In association with Supported by an unrestricted educational grant from

Infection prevention in IV therapy

IV3000◊ dressing: meeting the challenge

S&N-IV3000_13July_Final.indd 1 17/07/2015 09:22

MA Healthcare, St Jude’s Church, Dulwich Road, London SE24 0PB, UK Associate Publisher: Andrew Iafrati Tel: +44 (0)20 7501 6732. Web: www.markallengroup.com. Editor/Associate Publisher, Medical Education: Tracy Cowan Sub-editor: Sarah Kahn © 2015 MA Healthcare Designer: Louise Wood All rights reserved. No reproduction, transmission or copying of this publica- Published by: MA Healthcare, St Jude’s Church, tion is allowed without written permission. No part of this publication may Dulwich Road, London SE24 0PB, UK be reproduced, stored in a retrieval system, or transmitted in any form or by Tel: +44 (0)20 7501 6732 any means, mechanical, electronic, photocopying, recording, or otherwise, Email: [email protected] without the prior written permission of MA Healthcare or in accordance with Web: www.markallengroup.com the relevant copyright legislation. Although the editor, MA Healthcare and Smith & Nephew have taken great care to ensure accuracy, neither MA Healthcare nor Smith & Nephew will be liable for any errors of omission or inaccuracies in this publication. Published on behalf of Smith & Nephew by MA Healthcare.

S2 British Journal of 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 2 17/07/2015 09:22 Contents 4 Foreword 5 Use of dressings to secure intravenous devices 9 Non-tunnelled CVC following surgery 10 CVC in an outpatient haematology unit 11 PICC in an intensive care setting 12 PICC in an acute oncology setting 13 PICC in a community setting 14 Midline in a surgical ward 15 Peripheral cannula in the community 16 Peripheral cannula in an acute setting 17 Bene ts of an e-learning module

Declaration of interest: This supplement was commissioned and supported by Smith & Nephew. The authors are independent consultants who received a fee for their contribution. They are: Gemma Oliver, Katherine Hill, Christina Ronayne, Steve Hill, Vicki Shawyer, Janice Gabriel, Nicole Moodley, Rosemary Pease, Lesley Channer, Sandy Buckle, Carly Edmed, Pinky Virhia and Jennifer Pennycock

IV3000◊ dressing S3

S&N-IV3000_13July_Final.indd 3 17/07/2015 09:22 aseptic non-touch technique when inserting and accessing Foreword the device (RCN, 2010) and taking account of the anatomical location of device placement (Cicolini et al, 2009) as well as the ’s physical condition (Hart, 2008). While numerous factors can increase the propensity of an IV device to fail, the importance of choosing the correct IV dressing and applying it appropriately cannot be underestimated. Recent recommendations in the literature (Webster et al, 2013; Loveday et al, 2014) have challenged the traditional practice of routinely removing a PIVC at 72–96 hours. Studies have found that asymptomatic peripheral cannulae may not require removal at regular intervals as some remained healthy and asymptomatic with indwell PIVC times of up to 10 days (Powell et al, 2008). However, extending the potential PIVC dwell time requires careful insertion techniques and meticulous ongoing observation and maintenance; integral to this is the quality of the IV dressing. If managed eff ectively, with Gemma Oliver extended dwell times, increased cost savings (11% of catheter- Nurse Consultant, Integrated IV Care, East Kent related expenditure) can be achieved (Webster et al, 2013). Hospitals University NHS Foundation Trust This supplement discusses the requirements needed for an IV dressing to perform eff ectively in challenging healthcare ntravenous (IV) dressings should have two predominant contexts. It describes the challenges associated with the aims: to stabilise and secure the IV device and to prevent diff erent IV lines available, the settings in which they are used, Iinfection. In today’s healthcare environment, we are and the requirements of an IV dressing to perform eff ectively. constantly testing the limits of IV dressings and their ability It also acknowledges that, even when the most appropriate to fulfi l these aims as we extend the boundaries as to where, IV dressing is selected, its reliability is only as good as the skill when and how we provide IV therapy. and understanding of the practitioner placing it, so education There are many recommendations for the ideal IV on placement of the IV dressing is essential. dressing. It should be transparent in order to allow easy Cicolini G, Bonghi AP, Di Labio L, Di Mascio R (2009) Position of and early visualisation of any problems at the entry site peripheral venous cannulae and the incidence of thrombophlebitis: an (Department of Health, 2011), be sterile (Royal College observational study. J Adv Nurs 65(6): 1268–73 of Nursing (RCN), 2010), be secure yet gentle to remove, Department of Health (2011) High Impact Intervention Peripheral be unlikely to cause allergies, and be waterproof to allow intravenous cannula care bundle http://tinyurl.com/p7f645o (accessed 2 March 2015) patients to shower yet semipermeable so that moisture can Fletcher SJ, Bodenham AR (2000) Safe placement of central venous escape (Loveday et al, 2014). catheters: where should the tip of the catheter lie? Br J Anaesth 85(2): IV dressings for peripherally inserted venous cannulae 188–91 (PVIC) and central venous catheters (CVCs) should be able to Hadaway LC (2003) Infusing without infecting. Nursing 33(10): 58–63 secure the device completely. An unsecured PIVC allowing Hart S (2008) Infection control in intravenous therapy. In: Doherty L, device movement leads to the risk of mechanical phlebitis Lamb J (eds) Intravenous Therapy in Nursing Practice. 2nd edn. Blackwell Publishing, Oxford (Hadaway, 2003). An unsecured CVC dressing can result in the Kearns PJ, Coleman S, Wehner JH (1996) Complications of long arm- device tip being dislodged from its optimal position at the right catheters: a randomized trial of central vs peripheral tip location. JPEN J cavoatrial junction. CVCs with a poorly positioned tip have Parenter Enteral Nutr 20(1): 20–4 an increased risk of venous thrombosis (Kearns et al, 1996), Lavery I (2010) Infection control in IV therapy: a review of the chain of infection. Br J Nurs 19(19): S6–14 which is associated with catheter-related sepsis (Fletcher and Loveday HP, Wilson JA, Pratt RJ et al (2014) epic3: national evidence-based Bodenham, 2000). guidelines for preventing healthcare-associated infections in NHS The IV dressing should also act as an eff ective barrier hospitals in England. J Hosp Infect 86 Suppl 1: S1–70 against infection. Microorganisms can enter by migration Powell J, Tarnow KG, Perucca R (2008) The relationship between peripheral from the cannula via the interface with the skin. Inserting a intravenous catheter indwell time and the incidence of phlebitis. J Infus Nurs 31(1): 39–45 peripheral vascular cannula through the skin will breach the Royal College of Nursing (2010) Standards for infusion therapy. RCN, London body’s natural defences and open the to Webster J, Osborne S, Rickard CM, New K (2013) Clinically-indicated risks of infection (Lavery, 2010). Interrelated actions associated replacement versus routine replacement of peripheral venous catheters. with preventing IV device infection include maintaining an Cochrane Database Syst Rev 4: CD007798.

