations in the United States of America and some European countries, the European Pharmacopoeia monographs for Heparin Calcium (0332) and Heparin Sodium (0333) have undergone rapid revision and implementation in order to strengthen the level of testing required for quality control.

The revised monographs were adopted by the European Pharmacopoeia Commission on 25 June 2008 and are expected to come into effect on 1 August 2008, pending a decision by the European Committee on Pharmaceuticals and Pharmaceutical Care (CD-P-PH).

The revised monographs will be published in European Pharmacopoeia Supplement 6.4 and supersede the relevant monographs published in the British Pharmacopoeia 2008 and 2009 editions.

Further information and copies of the monographs can be obtained from the EDQM (European Directorate for Quality of Medicines & HealthCare) website“.

Redesigned peripheral IV catheter

The launch of the VantageCath has seen a radical redesign of the traditional peripheral IV catheter. Designed to not only prevent unexpected needlestick injuries, but also to eliminate the spillage of blood during the IV placement. The device is a product of a firm called Advantage Medical Devices from Solana Beach, CA.

Advantage Medical Devices state:

“The VantageCath is an innovative peripheral Intravenous (IV) Catheter Safety System designed to significantly reduce blood borne pathogen exposure without compromising the “pop and glide” that users want and need. Utilizing a patented “closed hub” design, blood is contained during the entire cannulation and needle retraction process. This eliminates the need to tamponade above the site of the IV catheter and allows the provider to have both hands free to secure the IV and attach tubing using sterile technique”.

Click here to view product animation.

Click here to view product page.

Needle and syringe redesigned

Christopher Holden has won an award redesigning the traditional needle and syringe. The ‘MediDome’ aims to eliminate needlestick injuries, simplify the process and speed up patient treatment.

Christopher has won a National Patient Safety Award of £3000 and NCR Internship worth £4000 for a duration of four weeks.

Christopher explains how the product works:

“A sterile cover is removed to expose adhesive wings that stick the MediDome to the required area for injection. The person administering the injection removes the blister cap and presses down on the top of MediDome until a little resistance is felt. A bubble on one of the wings is checked for blood - if it fills up the injection is halted. If all is well, they then give a small firm press until a click is heard, then softly compress and hold the dome. On release, MediDome returns to its original shape (but cannot be compressed again), is removed from the arm and disposed of for incineration. It is a fail safe single use design - once used it can never be used again, so syringes cannot be shared, and viruses such as HIV or blood born diseases cannot be passed on”.

Click here for more information.

 

Pediatric CVAD blood sampling

Kathleen Adlard examines the issues of central venous access device blood sampling from pediatric cancer patients.

Adlard, K. (2008) Examining the Push—Pull Method of Blood Sampling From Central Venous Access Devices. Journal of Pediatric Oncology Nursing. 25(4), p.200-207.

Abstract:

“The placement of a central venous access device (CVAD) has revolutionized supportive care for pediatric cancer patients. The CVAD is used to administer chemotherapy/biotherapy, blood products, total parenteral nutrition, antibiotics, and many other supportive medications. CVADs also provide the ability to obtain blood samples without the trauma associated with venipuncture. Frequent blood sampling is often needed to monitor the side effects and response of the cancer treatment. Unfortunately, the most common method requires discarding blood (0.5-10 mL, depending on the institution’s protocol) with each lab draws, for various reasons. For pediatric oncology patients, this can result in a large volume of blood being discarded and subsequently increase the need for blood transfusions. Repeated exposure to allogeneic (donor) blood products can put this patient population at additional risk for alloimmunization and febrile reactions. The purpose of this study is to test the limits of agreement between laboratory values (chemistry panel 18 and complete blood count) obtained using the push—pull and standard methods of blood sampling from CVADs in pediatric oncology patients” (Adlard 2008).

AVA conference brochure

The Association for Vascular Access (AVA) have published the brochure for the 22nd Annual Read more

Cannula insertion documentation

Our recent IVTEAM poll has just finished. We asked the question “Should you record lot/batch numbers following cannula insertion”? 87% of IVTEAM visitors felt that it was important to record lot/batch numbers. Thank you to all who voted.

Our new poll has just been launched. IVTEAM are now asking “When securing a peripheral cannula do you use strips for additional fixation”?

Please visit our poll at the bottom of the page and cast your vote now.

Fatal injection of ranitidine

This case study describes the case of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac(R) 50mg prescribed as a routine post-surgical prophylaxis for stress ulcer.

Oliva, A. et al (2008) Fatal injection of ranitidine: a case report. Journal of Medical Case Reports. 2, p.232.

