Presentation on theme: "Intravenous Drug Administration"— Presentation transcript:
1Intravenous Drug Administration Infection ControlNHS Greater Glasgow and ClydeGlasgow Royal Infirmary
2Learning Outcomesdiscuss the way intravenous drug administration can cause infection;identify potential entry points where organisms may gain access to the system;state how line/infusate sepsis can be detected.describe how risks of infection in intravenous drug administration and line use can be minimised;
3IV Drug Administration Potentially the most life threatening of allnursing interventions.Be aware of all potential hazards.Take great care to prevent complications.
4Potential Implications PainInfectionDelay in further interventionSide effects of antibioticsDelay in dischargeDeathPatientPain being unwellPhlebitisDelay in further interventions/treatmentsSide affects of antibiotics rash, nausea c.diff.Delay in dischargeDeath
5Potential Implications DivisionSundriesIncreased medical and nursing interventionDelay in discharge/next admitResistant organismsLitigationSundries.Antibiotics and antibiotic levels.Other tests Blood cultures, x-raysNeedles and syringes etc.Hotel costs
6Where organisms gain entry Peripheral catheters associated with very few infections, about one third of patients develop phlebitis. Although the risk of phlebitis is reduced if the veins in the hand are used.Peripheral arterial catheters-frequent manipulation increases the risk of infection.Central venous cathetersSubclavian.Internal jugularFemoral vein.Catheters inserted in the jugular vein are more likely to become colonised and are associated with a higher risk of infection.Causes – closeness to oro-pharangeal secretions, mechanical effects of head movement, difficulty of fixing and dressing the site.Multi-lumen catheters increase the risk of infection.The aseptic management of the catheter hub, connection ports and administration sets is essential to prevent contamination of the system and subsequent infection.
7From the infusate Through contamination of the infusate Most at risk are long term (>10 hour) infusatesSpecifically those made up in-houseTime for small numbers of organisms to grow profusely.Direct infusion of organisms = severe sepsisParticularly some Gram negative organisms which grow well in solutions.
8Solutions which increase growth potential TPNBlood and blood productsLipid emulsions/drugs
9ComplicationsPhlebitisCatheter related sepsisInfusate Contamination
10Preparation Have a clean trolley/surface area Prepare alcohol hand gel drug requiredalcohol wipesneedle, syringe and if required newconnectionglovessharps bin
11Never reuse single use vials Never prepare drugs in advance
12Hand hygieneCheck solution is clearDisinfect ampouleDisinfect the hubPut on glovesAdminister drug
13Avoid infusing drugs into the port on top of the venflon. Use non-touch technique of equipment/drugs in contact with the internal lumen of the cannula.Avoid infusing drugs into the port on top of the venflon.The reason for not using the port on top of the venflon isIt is hard to clean properly and it can easily be contaminated with skin flora.You are infusing at a 90 degree angle and this requires some pressure and if there are any foci of infection at the catheter tip they are more likely to be introduced into the bloodstream.
14After Care Discard sharps immediately. Remove gloves and wash hands. Record as necessary.Watch for signs of sepsis.If on a pump/TPN, central line - four hourly temp chart.Venflon care plan.
15Giving setsChange giving set after administration of blood or blood productsAfter 24 hours of TPN administrationAfter 72 hours if clear fluids are usedUse filters if infusing in-house prepared infusions lasting longer that 12 hoursAll in-house infusion should be changed after 24 hours
16Infusate Sepsis10 hours after infusion 3 commenced patient spiked a temp.Patient pulled out venflon.Venflon resited same infusion recommenced.Temp spiked again, blood cultures taken.Environmental Pseudomonas sp isolated from blood.
17Treatment Stop the infusion - inform medical staff Send the infusate for culture.Send blood cultures & swab from site.Monitor vital signs.Remove the line - send tip.
18Dressings Not the most important factor. Dry dressings - do not alter skin floraFilm dressings can increase skin floraNon-sterile tape - no evidence against for peripheral veins.Don’t store tape in pockets.
19Key pointsintravenous drug administration if not done properly can cause infectionhand hygiene, aseptic technique, correct preparation and administration of iv.drugs/solutions and line changes will minimise the risk of infectionpatients should be closely monitored for signs of infection
20Remember Hand Hygiene What have you just done? Most Important FactorRememberWhat have you just done?What are you going to do?Hand Hygiene