S4 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 4 17/07/2015 09:22 n modern medicine, intravenous (IV) therapy is a Use of dressings fundamental component of care for patients both in Ithe hospital setting and in the community (Griffi ths, 2007; Scales, 2008). It has been reported that more than to secure 60% of patients admitted to hospital are likely to receive IV therapy via a vascular access device (Aziz, 2009). However, intravenous devices a number of complications are associated with this therapy, as the vascular access device breaches the integrity of the skin, which is the body’s main defence barrier There are a variety of vascular devices against microorganisms. Phlebitis is the most common available that require intravenous complication of peripheral IV therapy, which places the patient at increased risk of erythema, pain, swelling, dressings to prevent infection localised infection and catheter-related bloodstream infections (CRBSIs) (Campbell and Bowden, 2011).

Which vascular access device? A vascular access device provides access to the vascular system for the administration of medications, fl uids, blood products and parental nutrition (Bowden, 2010). In recent years, there has been an increase in the number and range of vascular access devices used in both the acute hospital and community (Kelly, 2011). When considering which vascular access device is most suitable for a particular patient, many factors need to be considered, such as patient characteristics (for example, age and condition of the peripheral veins) and type/duration of IV therapy (Hadaway, 2002). If possible, patients should be fully informed of the benefi ts and risks of the vascular access device proposed for them so that they can be included in the decision-making process (Mickler, 2008).

Peripheral venous cannulas A short peripheral venous cannula (PVC) is a short-term Katherine Hill device that is inserted, usually into the veins of the hand Lecturer/Practitioner, Practice Development, or forearm, to administer IV therapy within the hospital NHS Greater Glasgow and Clyde setting (Bowden, 2010). The PVC is the most commonly used vascular access device; however, it is unsuitable for the administration of vesicant and irritant medications, or solutions with a pH of less than 5 or greater than 9, as these will damage the intima of the vein (Kelly, 2011; Royal College of Nursing (RCN), 2010). While much guidance states that PVCs should be considered for removal after 72 hours (RCN, 2010; Infusion Nurses Society, 2011), in order to minimise the risk of phlebitis and resultant infection, more up-to-date evidence suggests there is no clinical benefi t in routinely changing PVCs every 72–96 hours and that there may be a cost saving with changing only when clinically indicated by the presence of phlebitis (Webster et al, 2013). The use of a PVC should Christina Ronayne only be a short-term option and other vascular access Research Nurse, devices should be considered if IV therapy is planned for Liverpool Heart and Chest NHS Foundation Trust longer than 5 days (Hadaway, 2002).

IV3000◊ dressing S5

S&N-IV3000_13July_Final.indd 5 17/07/2015 09:22 Midline catheters For more lengthy IV therapy, one option is a midline catheter, as it can remain indwelling for up to 6 weeks. It is suitable for patients who are discharged early from hospital but still require medium- to long-term therapy, for example, IV antibiotics for cellulitis or endocarditis Illustrations: Peter Lamb Peter Illustrations: (Kelly, 2011). Midlines are inserted into the antecubital fossa, with the tip lying in the axillary vein in the upper arm. Although still a peripheral device, there is a greater flow rate of blood around the catheter tip, which dilutes the medications being administered and reduces the risk of damage to the intima of vein and chemical phlebitis (Griffiths, 2007).

There are many factors Figure 1. Positioning of a non-tunnelled to consider when selecting

Brachiocephalic vein a vascular device, such Subclavian vein Superior vena cava

Cephalic vein as patient characteristics and type or duration of PICC intravenous therapy

Median cubital vein Central venous catheters Brachial vein Non-tunnelled central venous catheters (CVCs) are PICC commonly used in emergency departments and critical care areas. These are invasive devices, inserted via the subclavian, jugular or femoral vein (Hadaway, 2002) (Figure 1), to allow the delivery of medications and fluids into the fast-flowing central circulation, ensuring rapid Figure 2. Positioning of a peripherally inserted central catheter distribution of the medication while reducing the risk of chemical phlebitis from vesicant and irritant drugs (Scales, 2008). The optimal dwell time for non-tunnelled Superior vena cava Vein entry site CVCs is unknown, but the insertion site should be closely observed and the patient’s overall condition monitored Subcutaneous for clinical signs of phlebitis or infection (Scales, 2008). tunnel This vascular access device has the highest rate of CRBSI Dacron cuff and should be only considered as a temporary access device (Jones, 2004; Kelly, 2011).

