Intravenous products: News Medical report “Increased focus on providing optimum patient care in the most cost efficient way is fuelling demand for intelligent infusion devices termed “Smart Pumps.” A report from InMedica, a division of IMS Research (recently acquired by IHS Inc. (NYSE:IHS)), on the global market for infusion pumps found that, despite market saturation in the developed countries, demand for advanced technology is being maintained; infusion pump suppliers must offer technically advanced products at competitive prices to maintain market share. Smart pumps with software to reduce the risk of dose error in IV therapy, to provide safer patient care, is becoming increasingly important, in the light of reimbursement restrictions for “never events” in U.S. hospitals. InMedica predicts the U.S. market for large-volume infusion pumps will increase to $500 million by 2015.”

Click here for the full story.

Intravenous products: Infection Control Today report “Covalon Technologies Ltd. announces Food and Drug Administration (FDA) approval of IV Clear, a breakthrough antimicrobial silicone adhesive film dressing designed for securing vascular intravenous access devices.”

Click here for the full story.

Intravenous products: Medgadget.com report “BiO2 Medical has received CE Mark approval for the Angel Catheter, a nitinol inferior vena cava (IVC) filter permanently attached to a central venous catheter, for the use of preventing pulmonary embolism in critically ill patients. The multi-lumen catheter can be used like a normal central venous system for administering medications, fluids or blood products, blood sampling and monitoring of central venous pressure. At the same time it provides pulmonary embolism prophylaxis by means of the attached IVC filter.”

Click here for the full story.

Intravenous literature: Allcock, K., Jagannathan, B., Hood, C.J. and Marshall, M.R. (2012) Exsanguination of a home hemodialysis patient as a result of misconnected blood-lines during the wash back procedure: a case report. BMC Nephrology. 13. Click here for provisional pdf.

Abstract (provisional):

Background - Home hemodialysis is common in New Zealand and associated with lower cost, improved survival and better patient experience. We present the case of a fully trained home hemodialysis patient who exsanguinated at home as a result of an incorrect wash back procedure.

Case presentation - The case involves a 67 year old male with a history of well controlled hypertension and impaired glucose tolerance. He commenced on peritoneal dialysis in 2006 following the development of end stage kidney failure secondary to focal segmental glomerulosclerosis. He transferred to hemodialysis due to peritoneal membrane failure in 2010, and successfully trained for home hemodialysis over a 20 week period. Following one month of uncomplicated dialysis at home, he was found deceased on his machine at home in the midst of dialysis. His death occurred during the wash back procedure performed using the “open circuit” method, and resulted from misconnection of the saline bag to the venous end of the extracorporeal blood circuit instead of the arterial end. This led to approximately 2.3L of his blood being pumped into the saline bag resulting in hypovolaemic shock and death from exsanguination.

Conclusions - Despite successful training, critical procedural errors can still be made by patients on home hemodialysis. In this case, the error involved misconnection of the saline bag for wash back. This case should prompt providers of home hemodialysis to review their training protocols and manuals. Manufacturers of dialysis machinery should be encouraged to design machines specifically for home hemodialysis, and consider distinguishing the arterial and venous ends of the extracorporeal blood circuit with colour coding or incompatible connectivity, to prevent occurrences such as these in the future.

Intravenous literature: Höflea, M., Haucka, M., Engela, A.K. and Senkowski, D. (2012) Viewing a needle pricking a hand that you perceive as yours enhances unpleasantness of pain. Pain. 153(5), p.1074–1081.

