Venflon, Friend or Foe? Saranaz Jamdar Saranaz Jamdar Consultant Microbiologist Consultant...
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Transcript of Venflon, Friend or Foe? Saranaz Jamdar Saranaz Jamdar Consultant Microbiologist Consultant...
Venflon, Friend or Foe?Venflon, Friend or Foe?
Saranaz JamdarSaranaz Jamdar Consultant MicrobiologistConsultant Microbiologist
Venflon or Cannula?Venflon or Cannula?
Venflon is a brand name not the Venflon is a brand name not the devicedevice
Manufactured by BDManufactured by BD Peripheral vascular catheter (PVC) or Peripheral vascular catheter (PVC) or
cannulacannula In Forth Valley we currently use In Forth Valley we currently use
B/BraunB/Braun
History of IV InfusionHistory of IV Infusion
William Harvey, explained blood William Harvey, explained blood circulation, 1628circulation, 1628
11stst book on application book on application
of intravenousof intravenous
infusion in humans, infusion in humans,
Major 1664 andMajor 1664 and
Elsholtz 1667Elsholtz 1667
History of IV InfusionHistory of IV Infusion
11stst proper IV infusion proper IV infusionDr Thomas LattaDr Thomas Latta22ndnd Cholera Cholera
pandemic, affectingpandemic, affecting
UK, 1832UK, 1832
Traditional IV Infusion NeedlesTraditional IV Infusion Needles
First IV CannulaFirst IV Cannula
11STST modern cannula, “Branula” modern cannula, “Branula”Dr B Braun, Germany 1962Dr B Braun, Germany 1962
Later ModelsLater Models
Modern modelsModern models
ComplicationsComplications
Extravasation Extravasation
ComplicationsComplications
Haemorrhage/bleedingHaemorrhage/bleeding
ComplicationsComplications
InfectionInfection− locallocal− SystemicSystemic
Staph aureusStaph aureus (MSSA, MRSA) (MSSA, MRSA) Streptococcus spp.Streptococcus spp. Gram negative bacteriaGram negative bacteria Candida spp.Candida spp.
Staphylococcus aureusStaphylococcus aureus
Streptococcus spp.Streptococcus spp.
Gram Negative Bacteria Gram Negative Bacteria
EnterobacteraciaeEnterobacteraciae Pseudomonas sp.Pseudomonas sp. Environmental organismsEnvironmental organisms
Candida spp.Candida spp.
Some ExamplesSome Examples
Some MoreSome More
Infection in Forth ValleyInfection in Forth Valley
Local infection (5 so far this week!)Local infection (5 so far this week!)Bacteraemia (1 this week!)Bacteraemia (1 this week!)Secondary site of infectionSecondary site of infection (ask me in a few months) (ask me in a few months)
– AbscessAbscess– Osteomyelitis/septic arthritisOsteomyelitis/septic arthritis– EndocarditisEndocarditis– Overwhelming sepsisOverwhelming sepsis– DeathDeath
Staphylococcus aureus, RETURNS
BEWARE
Situation in Forth ValleySituation in Forth Valley
Origin of SAB
0
2
4
6
8
10
12
14
Apr-10
May-10
Jun-10
Jul-10
Aug-10
Sep-10
Oct-10
SA
B N
um
bers
Other
Unknow n
Skin & Soft Tissue
Device associated
Some Real Cases in FVSome Real Cases in FV
Case 1Case 1 Patient admitted with D+VPatient admitted with D+V IV fluidsIV fluids IV cannula site inflamedIV cannula site inflamed Grew Grew Staph aureus Staph aureus (MSSA)(MSSA) Clinical deterioration despite Clinical deterioration despite
antibiotic therapyantibiotic therapy
Case 1Case 1
Theatre for debridement and Theatre for debridement and drainage of abscessdrainage of abscess
Grew S.aureus (MSSA) againGrew S.aureus (MSSA) again
Some Real Cases in FVSome Real Cases in FV
Case 2Case 2 NeonateNeonate IV cannula on legIV cannula on leg Local infection and spread to jointLocal infection and spread to joint Septic arthritis of kneeSeptic arthritis of knee Bacteraemia, Bacteraemia, Staph aureusStaph aureus
Case 2Case 2
Some Real Cases in FVSome Real Cases in FV
Case 3Case 3IV cannula site infection, IV cannula site infection, another hospitalanother hospital
Bacteraemia, Bacteraemia, another hospitalanother hospital
Secondary site involvement, silentSecondary site involvement, silentBack pain, started in SRI 6/52 laterBack pain, started in SRI 6/52 laterDiscitis, psoas abscess, ? aortitisDiscitis, psoas abscess, ? aortitisLoculated pulmonary empyemaLoculated pulmonary empyema
Case 3, MRICase 3, MRI
Case 3, CT ChestCase 3, CT Chest
Situation in Forth Valley and Situation in Forth Valley and ElsewhereElsewhere
Considerable morbidity and mortality Considerable morbidity and mortality associated with Cannula site associated with Cannula site infectioninfection
Patient dies from Patient dies from
infection of aninfection of an
intravascular intravascular
device, how dodevice, how do
you defend yourself?you defend yourself?