Skin entry site Peripherally inserted central catheters Peripherally inserted central catheters (PICCs) are inserted into a peripheral vein and advanced until the tip sits within a central vein (Scales, 2008) (Figure 2). These vascular access devices are traditionally used in oncology; however, there has been an increase in their use in other Figure 3. Positioning of a tunnelled central venous catheter specialties (Kelly, 2013). PICCs are a reliable and stable

S6 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 6 17/07/2015 09:22 option for patients who require long-term therapy, extravasation (Royer, 2003). Historically, vascular access in particular those receiving irritant, vesicant and devices were secured by suturing them to the skin (Gabriel, hyperosmolar solutions (Obaid and Amerasekera, 2011). 2010); however, in recent years, dressings have been However, as this is an external catheter, it is important developed that aim to protect the entry site and secure the to assess whether this type of vascular access device access device. Some of these dressings have an integral hub is compatible with the patient’s activity and lifestyle lock, e.g. StatlockTM (Bard Medical); others have adhesive (Hadaway, 2002). strips that anchor the wings of the device to the skin e.g. IV3000◊ (Smith & Nephew) and TegadermTM (3M). The Other options ideal IV dressing is secure (to prevent device dislodgement), Other long-term options include tunnelled CVCs and transparent (to permit assessment of the device and implanted ports. Tunnelled CVCs, such as Hickman surrounding skin), and will promote an environment around catheters, are inserted into either a jugular or subclavian the entry site that reduces the risk of infection. vein and can remain indwelling for years (Figure 3). They are often chosen for patients requiring long-term, continuous Infection prevention or intermittent therapy, for example, chemotherapy (Kelly, In recent years, much has been written about preventing 2011). The skin insertion site is usually a short distance infection associated with the use of vascular access devices away from the vein insertion site, which reduces the risk of (Le Corre et al, 2003; Jones, 2004; Rickard and Ray-Barruel, CRBSI (Scales, 2008). In addition, there is a fibrous Dacron 2009). The advent of the care bundles for central venous cuff which, when positioned in the skin tunnel, stabilises access devices (Institute for Healthcare Improvement, 2011) the device and reduces the migration of microorganisms and peripheral devices (Health Protection Scotland, 2012) into the catheter tract (Kelly, 2011). Implanted ports are has dramatically reduced the incidence of CRBSIs (Szakmany small access devices that are inserted into a surgically et al, 2011). A key element of both the central venous access created subcutaneous pocket; a catheter then connects the device bundle and the peripheral device bundle is that the port to a central vein. When administering medication, dressing should be dry and in place. In general, film dressings the port is accessed by puncturing the skin with a needle, have been found not only to be more durable than gauze which may cause the patient some discomfort (Hadaway, dressings, but also to have a high moisture vapour transfer 2002). This device is a suitable option for patients requiring rate (MVTR), which causes them to adhere better to skin, long-term intermittent IV therapy, in particular those with even when the patient is sweating excessively (Jones, 2004). body image concerns (Jones, 2004). The primary advantage Furthermore, Richardson (1991) found that a high MVTR of this vascular access device is that it is fully implanted, minimises the presence of fluid around the entry site, thereby reducing the risk of infection and allowing resulting in a suboptimal environment for bacterial growth. activities of daily living (Jones, 2004; Kelly, 2011). Securing the vascular access device The ideal dressing and protecting the entry site As stated above, a number of vascular access devices are would be secure to prevent available, reflecting a diverse patient group and varying clinical situations. However, all of these invasive devices dislodgement, transparent breach the integrity of patient skin and so significantly increase the risk of CRBSI (Campbell and Bowden, 2011). to permit assessment and The other major risk with all vascular access devices is dislodgement and, to promote patient wellbeing and it should promote recovery, it is essential that accidental device loss is minimised. Untimely dislodgement can lead to loss of an environment that therapy and extravasation of medication, and also can cause patient distress when the device is replaced. Peripheral reduces infection device loss is a persistent problem and, although there is no precise data on the cost of extra bed days caused by failure to administer treatment owing to accidental device loss, To date, research has failed to identify a reduction in anecdotally this remains a huge issue. infection rates when using one of the many transparent In addition, inadequately securing the device can result dressings on the market, or dry gauze (Le Corre et al, 2003), in phlebitis, leakage of infusate from the entry site and although there are perceived benefits with transparent

