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Saranaz Jamdar Consultant Microbiologist

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Presentation on theme: "Saranaz Jamdar Consultant Microbiologist"— Presentation transcript:

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?

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?

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