Hemodialysis infection prevention

Intravenous news: APIC report “In an effort to establish universally accepted best practices for Read more

Ultrasound VAD guidance by RN

Intravenous literature: AVA have published a new position statement on the use of ultrasound guidance by Read more

Plasma transfusion guidelines

Intravenous literature: Roback, J.D., et al (2010) Evidence-based practice guidelines for plasma Read more

Standards for infusion therapy

Intravenous literature: The RCN report “The Royal College of Nursing has published expanded and updated Read more

CDC IV guideline review

Intravenous news: The Centers for Disease Control and Prevention (CDC) are expanding and updating the 2002 version of the ‘Guidelines for the Read more

PICC tip position statement

Intravenous news: The Infusion Nurses Society (INS) convened a national task force of infusion therapy experts to Read more

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.

Extravasation guidelines

The North Trent Cancer Network have published extravasation guidelines. “This policy describes the procedure to be followed following extravasation of cytotoxic chemotherapy. Not all chemotherapy is vesicant (i.e. can cause severe tissue damage when given into the surrounding tissue) but most chemotherapy potentially causes irritation and injury to the tissue and should be treated according to the following procedure. If tissue damage is suspected then treatment must be initiated quickly” (NTCN 2008).

 

 

The contents of the guidelines include:

• Recognition of an Extravasation from a Peripheral cannula  
• Recognition of an extravasation from a Central Venous Access Device                 
• Action to be Taken if Extravasation Occurs via a Peripheral Cannula 
• Action to be taken if an extravasation Occurs via a Central Venous Access Device 
• Guidelines for the Management of Extravasation during Administration of Cytotoxic Chemotherapy  
• Quick Reference Guide for Immediate Treatment of Extravasation via a Peripheral Cannula – Algorithm
• Principles for Minimising Extravasation while Administering Cytotoxic Drugs  
• Guidelines for Assessing Patency  
• North Trent guidelines for the management of extravasation from cytotoxic chemotherapy  

Click here to access the full guideline.

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Central venous catheter-related infection guidelines

Wolf, H.H., Leithauser, M., Maschmeyer, G., Salwender, H., Klein, U., Chaberny, I., Weissinger, F., Buchheidt, D., Ruhnke, M., Egerer, G., Cornely, O., Fatkenheuer, G. and Mousset, S. (2008) Central venous catheter-related infections in hematology and oncology : guidelines of the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Oncology (DGHO). Annals of Hematology. 87(11), p.863-76.

Abstract:

Catheter-related infections (CRI) cause considerable morbidity in hospitalized patients. The incidence does not seem to be higher in neutropenic patients than in nonneutropenic patients. Gram-positive bacteria (coagulase-negative staphylococci, Staphylococcus aureus) are the pathogens most frequently cultured, followed by Candida species. Positive blood cultures are the cornerstone in the diagnosis of CRIs, while local signs of infection are not necessarily present. Blood cultures should be taken from peripheral blood and from the venous catheter. A shorter time to positivity of catheter blood cultures as compared with peripheral blood cultures supports the diagnosis of a CRI. In many cases, a definite diagnosis requires catheter removal and microbiological analysis. The role plate method with semiquantitative cultures has been established as standard in most laboratories. Antimicrobial treatment of CRI should be directed by the in vitro susceptibility of the isolated pathogen. Primary removal of the catheter is mandatory in S. aureus and Candida infections, as well as in case of tunnel or pocket infections. Future studies will elucidate whether the rate of CRI in neutropenic patients may be reduced by catheters impregnated with antimicrobial agents.

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Vascular access guidelines

The vascular access society have made available vascular access guidelines. These are aimed mainly at renal medicine. However, topics such as ‘placement and management of a tunneled catheter’, ‘management of central venous obstruction’ or ‘management of tunneled catheter infection’ should all be an interesting read for any intravenous practitioner.

Click here for the full guidelines.

External jugular catheter

The Infusion Nurse Society has published a position statement on the role of a qualified licensed registered nurse, who is proficient in infusion therapy, during the insertion, care and removal of external jugular catheters.

INS (2008) The Role of the Registered Nurse in the Insertion of External Jugular Peripherally Inserted Central Catheters and External Jugular Peripheral Intravenous Catheters. Journal of Infusion Nursing. 31(4), p.226-227.

Abstract: 

‘As a leader in infusion therapy, the Infusion Nurses Society convened a national task force of experts to examine the practice of registered nurses placing catheters in external jugular veins. It is the position of the Infusion Nurses Society that a qualified licensed registered nurse, who is proficient in infusion therapy, may insert, care for, maintain, and remove external jugular peripherally inserted central catheters and external jugular peripheral intravenous catheters’.

 

Improving patient safety

Simon Keady and Meera Thacker offer an insight into the rationale and steps being taken in response to recent NPSA alerts.

Reference

Keady S. and Thacker M. (2008) National Patient Safety Agency: Improving patient safety across all critical care areas. Intensive and Critical Care Nursing. 24, p.137-140.

“The National Patient Safety Agency (NPSA) reviews patient safety incidents throughout the National Health Service (NHS) in the United Kingdom and aims to initiate preventative measures. Recent alerts include injectable medication, oral syringes for enteral administration, preventing hyponatraemia in children and anticoagulation. This article gives an insight into the rationale and steps currently being undertaken to respond to these recommendations” (Keady and Thacker 2008).

New extravasation guidelines

The European Oncology Nursing Society have just issued new chemotherapy extravasation guidelines. The guidance is comprehensive and includes risk factors, explains recognition and includes examples of documentation… plus much more. Click here to view the full document.

Community IV’s for children

Just had a request for information concerned with children in receipt  of IV’s in the community. I could not help much However, I am aware of the RCN publication Administering IV therapy to children in the community. If anyone has any additional information I am happy to post on this site.

New saving lives high impact interventions

The Department of Health have revised the care bundles for a number of high impact interventions such as cannulation and central venous catheters. Chlorhexidine 2% gets a number of mentions and the dwell time for peripheral cannulae has been extended to 96 hours – wow!

NMC Standards for medicine management

Just to quickly draw your attention to new standards concerned with medicine management from the NMC. The standard has a few sections concerned with intravenous drug administration. It is of particular interest that the standard recommends that two people (one the registrant) checks IV drugs. The new standard can be viewed here.

VIP score

Infusion phlebitis is an IV problem that continues to impact upon patient care. The RCN state that infusion phlebitis rates should not exceed 5%. The Visual Infusion Phlebitis (VIP) score was developed to assist with the monitoring of cannula sites.

Check out the VIP score at the following link – VIP score

Blood cultures

Recent advice from the DoH (Department of Health) has focussed upon standardising the approach taken when obtaining blood cultures. In particular the guidance looks at reducing the incidence false positives. Hopefully taking the incidence of false positives from approximately 12% to a more realistic 3%. The national guidance can be viewed here.