IV3000◊ dressing S7

S&N-IV3000_13July_Final.indd 7 17/07/2015 09:22 dressings. One of these is the ability to visualise the insertion J Infus Nurs 34(1S). http://tinyurl.com/pq3xwwq (accessed 25 site. Part of the CRBSI bundle is to assess the catheter February 2015) insertion site daily for signs of infection. A transparent Institute for Healthcare Improvement (2011) Implement the IHI dressing facilitates this without the need to remove or Central Line bundle. http://tinyurl.com/6qxsdjw (accessed 25 otherwise disturb the dressing, saving both nursing time February 2015) and minimising the risk of contamination. Le Corre et al Jones A (2004) Dressings for the management of catheter sites: a review. Journal for the Association of Vascular Access 9(1): 26–33 (2003) identified that this led to an overall cost saving when Kelly LJ (2011) A guide to the use and care of vascular access devices transparent, semipermeable dressings were used. in the palliative care setting. Int J Palliat Nurs 17(9): 425–9 The other advantage with the use of a semipermeable Kelly LJ (2013) A practical guide to safe PICC placement. Br J Nurs dressing is that the patient is able to shower/wash without 22(8): S13–9 the need for dressing renewal. For longer term devices in Le Corre L, Delorme M, Cournoyer S (2003) A prospective, particular—PICCs, midlines and tunnelled central venous randomized trial comparing a transparent dressing and a dry access devices—this may greatly improve quality of life gauze on the exit site of long term central venous catheters of hemodialysis patients. J Vasc Access 4(2): 56–61 for the patient and reduce costs incurred by frequent dressing changes. Mickler PA (2008) Neonatal and paediatric perspectives in PICC placement. J Infus Nurs 31(5): 282–5 Obaid DR, Amerasekera SSH (2011) Peripherally inserted central Conclusion venous catheters. British Journal of Cardiac Nursing 6(8): 386–90 Although there is no research evidence to demonstrate Richardson MC (1991) An in-vivo assessment of microbial that any one semipermeable film dressing is superior over proliferation under transparent film dressings. In: Maki DG (ed) another, IV3000◊ does have the characteristics described Improving catheter site care. International congress and symposium above as being essential for an IV dressing. The latest series No. 179. Royal Society of Medicine Series, London version of IV3000 contains two securing strips that have Rickard C, Ray-Barruel G (2009) Systematic Review of Infection Control Literature Relating to Intravascular Devices. http:// been improved to increase conformability and therefore tinyurl.com/q57shgj (accessed 25 February 2015) aid security (Smith & Nephew, 2013a; 2013b). The adhesive Royal College of Nursing (2010) IV Therapy Forum: Standards For used is positioned in a grid pattern to facilitate easy dressing Infusion Therapy. 3rd edition. RCN, London removal (Wille et al, 1993) and maximise comfort (Wheeler, Royer T (2003) Improving short peripheral IV outcomes: clinical 1991), while the dressing’s high MVTR (Tompkins, 2008) trial of two securement methods. Journal of the Association for ensures it remains in place, even in the presence of moisture Vascular Access 8(4): 45–9 caused by sweating. The dressing is transparent and comes Scales K (2008) Intravenous therapy: a guide to good practice. Br J in a variety of sizes designed for the variety of vascular Nurs 17(19): S4–12 access devices available. It also helps prevent bacterial Smith & Nephew (2013a) Tensile strength testing of IV3000 current and new strip/label materials. Report: W11437/R21. Data on file contamination (Benson, 2003). The following case studies Smith & Nephew (2013b) Adhesion to steel testing of IV3000 current provide examples of the use of IV3000 on patients with and new strip/label materials. Report: W11437/R22. Data on file different lines in various clinical settings. Szakmany T, Pain T, Beckett P, Jerrett H, Hermon A (2011) Eliminating catheter-related bloodstream infection on the : not a myth! at European Society of Intensive Aziz A (2009) Improving peripheral intravenous cannula care: Care Medicine Annual Congress 2011, Berlin. http://tinyurl.com/ implementing high-impact interventions. Br J Nurs 18(20): 1242–6 ptrdyqt (accessed 25 February 2015) Benson R (2003) Bacterial barrier testing of IV3000: Smith & Nephew Tompkins L (2008) IV3000 1 Hand Dressing Physical Properties. Research Centre Work Report WRP-TW042-281, Report 0505005. Smith & Nephew Wound Management Laboratory Report: Smith & Nephew, Hull DS/07/224/R1a. Smith & Nephew, Hull Bowden T (2010) Peripheral cannulation: a practical guide. British Webster J, Osborne S, Rickard CM, New K (2013) Clinically- Journal of Cardiac Nursing 5(3): 124–31 indicated replacement versus routine replacement of peripheral Campbell C, Bowden T (2011) Peripheral vascular access devices: care venous catheters. Cochrane Database Syst Rev 4:CD007798 and maintenance. British Journal of Cardiac Nursing 6(3): 132–40 Wheeler S, Stolz S, Maki DG (1991) A prospective, randomised, Gabriel J (2010) Vascular access devices: securement and dressings. three-way clinical comparison of a novel, highly permeable, Nurs Stand 24(52): 41–6 polyurethane dressing with 206 Swan-Ganz pulmonary artery Griffiths V (2007) Midline catheters: Indications, complications and catheters: OPSITE IV3000 vs. Tegaderm vs. gauze and tape. II. maintenance. Nurs Stand 22(11): 48–57 Nursing issues: effectiveness and tolerance as catheter dressings. In: Maki DG, ed, International Congress and Symposia Series No. Hadaway LC (2002) IV rounds: choosing the right vascular access 179, ‘Improving Catheter Site Care’, Royal Society of Medicine device, part II. Nursing 32(10): 74–6 Series, London, New York, 67-72 Health Protection Scotland (2012) PVC Care Bundle. http://tinyurl. Wille JC, Blusse van Oud Alblas A, Thewessen EAPM (1993) A com/c5eosln (accessed 25 February 2015) comparison of two transparent film-type dressings in central Infusion Nurses Society (2011) Infusion nursing standards of practice venous therapy. J Hosp Infect 23(2): 113–21

S8 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 8 17/07/2015 09:22 Non-tunnelled CVC A 64-year-old woman attended the author’s trust for elective surgery for a large pelvic mass, thought to be ovarian or sarcoma cancer. She underwent bilateral following surgery insertion of nephrostomy tubes followed by pelvic exenteration, and was then admitted to critical care for Steve HiIl, Procedure Team Manager, elective post-surgical management. It was estimated that Christie NHS Foundation Trust, she would spend 2 days in the critical care unit. Manchester Preoperatively, an anaesthetist had inserted a quadruple lumen non-tunnelled central venous catheter (CVC) into the patient’s right internal jugular vein. A multiple lumen device was required for her postoperative management, which included intravenous (IV) administration of: • Total parenteral nutrition (TPN) • Noradrenaline • Paracetamol • Omeprozole • Pabrinex • Ciprofl oxacin. The non-tunnelled CVC was in place for 7 days postoperatively, and was removed when the TPN was discontinued. The catheter was secured with the ported IV3000◊ dressing. Outcomes The anaesthetist found the ported IV3000 simple and easy to apply. Its adhesion strips facilitated good securement for as long as the device was in situ (Figure 1). As the dressing was transparent, the nursing/medical teams could easily assess the skin and insertion site. No signs of infections were observed while the dressing was in place, or during the dwell time of the catheter. No moisture build-up under the dressing were observed, and there were no signs of infection, erythema, tenderness or oozing around the entry site. The dressing remained intact and in place throughout the postoperative period, and secured the device. It was therefore considered a cost-effi cient option. Despite the position of the right internal jugular placement, the patient did not fi nd the catheter Figure 1. The IV3000 dressing in situ around troublesome, and stated that the dressing was the non-tunnelled central venous catheter comfortable, and held the catheter in place.

