1. Intravenous Drug Administration
Infection Control
NHS Greater Glasgow and Clyde
Glasgow Royal Infirmary

2. Learning Outcomes
discuss 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;

3. IV Drug Administration
Potentially the most life threatening of all
nursing interventions.
Be aware of all potential hazards.
Take great care to prevent complications.

4. Potential Implications
Pain
Infection
Delay in further intervention
Side effects of antibiotics
Delay in discharge
Death
Patient
Pain being unwell
Phlebitis
Delay in further interventions/treatments
Side affects of antibiotics rash, nausea c.diff.
Delay in discharge
Death

5. Potential Implications
Division
Sundries
Increased medical and nursing intervention
Delay in discharge/next admit
Resistant organisms
Litigation
Sundries.
Antibiotics and antibiotic levels.
Other tests Blood cultures, x-rays
Needles and syringes etc.
Hotel costs

6. Where 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 catheters
Subclavian.
Internal jugular
Femoral 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.

7. From the infusate Through contamination of the infusate
Most at risk are long term (>10 hour) infusates
Specifically those made up in-house
Time for small numbers of organisms to grow profusely.
Direct infusion of organisms = severe sepsis
Particularly some Gram negative organisms which grow well in solutions.

8. Solutions which increase growth potential
TPN
Blood and blood products
Lipid emulsions/drugs

9. Complications
Phlebitis
Catheter related sepsis
Infusate Contamination

10. Preparation Have a clean trolley/surface area Prepare alcohol hand gel
drug required
alcohol wipes
needle, syringe and if required new
connection
gloves
sharps bin

11. Never reuse single use vials
Never prepare drugs in advance

12. Hand hygiene
Check solution is clear
Disinfect ampoule
Disinfect the hub
Put on gloves
Administer drug

13. Avoid 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 is
It 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.

14. After 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.

15. Giving sets
Change giving set after administration of blood or blood products
After 24 hours of TPN administration
After 72 hours if clear fluids are used
Use filters if infusing in-house prepared infusions lasting longer that 12 hours
All in-house infusion should be changed after 24 hours

16. Infusate Sepsis
10 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.

17. Treatment 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.

18. Dressings Not the most important factor.
Dry dressings - do not alter skin flora
Film dressings can increase skin flora
Non-sterile tape - no evidence against for peripheral veins.
Don’t store tape in pockets.

19. Key points
intravenous drug administration if not done properly can cause infection
hand hygiene, aseptic technique, correct preparation and administration of iv.drugs/solutions and line changes will minimise the risk of infection
patients should be closely monitored for signs of infection

20. Remember Hand Hygiene What have you just done?
Most Important Factor
Remember
What have you just done?
What are you going to do?
Hand Hygiene