Abstract:

Introduction: Ranitidine hydrochloride (Zantac®), a histamine-2-receptor antagonist, is a widely used medication with an excellent safety record. Anaphylactic reaction to ranitidine is an extremely rare event and a related death has never been described in the literature.

Case presentation: We present the clinical history, histological and toxicological data of a 51-year-old man with negative anamnesis for allergic events, who died suddenly after the intravenous administration of one phial of Zantac® 50mg prescribed as a routine post-surgical prophylaxis for stress ulcer. 

Conclusions: Although the incidence of anaphylactic reactions related to ranitidine is low, caution needs to be exercised on administration of this drug. In addition, further study is needed to define strategies for the prevention of adverse drug reactions in hospitalized patients. 

Click here to view the article.

Wristband warnings

IVTEAM have reported before on the use of wristbands in healthcare (click here). Well, its back in the press and yes we still have a problem with the ‘Do Not Resuscitate’ wristband!

BroMenn Healthcare and St. Joseph announced Monday that the two health care organizations have collaborated on color-coded wristbands to immediately alert doctors and hospital staff to critical information about patients. Eureka Community is part of BroMenn Healthcare.

“It’s an exterior red flag to (staff) that there’s something to be aware of,” explained Mary Anne Kirchner, a registered nurse and BroMenn clinical education specialist.

A red band indicates a patient allergy, yellow identifies a patient at risk of falling, purple is a sign that the patient has a do-not-resuscitate order on file, and pink is for patients with an arm or leg that shouldn’t be used for procedures such as blood pressure checks, intravenous infusions and blood draws.

Click here for the full story.

Vascular access in court

Four condemned prisoners are attempting to stop executions in Mississippi. They say the state’s method of lethal injection is unconstitutional because it might cause pain.

The inmates have issues with numerous parts of the process. One particular issue that they highlight is that they believe the insertion of the intravenous needle could also be a painful because the execution staff in Mississippi are not properly trained.

State officials dismiss the allegations, saying in court papers that the staff “is a highly trained team of paramedics” and that a state pathologist is on hand.

Click here for the full story.

ASHP’s IV Safety Summit

ASHP and its partners will gather healthcare practitioners, thought leaders and medication-safety experts from around the nation to achieve consensus on actions that bring about real and lasting improvements in the use of IV medications, protecting patients from harm and death due to errors.

Summit Goals

• Achieve consensus on an initial set of broadly applicable standard practices and methods that are effective in preventing patient harm or death associated with the use of intravenous medications.
• Identify barriers to adoption or implementation of the practices and recommend specific actions to overcome them. Practices will be prioritized into an essential core group for immediate implementation and those requiring a phased-in approach.
• Identify areas for future research and issues that are specific to and should be resolved by various stakeholder groups.

The summit will take place on July 14 & 15, Rockville, Maryland. The organizers request that you check the ASHP website for summary materials and updates.

 

ANTT conference

The Aseptic Non Touch Implementation team have announced the 1st National Conference on Aseptic Non Touch Technique (ANTT) on the 29th September 2008 - London, UK. This National Conference for ANTT will present important latest evidence and developments from leading NHS hospitals.

Speakers include; Dr Carole Pellowe will update on EPIC2 progress and explain how ANTT is the vehicle for hospitals to successfully deliver best aseptic practice guidance from EPIC2, DOH and the ICP in the workplace. Renowned experts in the field; Stephen Rowley, Dr Peter Wilson, Annette Jeanes and Andrew Jackson will provide practical insight and the context of aseptic management in health care settings.

Click here for further information.

 

Neonatal IV dressing

Neonatal IV dressing technique is under represented in the literature. This article attempts to redress the balance.

Sharpe, E.L. (2008) Tiny Patients, Tiny Dressings: A Guide to the Neonatal PICC Dressing Change. Advances in neonatal care. 8(3), p.150-62.

Abstract:

Advances in neonatology now support the survival of the tiniest of infants. The peripherally inserted central catheter (PICC) has now become an integral part of routine practice in neonatal intensive care units around the world. Keen attention to safe maintenance of these devices is essential. A properly applied and maintained PICC dressing is the first line of defense to minimize the risk of complications such as dislodgement, migration, and infection. This article describes a neonatal PICC dressing change and discusses the frequently encountered quandaries surrounding this important procedure, including dressing materials, frequency, site preparation, barrier precautions, and other relevant concerns.

 

External jugular Groshong catheter

This article attempts to demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access.

Ishizuka, M., Nagata, H., Takagi, K., Horie, T., Furihata, M.., Nakagawa, A. and Kubota, K. (2008) External jugular Groshong catheter is associated with fewer complications than a subclavian Argyle catheter. European surgical research. 40(2), p. 197-202.