IV3000◊ dressing S9

S&N-IV3000_13July_Final.indd 9 17/07/2015 09:22 CVC in an outpatient used until the catheter exit site has healed and to allow suffi cient time for the DacronTM cuff to embed or for the tissues to graft onto the cuff (usually 3 weeks). More haematology unit research is required to demonstrate the effi cacy of the dressing for longer-term use with tunnelled CVCs. While Steve Hill, Procedure Team Manager, the Epic3 guidelines confi rm that a dressing is required The Christie NHS Foundation Trust, Manchester until the site is healed, they also state that ‘a dressing may no longer be required once the insertion site is healed’. It is therefore left to the clinician’s judgement and the patient to decide whether to keep it in place at this point. In the author’s haematology unit, IV dressings are used for the duration of therapy if the patient prefers, with weekly dressing changes. In this case, the patient chose to keep the dressing in place during treatment, as she felt more reassured that it was protecting the exit site. Outcomes The catheter site was examined daily when the patient attended for treatment. Over 6 days, there were some reports of slight redness, approximately 0.5 cm around the exit site, depending on who observed the site, although the patient explained that it normally looked like this and there was no pain or discomfort in the area. Nevertheless, the exit site was swabbed and blood samples were ◊ Figure 1. The IV3000 dressing in situ over taken, which revealed no signs of bacterial growth but a a dual-lumen tunnelled CVC c-reactive protein (CRP) rate of <5. The CRP rate remained at this level throughout the This case study concerns a 25-year-old woman who 2-week follow-up period, during which time no signs of was undergoing phase II induction treatment for acute exit-site infection were observed. lymphocytic leukaemia and was preparing for a bone The patient found the dressing comfortable and marrow transplant. Her treatment involved the insertion accepted that having a catheter and IV dressing was a part of a dual-lumen cuff ed tunnelled central venous catheter of her life for the time being. She showered daily, but did (CVC). On the fi rst day of this evaluation, the CVC had not wear the protective cover over the dressing. It was been in situ for 68 days and the patient was 2.5 weeks only at the end of the 7-day evaluation that the dressing into the second phase of her treatment. She appeared started to peel slightly at the edges, although this did not to be coping extremely well with the treatment, but signifi cantly aff ect its integrity over the catheter site. her haematological profi le illustrated how vulnerable Since the tunnelled CVC was inserted, up to and and prone to infection she was. Throughout the 7-day including the above evaluation period, the patient has evaluation period, her blood counts showed a neutropenic not experienced any CVC-related episodes of infection, picture, with her white cell count ranging from 0.2 to 0.9 despite being in an exceptionally vulnerable clinical x 109/L and her neutrophil counts from 0.3 to 0.00 x 109/L. condition. This is a testament to the practice of the staff Due to the nature of her treatment, she was caring for this patient. receiving chemotherapy and other intravenous (IV) Although the evidence on the use of a transparent support including cytarabine, cyclophosphamide, semipermeable dressing such as IV3000 on a healed entry blood transfusions, blood product support, site is unclear, this case illustrates how it can be used prophylactic antibiotics to cover neutropenic episodes, successfully as part of a care and maintenance strategy to and low molecular weight heparin for a non-CVC- prevent infection in a vulnerable patient. related thrombosis. In the author’s trust, IV3000 is the standard IV dressing Loveday, HP, Wilson JA, Pratt RJ et al (2014) epic3: national evidence-based guidelines for preventing healthcare-associated for patients with tunnelled CVCs. As recommended by infection in NHS hospitals in England. J Hosp Infect 86(Suppl Epic3 (Loveday et al, 2014), IV dressings are generally only 1): S1–70

S10 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 10 17/07/2015 09:22 PICC in an intensive A 70-year-old man underwent Hartmann’s procedure for bowel cancer. Following surgery, he developed sepsis and was admitted to intensive care. A laparotomy revealed an care setting anastomotic leak. A peripherally inserted central catheter (PICC) line was placed to deliver parenteral nutrition, as Vicki Shawyer, Senior Vascular Access Nurse well as the following intravenous (IV) medications: Specialist, Royal Devon and • Propofol infusion Exeter Hospital • Remifentanil infusion • Paracetamol 1 g four times a day • Frusemide 40 mg two times a day • Fluconazole 400 mg once a day • Piperacillin with tazobactam 4.5 g three times a day. The IV antibiotics were prescribed for 7 days and the diuretic for 8 days, while the parenteral nutrition continued for 14 days, followed by enteral nutrition via a nasogastric tube for the rest of his hospital stay. Sedation medications were used for the fi rst 4 days. Outcomes The patient was extremely unwell, and when the PICC was fi rst inserted, he was febrile and his skin was clammy to the Figure 1. The skin before the  rst dressing touch. The PICC was in situ for a total of 6 weeks, and the was applied ported IV3000◊ dressing was used throughout this period. Both the dressing and the needle-free connector were changed every 7 days. Throughout the 6-week period, each IV3000 dressing remained intact until its scheduled dressing change. It was therefore considered to be cost-eff ective. In addition, the skin under the dressing was found to be dry and intact at each dressing change, with no signs of irritation. Despite the long-term use of parenteral nutrition, it was not necessary to switch to a chlorhexidine gluconate-containing IV dressing, which the trust protocol recommends for the prevention of local site infection. Figure 2. Condition of the skin after The dressing fi tted over the PICC line and its dressing removal stabilisation device, keeping them secure and reducing the risk of migration and contamination. In addition, the dressing’s design—it is ported at the top with extra strong sides—helped to secure the PICC line, especially at the sides. The dressing was easy to remove, with clear guidance on which section to remove and in what order. Following removal, no adhesive was left on the skin and the patient did not experience any skin irritation. Figures 1 and 2 show the appearance of the skin before and after dressing removal. The patient was repositioned every 2 hours, during which time the dressing remained intact (Figure 3). He did not comment on any dressing-related discomfort. The patient Figure 3. The dressing is intact, despite was discharged to the ward after 20 days in intensive care 2-hourly patient repositioning and then home one week after the fi nal dressing change.