Abstract:

“Don’t look and it won’t hurt” is commonly heard advice when receiving an injection, which implies that observing needle pricks enhances pain perception. Throughout our lives, we repeatedly learn that sharp objects cause pain when penetrating our skin, but situational expectations, like information given by the clinician prior to an injection, may also influence how viewing needle pricks affects forthcoming pain. How both previous experiences and acute situational expectations related to viewing needle pricks modulate pain perception is unknown. We presented participants with video clips of a hand perceived as their own being either pricked by a needle or touched by a Q-tip, while concurrently applying painful or nonpainful electrical stimuli. Intensity and unpleasantness ratings, as well as pupil dilation responses, were monitored. Effects of situational expectations about the strength of electrical stimuli were investigated by manipulating the contingency between clips and electrical stimuli across experimental blocks. Participants were explicitly informed about the contingency. Intensity ratings of electrical stimuli were higher when a clip was associated with expectation of painful compared to nonpainful stimuli, suggesting that situational expectations about forthcoming pain bias perceived intensity. Unpleasantness ratings and pupil dilation responses were higher when participants viewed a needle prick, compared to when they viewed a Q-tip touch, suggesting that previous experiences with viewing needle pricks primarily act upon perceived unpleasantness. Thus, remote painful experiences with viewing needle pricks, together with information given prior to an injection, differentially shape the impact of viewing a needle prick on pain perception.

Intravenous literature: Elhassan, H.A. and Dixon, T. (2012) MRSA contaminated venepuncture tourniquets in clinical practice. Postgraduate Medical Journal. 88(1038), p.194-7.

Abstract:

INTRODUCTION: Meticillin-resistant Staphylococcus aureus (MRSA) hospital-acquired infection is associated with increased patient mortality. National guidelines state that shared patient equipment must be cleaned after use. The authors sought to identify MRSA contamination in a sample of non-disposable venepuncture tourniquets and audit cleaning habits between patient contacts.

MATERIALS AND METHODS: Fifty tourniquets were collected from junior doctors, nursing staff and wards from two district general hospitals in Essex, UK in 2007. A questionnaire was completed at the time of collection for each tourniquet. The tourniquets were cultured using standard microbiology techniques.

FINDINGS: 18/50 (36%) tourniquets were positive for S. aureus and of these 6/50 (12%) were MRSA positive. 33/43 (77%) healthcare professionals using non-disposable tourniquets for venepuncture made no attempts at cleaning their tourniquets. 10/43 (23%) staff admitted to cleaning their tourniquets. The tourniquets were used for an average of 14 weeks on approximately three different patients per day. 30/50 (60%) tourniquets were visibly soiled and of these 13 were blood stained and 20/50 (40%) appeared ‘clean’. Worn tourniquets when compared with the ‘clean’ tourniquets were more likely to be contaminated with S. aureus, 15/30 (50%) vs 3/20 (15%), and MRSA 5/30 (17%) vs 1/20 (5%).

CONCLUSION: Non-disposable venepuncture tourniquets are contaminated with MRSA and pose a risk to patients. The majority of clinical staff do not clean them between patient contacts as recommended by guidelines. The use of non-disposable venepuncture tourniquets should be abandoned. The introduction of disposable tourniquets to clinical practice should be an adjunct to current measures for MRSA prevention.

Intravenous news: News Medical report “Johnson & Johnson (JNJ) the world’s most comprehensive and broadly based manufacturer of health care products, as well as a provider of related services for the consumer and pharmaceutical and medical devices and diagnostics markets, has been awarded the 2012 Corporate Health Achievement Award (CHAA) by the American College of Occupational and Environmental Medicine (ACOEM). JNJ received the award because of its long history of commitment to the safety and health of its workers – a commitment that stretches back to the creation of its Credo in the 1940s.”

Click here for the full story.

Intravenous literature: Pittiruti, M. (2012) Ultrasound guided central vascular access in neonates, infants and children. Current Drug Targets. Apr 18. [Epub ahead of print]

Abstract:

