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

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Presentation on theme: "Venflon, Friend or Foe? Saranaz Jamdar Saranaz Jamdar Consultant Microbiologist Consultant Microbiologist."— Presentation transcript:

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

2 Venflon or Cannula? Venflon is a brand name not the device Venflon is a brand name not the device Manufactured by BD Manufactured by BD Peripheral vascular catheter (PVC) or cannula Peripheral vascular catheter (PVC) or cannula In Forth Valley we currently use B/Braun In Forth Valley we currently use B/Braun

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

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

5 Traditional IV Infusion Needles

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

7 Later Models

8 Modern models

9 Complications Extravasation Extravasation

10 Complications Haemorrhage/bleeding Haemorrhage/bleeding

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

12 Staphylococcus aureus

13 Streptococcus spp.

14 Gram Negative Bacteria Enterobacteraciae Enterobacteraciae Pseudomonas sp. Pseudomonas sp. Environmental organisms Environmental organisms

15 Candida spp.

16 Some Examples

17 Some More

18 Infection 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 infection Secondary site of infection (ask me in a few months) (ask me in a few months) –Abscess –Osteomyelitis/septic arthritis –Endocarditis –Overwhelming sepsis –Death

19 Staphylococcus aureus, RETURNS BEWARE

20 Situation in Forth Valley

21 Some Real Cases in FV Case 1 Patient admitted with D+V Patient admitted with D+V IV fluids IV fluids IV cannula site inflamed IV cannula site inflamed Grew Staph aureus (MSSA) Grew Staph aureus (MSSA) Clinical deterioration despite antibiotic therapy Clinical deterioration despite antibiotic therapy

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

23 Some Real Cases in FV Case 2 Neonate Neonate IV cannula on leg IV cannula on leg Local infection and spread to joint Local infection and spread to joint Septic arthritis of knee Septic arthritis of knee Bacteraemia, Staph aureus Bacteraemia, Staph aureus

24 Case 2

25 Some Real Cases in FV Case 3 IV cannula site infection, another hospital IV cannula site infection, another hospital Bacteraemia, another hospital Bacteraemia, another hospital Secondary site involvement, silent Secondary site involvement, silent Back pain, started in SRI 6/52 later Back pain, started in SRI 6/52 later Discitis, psoas abscess, ? aortitis Discitis, psoas abscess, ? aortitis Loculated pulmonary empyema 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 Considerable morbidity and mortality associated with Cannula site infection Patient dies from Patient dies from infection of an infection of an intravascular intravascular device, how do device, how do you defend yourself? you defend yourself?

29 IV Cannula, Whose Responsibility Is It? EVERYBODYS EVERYBODYS

30 Prevention of Cannula Site Infection

31 Does the patient need IV access for TREATMENT? Does the patient need IV access for TREATMENT? If the answer is YES, proceed to the PVC insertion bundle 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 Remember bleeding the patient does not qualify as need for insertion of an IV cannula

32 PVC Insertion Bundle A PVC is clinically indicated A PVC is clinically indicated Hand hygiene is carried out Hand hygiene is carried out Skin is decontaminated Skin is decontaminated Aseptic (no touch) technique Aseptic (no touch) technique Sterile dressing including date and time label 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 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 either or If not possible, use either STERILE GLOVES 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: _____________

34 Skin Decontamination ChloraPrep ChloraPrep

35 Adhesive Dressing With date and time label With date and time label

36 Follow Up Regular monitoring of the site by the staff on the ward Regular monitoring of the site by the staff on the ward Documentation in patients notes Documentation in patients notes When to replace the cannula, 72 hrs When to replace the cannula, 72 hrs When to remove the cannula, clinical need When to remove the cannula, clinical need When is a cannula site infected When is a cannula site infected

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

38 Infected Cannula Site Documentation alone will not cure it Documentation alone will not cure it Swab the site for culture and sensitivity Swab the site for culture and sensitivity Assess the clinical picture Assess the clinical picture Commence appropriate antibiotic treatment 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 Front door services, need for IV access Documentation, stickers in notes Documentation, stickers in notes PVC care bundle implementation PVC care bundle implementation Change of skin cleansing solution Change of skin cleansing solution ? Change of IV cannula brand ? Change of IV cannula brand

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

42 New Products, any good? FastBand FastBand

43 Any Questions?


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