Infection Control Measures in IV

Drug Administration

Prepared by : Dr. Ahmed Kholeif

General Practitioner

Date : 12th November,2012

Objective:

Every member of SHHC staff involved with intravenous therapy will be able to apply the correct infection control precautions to this procedure .

Introduction:

Vascular access devices is vital for administering various fluids and drug therapies. it's critical to maintain an appropriate infection control measures to save lives and money and reduce healthcare burdens.

Types of intravenous devices:

1. Peripheral cannulas :

placed into a peripheral vein

2. Peripherally inserted central catheters (PICC)

Central line that is placed via the peripheral vasculature. Its tip terminates in the superior vena cava

3. Peripheral midline catheters :

Shorter version of the PICC, Its tip terminates in the axilla

Types of intravenous devices:

4. Skin tunneled cuffed central catheters (Hickman lines)

Central venous catheter most often used for the administration of chemotherapy

Types of intravenous devices:

Phlebitis:

Inflammation of a blood vessel

Thrombophlebitis:

Similar to phlebitis but a thrombus (or clot) is in addition involved

Local Infection (abscess):

A microscopic organism may use the tiny hole in the skin created by the IV catheter to find its way into the body, and cause an infection

Expected Intravenous Catheter Complications

Infiltration :

This occurs when the catheter unintentionally enters the tissue surrounding the blood vessel and the IV fluid go into the tissues.

Hematoma:

collection of blood caused by internal bleeding.

Hypothermia:

When large amounts of cold fluids are infused. Rapid temperature changes occurs and may precipitate ventricular fibrillation.

Expected Intravenous Catheter Complications

Staphylococcus epidermidis

Staphylococcus aureus

Enterococcus spp.

Klebsiella

Pseudomonas

E. Coli

Candida

Infectious Micro-organisms associated with IV therapy

Patients Skin – resident microflora

Equipment

IV Solutions & drugs

Environment

Health care provider Hands

Reservoirs

1.Collect all required equipment, checking expiry date and the correct catheter size for the purpose and length of infusion

2. Confirm patient identity and provide explanation

3. Hand washing

Should be performed before and after inserting, replacing , repairing, or dressing an intravascular catheter

INFECTION CONTROL MEASURES

4. Wearing gloves

Wear clean gloves, rather than sterile gloves, for the insertion or changing the dressing of peripheral intravascular catheters. Sterile gloves should be worn for the insertion of arterial, central, and midline catheters.

5. Patient skin preparation

Alcohol swab to remove bacteria prior to insertion and allow it to dry; this doesn’t protect the patient for a longer period. Chlorhexidine Gluconate with 70% alcohol gives longer duration of protection

INFECTION CONTROL MEASURES

6.Securing Catheter insertion site.

7.Disposing of contaminated or soiled equipment and linen appropriately .

8. Safe disposal of sharps .

9. Stay with your patient for 5 to 10 minutes to detect early signs and symptoms of hypersensitivity, such as sudden fever, joint swelling, rash, urticaria (hives), bronchospasm, and wheezing.

10.Documentation

To protect the site of venous access

To stabilize the catheter in placePrevent mechanical damageKeep site clean

Function of the dressing

1. Use sterile, transparent, semipermeable dressing to cover the catheter site it allows continuous visual inspection of the catheter site and require less frequent changes.

2. Replace catheter site dressing if the dressing becomes damp, loosened, or visibly soiled

3. No need to replace peripheral catheters more frequently than every 72 (even in the absence of signs of infection), the new catheter should be inserted into a separate site.

Catheter Site Dressing Regimens

4. For patients not receiving blood, blood products or fat emulsions, replace administration sets after 72 hours if clear fluids are used

5. For short-term CVC sites change dressing every 2 days for gauze and every 7 days for transparent dressings

6. Do not use topical antibiotic ointment or creams on insertion sites.

Catheter Site Dressing Regimens

Redness (erythema) and warmth with some fever

Pain or burning along the length of the vein

Swelling (edema)

Purulent discharge

If any of these signs are noted, the IV catheter must be removed immediately .

signs of infection

Bacterial phlebitis 

is usually an indication to an infection at the insertion site.

Chemical phlebitis 

is most commonly seen with peripheral IV devices when medications or solutions irritate the endothelial lining of the small peripheral vessel wall, for example:

erythromycin

tetracycline

vancomycin

Large doses of potassium chloride

multivitamins

Types of Phlebitis

Mechanical phlebitis

occurs when the size of the cannula is too big for the selected vein causing unnecessary friction on the internal lining of the vein leading to inflammation

Types of Phlebitis

1 . Phlebitis is most common after continuous infusions, developing 2 to 3 days after the vein is exposed to the drug or solution.

2. Phlebitis is more common in distal veins than in veins close to the heart.

Fighting Phlebitis

Use proper venipuncture technique.

dilute drugs correctly.

Monitor administration rates.

Observe the I.V. site frequently.

Change the infusion site regularly according to policy.

Steps to Prevent Phlebitis:

REMEMBER !

Adhering to aseptic technique during insertion, dressing changes, preparing medications will minimize the risk of infection

Cannula site rotation and using the appropriate Cannula size

Adequate securement of the IV device

Conclusion

Patients should be closely monitored for signs of infection

Patient education of the signs and symptoms of phlebitis

Good documentation is essential and it should be Daily as evidence that assessment has been carried out

Conclusion

Questions !

THANK YOU !