IV3000◊ dressing S11

S&N-IV3000_13July_Final.indd 11 17/07/2015 09:22 PICC in an acute She was diagnosed with neutropenic sepsis and prescribed IV antibiotics and fl uids. oncology setting Diffi culties were encountered in cannulation, so the decision was made to site a single-lumen, 4 Fr open- Janice Gabriel, Former Nurse Director, ended peripherally inserted central catheter (PICC), under Central South Coast Cancer Network ultrasound guidance. The PICC was placed in the basilic vein in her left upper arm. Outcomes The PICC was secured against the patient’s skin with the two sterile adhesive strips supplied with the ported IV3000◊ dressing. The insertion site was covered with a 5 cm2 sterile gauze (to absorb any blood that may have oozed from the cannulation site) and covered with IV3000 (Figure 1). This dressing combination remained in situ for 24 hours, when it was changed, as per the organisation’s policy for PICC dressings. The insertion site and surrounding area were then cleansed with 2% chlorhexidine gluconate and allowed to dry. A new IV3000 dressing was applied to the patient’s skin without sterile gauze, as there had been minimal blood loss from the cannulation site overnight. The nurse found the dressing easy to remove and apply, while the Figure 1. The PICC immediately patient did not report any discomfort during removal. after insertion The patient continued to receive the IV antibiotics for a further 5 days. As the ported IV3000 dressing is transparent, it allowed for easy observation of the PICC insertion site, without compromising the integrity of the dressing. There were no signs of exudate or phlebitis. When the patient’s pyrexia settled and she began to feel better, she was able to shower with assistance. The IV3000 dressing had a waterproof barrier that protected the PICC insertion site during showers and maintained its integrity. An indicator of the dressing’s vapour permeability is that the skin was found to be dry at each dressing change. After the patient had completed her course of IV antibiotics, her PICC was fl ushed with 10 ml of heparinised sodium chloride 10 I U/ml. The following Figure 2. Arm after removal of the PICC day, the continuation of her chemotherapy was discussed and dressing with her, and it was decided that she would have a break of 2 weeks before recommencing. She was given the A 77-year-old female was diagnosed with breast cancer in option of retaining the PICC for the future administration November 2014. Following a wide local excision on her of her chemotherapy, but declined. Although she had right breast and axillary clearance, she was transferred to found the PICC and its dressing comfortable during her the medical oncology team for cytotoxic chemotherapy hospital stay, she did not want any visual reminders of her (fl uorouracil (5FU), epirubicin and cyclophosphamide). The treatment between chemotherapy cycles. The PICC was fi rst two cycles were uneventful and venous access was therefore removed immediately before discharge. achieved easily with a peripheral cannula. Some 10 days after Apart from the small puncture hole resulting from the the third cycle, the patient felt unwell and became shivery, PICC insertion site, there were no other reminders of the owing to pyrexia. Her local chemotherapy unit arranged for device, including no redness or irritation caused by the her to be assessed immediately by the acute oncology team. dressing (Figure 2).

S12 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 12 17/07/2015 09:22 PICC in a community setting Nicole Moodley and Rosemary Pease, Rapid Response Nurse Practitioners, Lesley Channer, and Queen’s Nurse, all at Your Healthcare

A 65-year-old male was referred to a community intravenous (IV) therapy service by Royal Marsden Hospital while he was still receiving chemotherapy treatment. A peripherally inserted central catheter (PICC) Figure 1. Skin integrity before IV3000 was inserted to enable him to have chemotherapy dressing application treatment for a colorectal carcinoma at home. Weekly home visits were required to monitor and maintain the patency of the PICC and to change the dressing and the needle-free access device. At each visit, the PICC was fl ushed with 0.9% 10 ml normal saline to ensure that it remained patent and the exit site was clean, and to prevent infection. Meanwhile, the entry site was inspected using the visual infusion phlebitis (VIP) score. The patient’s history included a hiatus hernia in 2013, cancer of the colon in 2014 and atrial fi brillation in 2014. He had a right-sided ureteric stent inserted and a laparotomy for small bowel obstruction, both in 2014. In addition to the chemotherapy, the patient was receiving the following oral medication: Figure 2. Skin integrity following removal • Amiodarone 200 mg once daily of IV3000 dressing 2 weeks later • Lansoprazole 30 mg once daily • Hyoscine butylbromide 20 mg once daily accidental removal of the device. There was no build- • Tramadol 50 mg if required up of moisture under the dressing, with the device • Atenolol 50 mg once daily remaining secure at all times during the 7-day period. • Warfarin, as per international normalised ratio, as per the Despite his clinical diagnosis, the patient is active and dose in the anticoagulation book. the dressing did not restrict his arm movement or, indeed, The patient lives with his wife and receives no input his lifestyle. The dressing was easy to remove and left no from social services. When able to, he leads an active marks on the skin. Figures 1 and 2 depict the skin integrity family life. before and after 2 weeks’ use of IV3000. The patient stated that, as a subcutaneous catheter Outcomes securement device was already in situ when the IV3000 At the time of writing (March 2015), the ported IV3000◊ securing strips were applied, the strips caused pain and dressing had been in situ for 7 days, and did not appear irritation to his skin, so he stopped using them but to become uncomfortable for the patient, who was continued to use the dressing. instructed to contact the community team if a review of The patient showers daily, and uses a PICC line the dressing was required. waterproof shower protector, which he is able to apply The dressing was easy to apply, while its transparency over the dressing with ease. aided visualisation of the PICC entry site, facilitating Update: since this case study was fi rst written, the accurate assessment of the VIP score. In addition, the patient has been using the ported IV3000 dressing for dressing was eff ectively secured, and it protected the over 2 months without any problems, with only weekly PICC entry site, reducing the risk of contamination and dressing changes required.