IV Cannula, Whose Responsibility Is It?IV Cannula, Whose Responsibility Is It?
EVERYBODY’SEVERYBODY’S
Prevention of Cannula Prevention of Cannula Site InfectionSite Infection
Prevention of Cannula Site Prevention of Cannula Site InfectionInfection
Does the patient need IV access for Does the patient need IV access for TREATMENT?TREATMENT?
If the answer is YES, proceed to the If the answer is YES, proceed to the PVC insertion bundlePVC insertion bundle
Remember “bleeding the patient” Remember “bleeding the patient” does not qualify as “need” for does not qualify as “need” for insertion of an IV cannulainsertion of an IV cannula
PVC Insertion BundlePVC Insertion Bundle
A PVC is clinically indicatedA PVC is clinically indicated Hand hygiene is carried outHand hygiene is carried out Skin is decontaminatedSkin is decontaminated Aseptic (no touch) techniqueAseptic (no touch) technique Sterile dressing including date and Sterile dressing including date and
time labeltime label
Does the Patient Need IV AccessDoes the Patient Need IV Access 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 Is patients skin decontaminated and allowed to dry YES / NO Hand hygiene carried out prior to insertion Hand hygiene carried out prior to insertion YES / NO Aseptic Non Touch Technique is used to insert PVC Aseptic Non Touch Technique is used to insert PVC YES / NO If not possible, use eitherIf not possible, use either STERILE GLOVES or or MINI CHLORAPREP Sterile dressing applied after insertion 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 DecontaminationSkin Decontamination
ChloraPrepChloraPrep
Adhesive DressingAdhesive Dressing
With date and time labelWith date and time label
Follow UpFollow Up
Regular monitoring of the site by the Regular monitoring of the site by the staff on the wardstaff on the ward
Documentation in patient’s notesDocumentation in patient’s notes When to replace the cannula, 72 hrsWhen to replace the cannula, 72 hrs When to remove the cannula, clinical When to remove the cannula, clinical
needneed When is a cannula site infectedWhen is a cannula site infected
What to Watch for?What to Watch for?
Sometimes the first clue is pain at Sometimes the first clue is pain at the site of insertionthe site of insertion
Infected Cannula SiteInfected Cannula Site
Documentation alone will not cure itDocumentation alone will not cure it Swab the site for culture and Swab the site for culture and
sensitivitysensitivity Assess the clinical pictureAssess the clinical picture Commence appropriate antibiotic Commence appropriate antibiotic
treatmenttreatment– choice of antibioticchoice of antibiotic– choice of mode of administrationchoice of mode of administration
Do Do NOTNOT Think of Treating Local Infection Think of Treating Local Infection with Local Antibiotic Ointment with Local Antibiotic Ointment
Developments in Forth ValleyDevelopments in Forth Valley
Front door services, need for IV Front door services, need for IV accessaccess
Documentation, stickers in notesDocumentation, stickers in notes PVC care bundle implementationPVC care bundle implementation Change of skin cleansing solutionChange of skin cleansing solution ? Change of IV cannula brand? Change of IV cannula brand
? The Future in Forth Valley? The Future in Forth Valley
BD Venflon with safety deviceBD Venflon with safety device
New Products, any good?New Products, any good?
FastBandFastBand
Any Questions?Any Questions?