1. Saranaz Jamdar Consultant Microbiologist
Venflon, Friend or Foe?
Saranaz Jamdar
Consultant Microbiologist

2. 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

3. History of IV Infusion
William Harvey, explained blood circulation, 1628
1st book on application
of intravenous
infusion in humans,
Major 1664 and
Elsholtz 1667

4. History of IV Infusion 1st proper IV infusion Dr Thomas Latta
2nd Cholera
pandemic, affecting
UK, 1832

5. Traditional IV Infusion Needles

6. First IV Cannula 1ST modern cannula, “Branula”
Dr B Braun, Germany 1962

7. Later Models

8. Modern models

9. Complications
Extravasation

10. Complications
Haemorrhage/bleeding

11. Complications Infection Staph aureus (MSSA, MRSA) Streptococcus spp.
local
Systemic
Staph aureus (MSSA, MRSA)
Streptococcus spp.
Gram negative bacteria
Candida spp.

12. Staphylococcus aureus

13. Streptococcus spp.

14. Gram Negative Bacteria
Enterobacteraciae
Pseudomonas sp.
Environmental organisms

15. Candida spp.

16. Some Examples

17. Some More

18. 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

19. BEWARE
Staphylococcus aureus, RETURNS

20. Situation in Forth Valley

21. 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

22. Case 1 Theatre for debridement and drainage of abscess
Grew S.aureus (MSSA) again

23. 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

24. Case 2

25. 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

26. Case 3, MRI

27. Case 3, CT Chest

28. 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?

29. IV Cannula, Whose Responsibility Is It?
EVERYBODY’S

30. Prevention of Cannula Site Infection

31. 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

32. 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

33. Does 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 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: _____________

34. Skin Decontamination
ChloraPrep

35. Adhesive Dressing
With date and time label

36. 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

37. What to Watch for?
Sometimes the first clue is pain at the site of insertion

38. 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

39. Do NOT Think of Treating Local Infection with Local Antibiotic Ointment

40. 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

41. ? The Future in Forth Valley
BD Venflon with safety device

42. New Products, any good?
FastBand

43. Any Questions?