Ultrasound guided central venous cannulation is rapidly becoming the standard technique for achieving a central line in neonates, infants and children. Older techniques such as surgical cutdown and ‘blind’ percutaneous venipuncture have many disadvantages: they are time consuming, vein consuming and/or associated with dangerous immediate or late complications. On the other hand, ultrasound has only advantages, giving the operator the possibility of (a) choosing the most appropriate and safest venous access on the basis of ultrasound assessment, (b) performing a 100% safe insertion, (c) ruling out malpositions or pleuro-pulmonary damages, during and after the procedure. Ultrasound guided central venous cannulation has been described in many clinical studies of the last decade, each one showing the higher efficacy and safety of ultrasound guidance in children when compared to the traditional landmark method. Ultrasound can be used for puncturing many different deep veins of the arm, neck, groin and thorax. The vein can be visualized either in short axis or in long axis, while the puncture can be performed ‘in-plane’ (when the needle trajectory is included in the plane of the ultrasound probe) or ‘out-of-plane’ (when the needle trajectory is not in that plane). Though, the best clinical results of ultrasound guidance can be achieved – particularly in neonates and infants – only if the operator has been properly trained in this technique through an appropriate curriculum that should include theory lessons, simulation practice and a tutored learning curve.

Intravenous literature: Nienhaus, A., Kesavachandran, C., Wendeler, D., Haamann, F. and Dulon, M. (2012) Infectious diseases in healthcare workers – an analysis of the standardised data set of a German compensation board. Journal of Occupational Medicine and Toxicology. 7(1), p.8.

Abstract:

INTRODUCTION: Healthcare workers (HCW) are exposed to infectious agents. Disease surveillance is therefore needed in order to foster prevention.

METHODS: The data of the compensation board that covers HCWs of non-governmental healthcare providers was analysed for a five-year period. For hepatitis B virus (HBV) and hepatitis C virus (HCV) infections, the period analysed was extended to the last 15 years. The annual rate of occupational infectious diseases (OIDs) per 100,000 employees was calculated. For NSIs a rate per 1,000 employees was calculated.

RESULTS: Within the five years from 2005 to 2009 a total of 384 HCV infections were recognised as OIDs (1.5/100,000 employees). Active TB was the second most frequent cause of an OID. While the numbers of HBV and HCV infections decreased, the numbers for active TB did not follow a clear pattern. Needlestick injuries (NSIs) are still frequent even though their number declined for the first time in 2009 by 3.5%. NSIs were especially often reported at hospitals (29.8/1,000 versus 7.4/1,000 employees for all other HCWs).

CONCLUSION: Although they are declining, HCV infections remain frequent in HCWs, as do NSIs. Whether the reinforcement of the recommendations for the use of safety devices in Germany will prevent NSIs and therefore HCV infections should be closely observed.

Intravenous literature: Guembe, M., Pérez-Parra, A., Gómez, E., Sánchez-Luna, M., Bustinza, A., Zamora, E., Carrillo-Álvarez, A., Cuenca, A., Padilla, B., Martín-Rabadán, P. and Bouza, E. (2012) Impact on knowledge and practice of an intervention to control catheter infection in the ICU. European Journal of Clinical Microbiology & Infectious Diseases. May 9. [Epub ahead of print].

Abstract:

Information on the impact of care bundles has been mainly acquired in adult intensive care units (ICUs). However, specific data for educational programs are scarce. Our objective was to analyze the impact of an educational program on the knowledge and prevention of catheter-related bloodstream infection (CRBSI) in two pediatric intensive care units (P-ICUs). A prospective study was carried out at a large teaching institution in Madrid, Spain. Healthcare workers’ (HCWs) knowledge of guidelines for the prevention of CRBSI was assessed before and after the educational program using a questionnaire covering 12 issues. A 20-min program was offered to all HCWs on each ICU shift. The incidence density of CRBSI was assessed before, during, and after the educational program. A total of 174 questionnaires were completed by HCWs from both the neonatal ICU (N-ICU) and the P-ICU before the intervention and 54 were completed after the intervention (120 participants were not present during this period). The incidence density of CRBSI before, during, and after the intervention was 6.2, 5.2, and 9.3 in the N-ICU and 2.2, 3.1, and 2.9 in the P-ICU (p > 0.05). A single 20-min educational intervention on the prevention of CRBSI significantly improved HCWs’ knowledge, but was not enough to reduce the incidence density of CRBSI.