Abstract:

BACKGROUND: To demonstrate the efficacy and safety of insertion of a Groshong catheter via the external jugular vein (EJV) for central vein access. METHODS: Central venous access was done by either insertion of a Groshong catheter via the EJV or an Argyle catheter via the subclavian vein with single puncture. RESULTS: Eighty patients (group 1) were treated with 146 subclavian venous catheters for 2,770 catheter-days, and 98 patients (group 2) were treated with 147 external jugular venous catheters for 2,381 catheter-days. Fever appeared in 36.3% (53/146) and 16.3% (24/147) of the patients in groups 1 and 2, respectively (p < 0.01). The malposition and pneumothorax rates were 17.1% (25/146) and 2.0% (3/147; p < 0.01), and 2.7% (4/146) and 0% (0/147; p < 0.05) in the two groups, respectively. CONCLUSIONS: Insertion of a Groshong catheter via the EJV is more acceptable for central venous access than insertion of a conventional subclavian venous catheter.

 

PICC’s for children with cancer

This article describes PICC’s as a convenient, reliable vascular access device for children with cancer.

Abedin, S. and Kapoor, G. (2008) Peripherally inserted central venous catheters are a good option for prolonged venous access in children with cancer. Pediatric Blood & Cancer. 51(2), p. 251-5.

Abstract:

BACKGROUND: A long term venous access device is essential in children with malignancies for the safe administration of medication and to avoid repeated painful venipunctures. The advantage of peripherally inserted central venous catheters (PICC) over conventional central venous catheter (CVC) is easy bedside insertion without need for general anesthesia and theatre time. The purpose of this study was to evaluate our experience with PICCs particularly with regard to catheter life, reason for removal and complications in children suffering from various malignancies. PROCEDURE: A retrospective analysis of all PICCs inserted in children with cancer was done with regard to the demographic data, catheter life, reason for removal, and complications. The latter two were evaluated in association with patient age, catheter days, and year of insertion. RESULTS: Of 127 catheters inserted in 127 children, median catheter life was 161 days with a total of 18,955 catheter days (for 124 patients, 3 lost to follow-up). Elective removal occurred in 63/101 (62.4%) PICCs and removal due to complications resulted in a complication rate of 2.41 per 1,000 catheter days. The common reasons for catheter removal were suspected infection, breakage/leakage, dislodgement, phlebitis, and occlusion with rates of 1.27, 0.57, 0.31, 0.06, and 0.06 per 1,000 catheter days, respectively. CONCLUSION: We found PICC to be a convenient, cheap, safe, and reliable device for long term intravenous access in children with malignancies. This was possible with the help of dedicated catheter care nurses.

 

VisIV container reduces IV waste

Kennedy Health System recently announced that it has implemented the VisIV flexible intravenous container. Read more

Extravasation injury baby

Baby Lai Yok Shan, who lost her left arm soon after birth when it turned gangrenous, turned one year old on Read more

Baby died following extravasation

A coroner has ruled doctors at a Plymouth hospital were not to blame for the death of a two-week-old premature baby who died after the contents of her feeding tube leaked.

A paediatric expert at the inquest, Professor Peter Fleming, agreed with the doctors who treated Brooke, that the feeding fluid had led to a chemical erosion of the blood vessel it was in, causing it to leak into her liver and abdomen.

The coroner’s narrative verdict acknowledged the leakage contributed to Brooke’s death, but said her feeding tube had been inserted correctly by doctors.

The photograph shows Brooke Herridge who was born prematurely at 27 weeks.

Click here for the full story.

 

Marines learn IV access

Marines of 9th Engineer Support Battalion, 3rd Marine Logistics Group, practiced saving lives during the Combat Lifesavers Course.

With a limited number of corpsmen in the field, Marines often have to rely on fellow Marines to provide initial care. That’s one reason why deploying units must be 100 percent combat lifesaver certified, according to Petty Officer 2nd Class Prayot Bunmeema.

“Typically there is only one corpsman per squad of 15 Marines, and the corpsman can’t always be where he is needed,” he said. “That’s where the combat lifesaver Marines come in.”

Students learned how to assist victims who have lost too much blood by learning to insert and manage intravenous therapy to replenish bodily fluids, which is also a treatment for shock.

“The best part of the training is definitely the IVs,” said Pfc. Michael Schumacker, a bulk fuel specialist with 9th ESB.

Click here to view the full story.

 

Child cannulation competencies

The RCN have available an education and training competency framework for peripheral venous cannulation in children and young people.

