Post on 13-Jan-2016
Updated June 2011
Infection Control:Venepuncture and Cannulation
Insertion and Maintenance
Updated February 2012
Learning outcomes
• To understand the application of the chain of infection and standard precautions in relation to venepuncture and cannulation.
• Describe how vascular access device related infections can be prevented
• Describe how vascular access device related infections can be detected.
Updated February 2012
Risks associated with venepuncture and cannulation
• Includes risks to healthcare workers e.g.needlestick injuries
• High complication rate• Under reporting of phlebitis, catheter related sepsis• Compromises patient treatment• Extends treatment duration• Endangers patient survival• Costs millions of pounds annually for the NHS
• BBV could be transferred from the patient to the member of staff undertaking venepuncture/cannulation
• Is that likely to occur?
• When is it likely to occur?
• How can it be prevented?
Updated February 2012
5 stages at which a needlestick injury can occur
Stage % risk of needlestick injury
Preparation 6%
In use 42%
After use, before disposal
28%
During disposal 11%
After inappropriate disposal
13%
Updated February 2012
This data is based on a study of 322 NSIs over 27 months at Glasgow Royal Infirmary 2004-2005
Updated February 2012
Risk of transmission from sharps injury:HIV = 0.3% (1:300) HBV = 20-40% (1:3)HCV = 3-5% (1:30)
Incubation period:HIV = 15yrs HBV = varies HCV = 20yrs
plus
We cannot identify all patients with BBV
When a needlestick incident occurs:
• Follow the NHSGGC policy
• Two important reasons to report a needlestick injury
• To make sure you get the right treatment and advice.
• So that we can learn from how incidents occurred and help prevent them in the future.
Updated February 2012
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Infectious Agent/Organism
Updated February 2012
• Staphylococcus epidermidis • Staphylococcus aureus• Enterococcus spp. • Klebsiella• Pseudomonas• E. Coli• Serratia• Candida
Micro-organisms associated with Venepuncture and Cannulation related
infections
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Updated February 2012
Reservoirs
• Patients skin – resident microflora• Environment• Equipment• IV solutions & medicines• HCW hands -transient microflora
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Means of Exit
Updated February 2012
Means of Exit
• Secretions such as bodily fluids e.g. blood
• Skin e.g. skin scales
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Means of Exit
Route of Transmission
Updated February 2012
Route of Transmission
• Direct contact - on healthcare workers hands
• Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Means of Exit
Route of Transmission
Means of Entry
Updated February 2012
Means of entry
Contaminated on insertion
Contaminated fluid
Patient’s skin
microflora
Local infection
Operator’s microflora
Haematogenous spread
Migration down catheter inside and out
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Means of Exit
Route of Transmission
Means of Entry
Susceptible Host
Updated February 2012
Susceptible Host
• Extremes of age• Surgery• Extended length of stay in hospital• Compromised immune system• Chronic disease• Antibiotics• Vascular access device in-situ
Updated February 2012
The Chain of Infection –Venepuncture and Cannulation Insertion
and Maintenance
Reservoir
Infectious Agent/Organism
Means of Exit
Route of Transmission
Means of Entry
Susceptible Host
Updated February 2012
Standard Precautions
The minimal level of infection control precautions that apply in
all situations.
Updated February 2012Isolation
There are 10 elements to Standard Precautions
Hand Hygiene PPE
Clinical waste
Linen
SpillagesOccupational ExposureEnvironment
Cough etiquette
Patient Care Equipment
Updated February 2012
Updated February 2012
Updated February 2012
Preparation• Clean near patient tray and sharps bin
• Hand decontamination
• Skin prep
• Tourniquets
Remember if you are interrupted you need to decontaminate your hands again
Skin Preparation
• Clean visibly soiled skin with soap and water
• Apply alcohol based skin cleanser for 30 seconds
• Allow to dry
• Avoid touching the skin once the skin has been cleaned/disinfected
Updated February 2012
Updated February 2012
Dressings
Function of the dressing is:
• To protect the site of venous access
• To stabilise the device in place
• Prevent mechanical damage
• Keep site clean
Updated February 2012
Maintenance of PVC’s
Updated February 2012
Detection of Infection
Infection can present in a number of ways:
• Local site infection • Phlebitis• Systemic infection
Updated February 2012
IV site healthy 0 No phlebitis, observe cannula
1 of the following is evident•Slight pain, Slight redness
1 Possibly early phlebitis, observe cannula
2 of the following are evidentPain, erythema, swelling
2 Early stage of phlebitis, resite cannula
all of the following are evident: 3 Medium phlebitis, resite cannula,
consider treatment
All of the following are evident and extensive
Pain along the cannula, swelling, induration, palpable venous cord
4 Advanced phlebitis, or possible thrombophlebitis
resite cannula, consider treatment
All of the following are evident and extensive
Pain along the cannula, swelling, induration, palpable venous cord,
pyrexia
5 Advanced thrombophlebitis initiate treatment,
resite cannula
Updated February 2012
Inspection
Cannula must be inspected and findings documented in Adult PVC care plan at least once per day
1. Continuing clinical indication for PVC2. VIP Score3. PVC dressing dry and intact ?4. Was PVC dressing renewed ?5. Was PVC removed6. Reason for removal
Updated February 2012
PVC Insertion Information Affix patient label Name: Address: D.O.B: CHI number: Hospital: Ward:
Ensure the PVC dressing has date and time of insertion written on it. This implies that appropriate technique has been used for insertion.
