Transcript SJ Presentation

Venflon, Friend or Foe?
Saranaz Jamdar
Consultant Microbiologist
Venflon or Cannula?
 Venflon
is a brand name not the
device
 Manufactured by BD
 Peripheral vascular catheter (PVC) or
cannula
 In Forth Valley we currently use
B/Braun
History of IV Infusion
 William
Harvey, explained blood
circulation, 1628
 1st book on application
of intravenous
infusion in humans,
Major 1664 and
Elsholtz 1667
History of IV Infusion
1st proper IV infusion
Dr Thomas Latta
2nd Cholera
pandemic, affecting
UK, 1832
Traditional IV Infusion Needles
First IV Cannula
1ST modern cannula, “Branula”
Dr B Braun, Germany 1962
Later Models
Modern models
Complications
 Extravasation
Complications
 Haemorrhage/bleeding
Complications
 Infection
− local
− Systemic
 Staph
aureus (MSSA, MRSA)
 Streptococcus spp.
 Gram negative bacteria
 Candida spp.
Staphylococcus aureus
Streptococcus spp.
Gram Negative Bacteria
 Enterobacteraciae
 Pseudomonas
sp.
 Environmental organisms
Candida spp.
Some Examples
Some More
Infection in Forth Valley
Local
infection (5 so far this week!)
Bacteraemia (1 this week!)
Secondary site of infection
(ask me in a few months)
– Abscess
– Osteomyelitis/septic arthritis
– Endocarditis
– Overwhelming sepsis
– Death
BEWARE
Staphylococcus aureus, RETURNS
Situation in Forth Valley
Origin of SAB
14
SAB Numbers
12
10
Other
8
Unknow n
6
Skin & Soft Tissue
4
Device associated
2
0
Apr- May10
10
Jun10
Jul10
Aug- Sep10
10
Oct10
Some Real Cases in FV
Case 1
 Patient admitted with D+V
 IV fluids
 IV cannula site inflamed
 Grew Staph aureus (MSSA)
 Clinical deterioration despite
antibiotic therapy
Case 1
 Theatre
for debridement and
drainage of abscess
 Grew S.aureus (MSSA) again
Some Real Cases in FV
Case 2
 Neonate
 IV cannula on leg
 Local infection and spread to joint
 Septic arthritis of knee
 Bacteraemia, Staph aureus
Case 2
Some Real Cases in FV
Case 3
IV cannula site infection, another hospital
Bacteraemia, another hospital
Secondary site involvement, silent
Back pain, started in SRI 6/52 later
Discitis, psoas abscess, ? aortitis
Loculated pulmonary empyema
Case 3, MRI
Case 3, CT Chest
Situation in Forth Valley and
Elsewhere
 Considerable
morbidity and mortality
associated with Cannula site infection
 Patient dies from
infection of an
intravascular
device, how do
you defend yourself?
IV Cannula, Whose Responsibility Is It?
EVERYBODY’S
Prevention of Cannula
Site Infection
Prevention of Cannula Site
Infection
 Does
the patient need IV access for
TREATMENT?
 If the answer is YES, proceed to the
PVC insertion bundle
 Remember “bleeding the patient”
does not qualify as “need” for
insertion of an IV cannula
PVC Insertion Bundle
A
PVC is clinically indicated
 Hand hygiene is carried out
 Skin is decontaminated
 Aseptic (no touch) technique
 Sterile dressing including date and
time label
Does the Patient Need IV Access
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PVC Insertion Bundle and Removal Record
Is PVC clinically indicated for this patient
YES, WHY:
IV Fluids/Blood TransfusionIV Drugs
Diagnostics Chest Pain Please tick
Is patients skin decontaminated and allowed to dry
YES / NO
Hand hygiene carried out prior to insertion
YES / NO
Aseptic Non Touch Technique is used to insert PVC
YES / NO
If not possible, use either STERILE GLOVES or MINI CHLORAPREP
Sterile dressing applied after insertion
YES / NO
Patients Name:__________________________ Ward: _______________
Inserted by: _______________________ Date &
Time:________________
Size/Colour:______________________ Batch
No:___________________
Insertion Site: _______________________________________
Removed by: ______________ Date & Time: _____________
Skin Decontamination
 ChloraPrep
Adhesive Dressing
 With
date and time label
Follow Up
 Regular
monitoring of the site by the
staff on the ward
 Documentation in patient’s notes
 When to replace the cannula, 72 hrs
 When to remove the cannula, clinical
need
 When is a cannula site infected
What to Watch for?
 Sometimes
the first clue is pain at
the site of insertion
Infected Cannula Site
 Documentation
alone will not cure it
 Swab the site for culture and
sensitivity
 Assess the clinical picture
 Commence appropriate antibiotic
treatment
–
–
choice of antibiotic
choice of mode of administration
Do NOT Think of Treating Local Infection
with Local Antibiotic Ointment
Developments in Forth Valley
 Front
door services, need for IV
access
 Documentation, stickers in notes
 PVC care bundle implementation
 Change of skin cleansing solution
 ? Change of IV cannula brand
? The Future in Forth Valley
 BD
Venflon with safety device
New Products, any good?
 FastBand
Any Questions?