The framework identifies the competencies,learning outcomes and the indicative content necessary for education and training programmes to meet the needs of children and young people.It aims to support consistent curriculum and practice development so that practitioners can develop and,maintain the ability to carry out this task, regardless of where they work.

Click here to view the document.

Syringe disconnection alert

The MHRA have issued an alert warning of inadvertent syringe disconnection.

The issue is with procedure packs from various manufacturers which contain BD Medical Surgical Systems 2ml, 5ml and 10ml Plastipak Luer slip syringes.

The warning points to potential for the BD Luer slip syringes supplied in procedure packs to spontaneously disconnect or fail to maintain a secure connection to Luer fittings of other devices.

Click here for further information.

Potential infusion error

The MHRA have  issued an alert warning of potential infusion device drug error when using the Smiths Medical Graseby Omnifuse and Omnifuse PCA syringe pumps.

The MHRA have warned of the possibility of patients being given an additional/unnecessary infusion when syringes are changed or infusions restarted when using DrugPro software. If the user selects – but does not confirm – a drug protocol from the drug protocol library and then resets/stops the pump, the previously infused volume will not be added to the ‘total volume infused’ display.

Click here for further information.

Fatal intrathecal drug error

The Times of India reports that a 37-year-old engineer died on Wednesday morning, allegedly because of Read more

Central catheter infection rates

New York city and New York state hospitals report catheter related blood stream infection rates.

In New York City, 2.8 out of 1,000 central lines at medical intensive care units resulted in infections, compared to 3.6 upstate. In the city, another 2.7 out of 1,000 central lines in surgical ICUs resulted in infections, compared to 4.8 in upstate facilities.

Officials credited a collaborative among 60 hospitals in the New York metropolitan area aimed at reducing hospital-acquired infections. According to the most recent data provided by the collaborative, which was established in 2005 by the United Hospital Fund and the Greater New York Hospital Association, the rate of central line infections was 2.33 infections for each 1,000 central line days as of December 2007, down from 4.98 infections for each 1,000 central line days in June 2005.

Click here for the full story.

Another story click here.

High tech clean rooms

Hamad Medical Corporation has established the first pharmacy manufacturing  clean rooms in the Middle East. The clean rooms are being established in a bid to improve pharmaceutical activities within the corporation. Fully automated chemotheraphy machines have been installed in these rooms, which ensure sterile products, reduce human error and infections to patients.

Opening three such rooms yesterday at the hospital’s pharmacy department were Mohamed al-Nama, assistant executive director; Abdul-Rasak al-Kubaisi, assitant managing director Operations; Manal Borhan al-Zaidan, Al-Amal Cancer Centre director of Pharmacy; as well as corporation’s director of Marketing and Public Relations Mohamed al-Noaimi.

Al-Zaidan said that the decisions by the corporation to set up the additional clean rooms were to reiterate its commitment to excellence in patient care.

“These clean rooms are first of its kind in the Middle East and it is also very rare to find in the world as well with its high standard installations,” she said.

Click here to view the full story.

Click here for another story.

Heparin overdose

A Corpus Christi hospital says 14 babies in its neonatal intensive care unit received overdoses of the Heparin. 

Christus Spohn Hospital South CEO Bruce Holstein says the error in the dosage of the medicine - used to flush intravenous lines to prevent blood clots from forming - was discovered Sunday night by hospital nurses. He says the nurses noticed abnormalities in lab tests. 

Pharmacy operations were halted temporarily Monday. He said the error was believed to have happened in the pharmacy when the medicine was mixed.

Click the following links for the full story - Fox News - KRISTV - CBS News

UPDATE: The error was unrelated to product labeling or packaging of pediatric heparin, according to the statement by Dr. Richard Davis, chief medical officer of Christus Spohn Health System. 

IVTEAM beat nursing shortage

Dan Ast is a member of the IV therapy team at Via Christi Regional Medical Center-St. Joseph Campus.

As the nursing shortage worsens, Via Christi has adopted new ideas to make up for vacancies, things like the specialization of nurse tasks like those carried out by Ast and his team.

His bosses say these ideas have saved nurse time and improved care in spite of the shortage.

“It’s pretty simple how we can help,” Ast said, leaning back in his chair in his blue scrubs. “We’re nothing special compared with any other nurses, but we specialize in placing IVs, so we get really good at it. It’s not easy to place an IV, so a nurse on rounds might take 30 minutes to find and gather all the materials, then find the vein, then place it.

“I can do it all in 10 minutes or less.”

Saad Ehtisham, the senior vice president and chief nursing officer for Via Christi Wichita Health Network, said the IV team and other specialist teams created at Via Christi have become invaluable at a time when the vacancies have left hospitals 8.8 percent short of the registered nurses they need.