IV3000◊ dressing S13

S&N-IV3000_13July_Final.indd 13 17/07/2015 09:22 Midline in a The subject of this case study is a 41-year-old woman with a complex bowel history, including an ileal stricture performed in 2013, who was admitted to hospital surgical ward with abdominal pain and vomiting. MRI revealed a bowel stricture, which was treated conservatively with Vicki Shawyer, Senior Vascular Access Nurse intravenous (IV) fl uids, pain relief and anti-emetics. The Specialist, Royal Devon patient had multiple cannulations, and so was referred and Exeter Hospital to the vascular access team. She was in severe pain and unable to tolerate anything orally, so received infusions in the surgical ward. The following medications were administered: • Paracetamol 1 g three times a day • Tramadol 100 mg three times a day • Cyclizine 50 mg three times a day • Metoclopramide 10 mg three times a day • Omeprazole 40 mg two times a day • 0.9% sodium chloride 1000 ml over 8 hours. Outcomes When the midline was fi rst inserted, the patient’s skin was sweaty and clammy to the touch. As often occurs following insertion, there was bleeding at the entry site, which was therefore covered with a gauze dressing and Figure 1. The dressing was well secured the ported IV3000◊ dressing for 24 hours, as per the standard procedure, by which time the bleeding had stopped. IV3000 was then used alone for the remaining 14 days that the midline was in place, with the dressing and needle-free connector being replaced every 7 days. As the entry site was assessed daily using the visual infusion phlebitis (VIP) score, a transparent dressing was required. The dressing was a good size, fi tting over the stabilisation device and midline, keeping it secure and free from contamination (Figure 1). The dressing is ported at the top, which enabled the complete midline to be secured well at the sides, reducing the risk of migration and contamination. It was also easy to remove, with Figure 2. Dressing removal did not impair no adhesive left on the skin or signs of skin irritation skin integrity (Figure 2). The dressing remained intact over each 7-day period that it was in situ, while patient movement had no eff ect on it (Figure 3). At dressing change, the patient’s skin was observed to be dry, minimising the risk of excoriation. The skin integrity was the same as that on the surrounding skin further up the arm. The patient had had other midlines inserted in the past, and so was able to compare the new version of IV3000 with both the previous version and other IV dressings. She said the new version felt secure and comfortable, as it did not pull on her skin. Figure 3. Mobility had no effect The patient continued to receive IV infusions until she on conformability was able to tolerate fl uids and discharged home.

S14 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 14 17/07/2015 09:22 Peripheral cannula in community nurses administered the antibiotics in the patient’s home once daily throughout the 4-day course. The eff ectiveness of the ported IV3000◊ dressing was the community monitored during this time. Carly Edmed, Lead Intravenous Outcomes Specialist Nurse, Kent Community NHS The IV3000 dressing, which was placed over the Foundation Trust peripheral cannula when it was inserted, remained intact for the full 4 days. The cannula was eff ectively secured by an adhesive strip (Figure 1), while the dressing was large enough to cover it entirely with ease, thereby limiting the risk of contamination. The dressing adhered well to the patient’s skin. The patient was advised to continue with her normal lifestyle but to be mindful of the cannula when washing and dressing. She was able to wash on a daily basis and, while she avoided getting the dressing wet, she reported that she sometimes splashed it. Despite this, the dressing remained completely intact and free of infection. The patient said the dressing did not cause any irritation or limit her ability to maintain her activities of daily living. The IV3000 has a large transparent section, which covered the cannula exit site. This allowed the nurses to Figure 1. The peripheral cannula was inspect the site for any signs of infection, allergic reactions secured with an adhesive strip or problems with the line, such as misplacement or migration. Daily inspections using the visual infusion phlebitis (VIP) scoring chart indicated that the site remained free of infection throughout the treatment period. The community nurses found the dressing easy to apply and remove, which was assisted by clear markings showing which sections to remove/apply and in what order. Following the completion of the course of antibiotics, a stretching technique was used to remove the dressing. It was comfortably eased off , causing minimal distress to the patient and her skin (Figure 2). As the antibiotics eliminated the wound-site infection, the cannula was Figure 2. Skin integrity after removal removed and the patient was able to continue her of the dressing recovery from surgery.