PVC Maintenance Information
Modified V.I.P (Visual Infusion Phlebitis) Score
IV site appears healthy 0 No Phlebitis Observe Cannula
ONE of the following is evident: - slight pain or redness near site 1 Possible first signs Observe Cannula
TWO of the following are evident: - pain -redness - swelling 2 Early stage of phlebitis Re-site Cannula
ALL of the following are evident: - pain - redness - hardening of the surrounding tissue 3
As above including: - palpable venous cord 4 As above including: - pyrexia 5
Phlebitis / Thrombophlebitis
Re-site Cannula & Seek Further Advice
Day 1 (24 hours after insertion) Day 2 All 5 questions below MUST be answered
The PVC must be monitored at least once per day
All 5 questions below MUST be answered The PVC must be monitored at least once per day
1. Continuing clinical indication for PVC? Yes / No 1. Continuing clinical indication for PVC? Yes / No
2. VIP Score? 2. VIP Score?
3. PVC Dressing dry & intact? Yes / No 3. PVC Dressing dry & intact? Yes / No 4. Was PVC dressing renewed? Yes / No / NA 4. Was PVC dressing renewed? Yes / No / NA 5. Was PVC Removed? Yes / No 5. Was PVC Removed? Yes / No Removal Reason: ____________________________
Removal Reason: ____________________________
Comments/Actions Taken: Date: Initials:
Comments/Actions Taken: Date: Initials:
After Day 3 consider removal, if there is still a clinical reason justify rationale for PVC to remain insitu: Date: Initials:
Day 3 Day 4 All 5 questions below MUST be answered
The PVC must be monitored at least once per day
All 5 questions below MUST be answered The PVC must be monitored at least once per day
1. Continuing clinical indication for PVC? Yes / No 1. Continuing clinical indication for PVC? Yes / No
2. VIP Score? 2. VIP Score?
3. PVC Dressing dry & intact? Yes / No 3. PVC Dressing dry & intact? Yes / No
4. Was PVC dressing renewed? Yes / No / NA 4. Was PVC dressing renewed? Yes / No / NA
5. Was PVC Removed? Yes / No 5. Was PVC Removed? Yes / No Removal Reason: ____________________________
Removal Reason: ____________________________
Comments/Actions Taken:
Date: Initials:
Comments/Actions Taken:
Date: Initials:
L R Date: __________________ (See IV Dressing)
Time: __________________ Reason for Insertion:___________________ Flushed on insertion (if known)
Other Site: __________________
Adult Peripheral Venous Cannulation (PVC) ChartPlease use 1 chart per PVC
Updated February 2012
Prevention – Best practice
• Do not use the top port of PVC unless no other access
• “SCRUB THE HUB” pre and post use -using an alcohol wipe to clean
• Use needle free device with extension
Updated February 2012
Removal of the Cannula
• Perform hand hygiene• Wear gloves• Use sterile gauze• Apply pressure for approx 2-3 minutes• Inspect the cannula to ensure it is complete and
undamaged• Dispose of cannula into sharps bin• Perform hand hygiene
• DOCUMENT in Care plan or in notes
Updated February 2012
Key Points
• Venepuncture/cannulation if not undertaken properly can result in infection
• Hand hygiene, aseptic non-touch technique and correct preparation will minimise the risk of infection
• Patients should be closely monitored for signs of infection
• Good documentation is essential
• If it is not documented it is not done!!