Click here for the full story.

Fresenius acquire APP

Fresenius will acquire APP Pharmaceuticals, the US manufacturer of intravenous drugs, for $3.7 billion (£1.9 billion) in a deal that will help the German dialysis specialist break into the American market.

APP, the second-largest maker of intravenous generic drugs in the United States, will complement Fresenius’ Kabi unit, a global supplier of infusions and gastric tube feeding equipment, which so far has lacked a U.S. presence.

APP shareholders will receive $23 a share in cash, a 29 per cent premium to the last closing share price.

Follow the link for the full story in the Times or here for Forbes.

FDA update on heparin

The FDA have recently released a video update on the contaminated heparin issue.

Over the past several months, FDA has been alerting healthcare professionals and the public about medical products that may contain contaminated heparin, which has been associated with a number of serious adverse events. Here is an update and recommendations on this continuing issue.

If the video does not show click here.

FDA update page here.

 

Vascular access infection control

This article highlights the importance of education in infection prevention. The authors illustrate that procedures may be common place, however they discover that the delivery of education related to vascular access and infection prevention is limited.

Higgins, M. and Evans, D.S. (2008) Nurses’ knowledge and practice of vascular access infection control in haemodialysis patients in the republic of ireland. Journal of Renal Care. 34920, p.48-53.

Abstract:

“Vascular access hygiene is an integral component of haemodialysis care. Ensuring nurses possess sufficient knowledge and utilise recommended guidelines on infection control is essential for safe practice and patient safety. The study aimed to investigate nurses’ knowledge and practice of vascular access infection control among adult haemodialysis patients in the Republic of Ireland. A confidential self-completion questionnaire was sent to all 190 qualified nurses employed in nine haemodialysis units in the Republic of Ireland, which assessed knowledge and behaviour in infection control. Although 92% of respondents reported that policies had been developed by their units and 47% had received infection control education in the previous year, knowledge and adherence to best practice demonstrated significant scope for improvement. The study recommended the development of standard guidelines and regular reviews and updates of policies. Systems should also be developed to ensure a high level of compliance” (Higgins and Evans 2008).

Neonatal procedure pain

A paper in JAMA examines painful and stressful procedures in neonates cared for in Parisian intensive care units, and comes to the conclusion that on average, each baby undergoes about 10 painful procedures a day, the majority with no analgesia at all. Many of these are repeated failures of common procedures such as insertions of intravenous cannulas or central catheters. The authors acknowledge the difficulties of effective analgesia in neonates, but suggest that the evidence that early pain can have lasting consequences means ICU staff need to think carefully about the risks and benefits of ‘routine’ practices

Carbajal et al (2008) Epidemiology and Treatment of Painful Procedures in Neonates in Intensive Care Units. JAMA. 300, p.60-70. 

Pharmacy admix training

Trinity Regional Health System are to offer training programs for pharmacy technicians, those who prepare medications and assist licensed pharmacists. Previously, pharmacy technicians have been required to have only a high school education and a clean criminal record. New state laws in both Iowa and Illinois will ensure they require certification.

“This program is all about medication and patient safety when they come into the hospital. More education for staff means increased leadership and quality of standards,” said Amy Descamps, Trinity’s lead pharmacy technician, who will also be the training program’s lead instructor.

A 2006 case involving Emily Jerry, a 2-year-old cancer patient in Ohio, seems to have triggered a nationwide change in laws regarding pharmacy technicians. The girl’s abdominal tumor, which was the size of a grapefruit, had responded to treatment and shrunk. During her last round of chemotherapy, though, a pharmacy technician formulated her medicine at 26 times the level it should have been. The error went unnoticed and the girl died three days later.

Click here for the full story.

Refeeding syndrome

This recently published article in the BMJ reminds us of the critical issues associated with refeeding syndrome.

Mehanna, H.M., Moledina, J. and Travis, J. (2008) Refeeding syndrome: what it is, and how to prevent and treat it. BMJ. 336, p.1495-1498.

Abstract:

“Refeeding syndrome is a well described but often forgotten condition. No randomised controlled trials of treatment have been published, although there are guidelines that use best available evidence for managing the condition. In 2006 a guideline was published by the National Institute for Health and Clinical Excellence (NICE) in England and Wales. Yet because clinicians are often not aware of the problem, refeeding syndrome still occurs. This review aims to raise awareness of refeeding syndrome and discuss prevention and treatment. The available literature mostly comprises weaker (level 3 and 4) evidence, including cohort studies, case series, and consensus expert opinion. Our article also draws attention to the NICE guidelines on nutritional support in adults, with particular reference to the new recommendations for best practice in refeeding syndrome. These recommendations differ in parts from—and we believe improve on—previous guidelines, such as those of the Parenteral and Enteral Nutrition Group of the British Dietetic Association” (Mehanna et al 2008).

UK IVTEAM win award

A new IV team were the overall winners at the Calderdale and Huddersfield NHS Foundation Trust’s annual awards for staff innovation and excellence. Sian Bloomfield, Bev Waller and Bernie Coll are the “IV Team”.

This team tours Huddersfield Royal Infirmary and the Calderdale Royal Hospital, advising staff on the best ways of inserting tubes into patients as a way of reducing the risk of infection.

The Team won the £5,000 Gordon McLean Award, to be re-invested in the project.

Bev said: “We are shocked but very pleased; but this is not just our success.” Sian said: “This is the success of staff on the wards as they are the ones making the changes.”

The team has created new documentation, standardised equipment and set up a special IV trolley. It is so good the Government’s Health Department wants to widen its use among other hospital trusts.

I would also like to congratulate them… well done to you all… keep up the good work.

Click here for the full story.

Central venous access devices

Lynn Hadaway  has recently published an article that examines the essential care issues of central venous access devices.

Hadaway, L. (2008) Targeting therapy with Central Venous Access Devices. Nursing. 38(6), p.34-40.

Abstract: 

Zero in on your role in managing these common I.V. catheters so you can protect your patient from complications.

 

 

Topics in this article include:

• CVAD location
• Preventing infection
• CVAD management guidelines
• Stabilization advice
• Dressing changes
• Facts about flushing
• Flush solution
• Blood reflux after flushing
• Needlefree devices
• Removing the catheter

 

Environmental IV

I am very pleased to see that environmental questions are being asked of intravenous therapy.

Missoula’s two hospitals are moving toward sustainability and green practices as they examine the environmental health of the workplace.

Across the country, reducing waste, eliminating mercury and improving environmental stewardship is a trend evolving in the health care industry.

St. Patrick Hospital and Health Sciences Center was one of 141 hospitals, health systems and health care organizations recently awarded for its efforts by the nonprofit Practice Greenhealth.

Across town, Community Medical Center’s environmental awareness work group will hold its first meeting Friday to pursue green practices.

The hospital is also working to eliminate mercury in lab reagents and PVC plastics in intravenous tubing.

Click here for the full story.

 

Patient experience video

AstraZeneca have launched a website that allows anyone to upload a video of their experience with needles. It only contains a few videos at the moment. But over time I can see how health professions may benefit from patient experience posted on the Internet.

Thank you to Jon Moss for highlighting this site - you can check out his review of the ihateneedles site here or you can go straight to the videos at the ihateneedles site by clicking here.

Wireless may disrupt IV devices

It have recently been reported that Wireless systems used by many hospitals to keep track of medical equipment can cause potentially deadly breakdowns in lifesaving devices such as electronic infusion devices.

Some of the microchip-based “smart” systems are touted as improving patient safety, but a Dutch study of equipment — without the patients — suggests the systems could actually cause harm.

The wireless systems send out radio waves that can interfere with equipment such as respirators, external pacemakers and kidney dialysis machines, according to the study.

Researchers discovered the problem in 123 tests they performed in an intensive-care unit at an Amsterdam hospital. Patients were not using the equipment at the time. Nearly 20 percent of the cases involved hazardous malfunctions that would probably harm patients. These included breathing machines that switched off; mechanical syringe pumps that stopped delivering medication; and external pacemakers, which regulate the heart, that malfunctioned.

Click here to read the full story.

Click here for the story again - different report.

UPDATE - Another news item - Wireless Hospital Tracking System Study Needlessly Alarms Public.

Barcode patient

The nurse scans the wristband barcode to make sure it matched information on his medication and on her computer screen.

Wayne Memorial’s new Bedside Medication Verification (BMV) program officially launched this month. BMV supports the “Five Rights” of Medication Management: Right Patient, Right Medication, Right Dosage, Right Route, and Right Time. Caregivers scan the patient’s wristband barcode and then scan the code on the medication to be administered to correctly identify that the right medication at the right dose is being given to the right patient at the right time and by the right route (intravenous, oral, etc). 

 “This is a real milestone for Wayne Memorial,” said David Hoff, Chief Executive Officer. “BMV is one of the most important steps we’ve ever taken for patient safety.”    

Click here for more on this story

 

Jugular v Femoral catheterization

Parienti et al (2008) compare the risk of nosocomial complications associated with jugular and femoral central catheterization.

Parienti J.J., Thirion M., Megarbane B., Souweine B., Ouchikhe A., Polito A., Forel J.M., Marque S., Misset B., Airapetian N., Daurel C., Mira J.P., Ramakers M., du Cheyron D., Le Coutour X., Daubin C., Charbonneau P. and Members of the Cathedia Study Group (2008) Femoral vs jugular venous catheterization and risk of nosocomial events in adults requiring acute renal replacement therapy: a randomized controlled trial. JAMA, 299(20), p.1538-3598.

Abstract:

“Based on concerns about the risk of infection, the jugular site is often preferred over the femoral site for short-term dialysis vascular access. To determine whether jugular catheterization decreases the risk of nosocomial complications compared with femoral catheterization. A concealed, randomized, multicenter, evaluator-blinded, parallel-group trial (the Cathedia Study) of 750 patients from a network of 9 tertiary care university medical centers and 3 general hospitals in France conducted between May 2004 and May 2007. The severely ill, bed-bound adults had a body mass index (BMI) of less than 45 and required a first catheter insertion for renal replacement therapy. Patients were randomized to receive jugular or femoral vein catheterization by operators experienced in placement at both sites. Rates of infectious complications, defined as catheter colonization on removal (primary end point), and catheter-related bloodstream infection. Patient and catheter characteristics, including duration of catheterization, were similar in both groups. More hematomas occurred in the jugular group than in the femoral group (13/366 patients [3.6%] vs 4/370 patients [1.1%], respectively; P = .03). The risk of catheter colonization at removal did not differ significantly between the femoral and jugular groups (incidence of 40.8 vs 35.7 per 1000 catheter-days; hazard ratio [HR], 0.85; 95% confidence interval [CI], 0.62-1.16; P = .31). A prespecified subgroup analysis demonstrated significant qualitative heterogeneity by BMI (P for the interaction term 28.4). The rate of catheter-related bloodstream infection was similar in both groups (2.3 vs 1.5 per 1000 catheter-days, respectively; P = .42). Jugular venous catheterization access does not appear to reduce the risk of infection compared with femoral access, except among adults with a high BMI, and may have a higher risk of hematoma” (Parienti et al 2008).

Community IV care

Linda Kelly has recently published an article that examines the care of vascular access devices in community care.

Kelly, L. (2008) The care of vascular access devices in community care. British Journal of Community Nursing. 13(5), p.1462-4753.

“Infusion therapy is now an integral part of the majority of nurses’ professional practice (RCN, 2006). Infusion therapy is no longer confined to secondary care, and home intravenous therapy is becoming more commonplace (Keyley, 2002). As nurses, we are responsible for maintaining our skills and knowledge in relation to all aspects of patient care (RCN, 2006). This article provides an overview of the types of vascular access devices used in primary care, and provides guidance and recommendations to ensure best practice. Although there are many complications associated with vascular access devices (Docherty, 2006) this article will focus on the prevention of infection and maintainace of catheter patency in vascular access devices. Infection is one of the most serious complications that can result from the presence and use of a central venous catheter (Humar et al. 2000), however careful management of these devices can minimize the complications associated with infusion therapy” (Kelly 2008). 

 

ASHP House of Delegates

The House of Delegates of the American Society of Health-System Pharmacists (ASHP) considered a number of professional issues during its 60th annual session in Seattle. One such issue was…

“Standardization of Intravenous Drug Concentrations: To develop nationally standardized drug concentrations and dosing units for commonly used high-risk drugs that are given as continuous infusions; further, to encourage all hospitals and health systems to use infusion devices that interface with their information systems and include standardized drug libraries with dosing limits, clinical advisories, and other patient-safety-enhancing capabilities”.

Click here for more on this story.

 

Nursery ICU CRBSI free

UCSF’s William H. Tooley Intensive Care Nursery has gone 135 days without a single central line-associated bloodstream infection.

“The reduction in infection is really due to a change in culture at UCSF,” says Michelle Cathcart, RN. “Dr. Yao Sun has been instrumental in creating the cultural shift which supports nurses in their role as gatekeepers.”

In addition to hand hygiene, nurses at UCSF also enforce no wearing of jewelry or long-sleeve shirts in the NICU. These rules apply to anyone touching a baby, including nurses, physicians and family members. UCSF best practices also include the use of chlorhexidine, an antimicrobial agent for cleaning skin, and training a core group of nurses to do dressing changes for central lines.

Click here for the full story.
 

Preparing IV’s

Bruce Flickinger writes about the legislation associated with compounding sterile preparation.

“Things have changed in the past 20 years. Although avoiding contamination may be possible in such uncontrolled conditions, nobody now would admit to mixing intravenous and other sterile preparations on an open countertop. Doing so could cost a pharmacist his license and his livelihood, not to mention potentially compromise the safety of his patients and employees”.

Bruce further writes… “Standards for sterility and safety now have been codified in USP Chapter <797>, a federally enforceable standard introduced in 2004 and published in revised and updated form just this month”.

Click here for the full online article.

 

VuStik Inc.

VuStik Inc. has developed a machine that helps nurses decide where to stick a needle for intravenous access

Read more

Clinical skills network

The Clinical Skills Network - Yorkshire and Humberside have recently launched a new website. The network recognises that…

“Many challenges are faced when setting up clinical skills centres often requiring creative and innovative solutions with requests for information, support and guidance at a pragmatic level been continually sought from more established institutions. It has become clear that a support network is needed where individuals can come together to discuss issues of concern; share good practice and reduce the potential for re-invention of the wheel”.

Click here to visit the Clinical Skills Network.

IV history

Neil MacGillivray writes in the Herald about Dr Thomas Latta who was one of the forefathers of infusion therapy. Asking “if it is time for Edinburgh to honour the memory of a remarkable pioneer whose work has been largely forgotten”. 

“Dr Thomas Latta of Leith, who, during a cholera epidemic in 1832, treated cholera for the first time by the intravenous injection of saline, reporting his findings in a letter to the Lancet in May 1832, has been forgotten. His use of intravenous saline was for the time a remarkable attempt to correct the catastrophic loss of body fluids which is the main cause of death in cholera. Many decades were to pass before fluid replacement became recognised as the standard treatment that is in use today ” (MacGillivray 2008).

MacGillivray continues “A colleague of Latta’s in the Edinburgh Cholera Hospital in Drummond Street, Dr John Mackintosh, wrote after Latta’s death in 1833″: “Although Dr Latta’s exertions and fate must have been known to a number of influential men, his grave does not exhibit any monument of public gratitude.”

If you want to read more about Thamas Latta you will find an excellent article by Neil MacGillivray here.

 

Vascular Access Team

Specialist nurses are working across the Royal Devon & Exeter NHS Foundation Trust to develop and improve Intravenous Access – one of many initiatives expected to collectively contribute to a reduction in healthcare associated infections.

Over the next year the Vascular Access Team will be assessing current IV access practice at the RD&E hospital, developing practice to ensure patients are assessed and given the appropriate IV device for their healthcare needs; carrying out audit work to ensure lines are appropriately managed and the risk of infection reduced; and taking an active role in educating medical and nursing staff about the insertion, care and removal of IV devices.

Pictured from right to left: Senior Vascular Access Nurse Specialist Vicki Shawyer with Vascular Nurse Specialists Helen Williamson and Barbara Hector.

MADRI conference on CRBSI

The Multidisciplinary Alliance Against Device-Related Infections (MADRI) hosted its eighth annual conference June 6-8, 2008 in Lansdowne, VA where leading infection specialists presented on a variety of topics, including research goals in epidemiology and infection control, legal perspectives on MRSA and catheter-related blood stream infections (CRBSIs).

“Driven by discussions around improving patient care and the prevention of device-related infections, the eighth annual MADRI conference was a huge success,” said Rabih Darouiche, M.D., VA distinguished service professor, Departments of Medicine (Infectious Disease Section) and Physical Medicine and Rehabilitation and director of Center for Prostheses Infection and MADRI founder. “In an open and educational atmosphere, experts across disciplines were able to discuss challenges associated with device-related infections and exchange ideas about prevention and improvement of patient care.”

One of the main themes of the conference was CRBSIs, a common nosocomial infection that develops when bacteria enter the blood stream through a central venous catheter (CVC).

Click here for the full story.

 

Blood transfusion opposition

A judge has ruled that the rights of the Jehovah’s Witness parents of sextuplets born in Vancouver were not violated when doctors administered blood transfusions to the premature babies.

During the treatment of four premature babies transfusions were given against the wishes of the parents, who are members of a religion that opposes such medical procedures. After the transfusions, the babies were returned to their parents and since then their development has progressed well without any significant health problems.

In making his ruling, B.C. Supreme Court Chief Justice Donald Brenner noted that the babies were born Jan. 7, 2007 at the B.C. Women’s and Children’s Hospital at 25 weeks and had extremely low birth weights, requiring resuscitation. They were admitted to an intensive care unit where they received life support including ventilation, oxygen, intravenous nutrition, the drug erythropoietin and other medications. Two babies died due to complications. During the treatment of the other four, physicians deemed that blood transfusions