In January 2015, a 48-year-old woman was diagnosed with breast cancer and underwent a wide local excision of her left breast in April. Following discharge from hospital, she was transferred to the community intravenous (IV) specialist team. She required IV antibiotics for an infection at the mastectomy wound site. Due to the length of the treatment, which totalled 4 days, it was decided to continue administration of the IV antibiotics via a peripheral cannula, with a view to placing a peripherally inserted central catheter (PICC) at a later date. The

S15 British Journal of Nursing 2015, Vol 24 No 14

S&N-IV3000_13July_Final.indd 16 17/07/2015 09:22 Peripheral cannula in Chemotherapy was administered via a peripheral cannula. The insertion site and surrounding area were cleansed using 2% chlorhexidine gluconate in alcohol an acute setting and allowed to dry. Peripheral venous cannulation was achieved at the second attempt using an aseptic non- Pinky Virhia, Lecturer Practitioner, Practice touch technique. Development Department, and Jennifer Pennycock, Practice Development Facilitator, Outcome both at NHS Greater Glasgow and Clyde The cannula was secured on the patient’s skin with the two sterile adhesive fi xing strips supplied with the ported IV3000 dressing. These strips kept the cannula secure, preventing its movement. The transparent nature of the dressing allowed for easy observation of the puncture site without compromising the dressing’s integrity. The visual infusion phlebitis (VIP) score remained at zero during this time. The cannula was removed the following day when the consultant decided that a blood transfusion was not necessary. During the 25 hours that the cannula and dressing were in place, the patient did not report any discomfort during the dressing’s application and removal. The dressing itself was very easy to apply and remove. The patient was able to wash herself during her hospital stay, and the IV3000 dressing provided a waterproof Figure 1. Skin integrity before application barrier that both maintained its integrity and protected of IV3000◊ the cannula. Apart from the small puncture hole resulting from the insertion site, there were no other reminders of the cannula, including no redness or irritation caused by the dressing. Despite the vulnerable nature of the patient’s skin, its integrity was not compromised during dressing removal (Figures 1 and 2).

Figure 2. Skin integrity after 25 hours’ use of IV3000

A 76-year-old female was admitted to her local hospital with ascites and pleural eff usions. A computerised tomography (CT) scan showed an ovarian mass. Following biopsy, cytology revealed adenocarcinoma, likely of ovarian origin. The patient was referred to the regional medical oncology team for review, and a treatment plan was devised that included the administration of carboplatin AUC5 400 mg. Her past medical history included diverticular disease, osteoporosis and osteoarthritis.

IV3000◊ dressing S16

S&N-IV3000_13July_Final.indd 17 17/07/2015 09:22 • Chapter 8: infection prevention, including hand hygiene, aseptic non-touch technique, identifying patients at IV3000 product range increased risk, routes of contamination, plus national 1 infection prevention guidelines and safe disposal of sharps. Selection of the correct dressing for insertion sites is advised as a best practice to prevent infections . Benefi ts of an At end of the course, the user should be able to: IV3000 offers an extensive range of dressings designed to meet the most common IV therapy practices. • Assess the patient’s understanding of the procedure Our range includes four types of dressings in various sizes2: e-learning module • Assess the condition of the patient’s veins, distinguish between diff erent structures, and recognise and locate veins Ported dressings suitable for venepuncture and cannulation A transparent film dressing with moisture-responsive technology that incorporates non-woven wings which reinforce fixation around • Identify and access suitable veins in order to achieve the catheter site. The dressing has an opening designed to host the cannula’s port. The dressing also includes two sterile IMPROVED The venepuncture and peripheral venepuncture and cannulation successfully securing strips for catheter or tube fixation and a sterile documentation label3-5. IV cannulation e-learning module • Recognise and manage any complications arising during is already being rolled out in some and from the procedure. Sizes* S&N code Quantity per carton Recommended indication NHS organisations Nevertheless, the e-learning module does not certify 5cm x 6cm 66004011 100 Paediatric competence• Chapter and8: infection is not a replacementprevention, includingfor hands-on hand training, hygiene, IV3000 product7cm x 9cm range4006 100 Peripheral a fullaseptic clinical non-touch assessment technique, or professional identifying clinical patients judgement. at 9cm x 12cm (oval) 66004009 50 Central increased risk, routes of contamination, plus national 1 infectionKatherine preventionHill is a practice guidelines development and safenurse disposal at NHS Greaterof sharps. Selection of the correct dressing11cm x 14cm for insertion 66800512sites is advised as 25a best practice to preventPICC infections . The venepunctureBenefi and peripheral ts IV cannulation of an e-learning GlasgowAt end and of Clyde, the course, who is implementing the user should the e-learning be able to: module in IV3000 offers an extensive *Availability range andof dressingsproduct code could designed vary per country to meet the most common IV therapy practices. module, sponsored by Smith & Nephew, provides digital her• trust.Assess She the is involved patient’s in understandingthe delivery of education of the procedure and training, Our range includes four types of dressings in various sizes2: training on venepuncture and peripheral cannulation. It is ranging• Assess from the clinical condition skills toof specialty-specifi the patient’s veins, c training, distinguish and talks Non-ported dressings e-learning module 3,4 based on the work of Leeds Teaching Hospital NHS Trust, aboutbetween it here: diff erent structures, and recognise and locate veins A Portedtransparent dressings film dressing with moisture-responsive technology with twoIMPROVED securing strips and documentation label . the Royal College of Nursing Standards for Infusion Therapy suitable for venepuncture and cannulation The backing paper design allows users to apply the dressing using only one hand5. A transparent film dressing with moisture-responsive technology that incorporates non-woven wings which reinforce fixation around and the Royal Marsden Hospital’s manual of clinical nursing Why• Identify did you and think access that suitable an alternative veins in order form to achieve the catheter site. The dressing hasSizes* an opening designedS&N to host code the cannula’s port.Quantity The dressing per carton also includes Recommended two sterile indication IMPROVED procedures. The module venepuncture comprises and eight peripheral e-chapters, each ofvenepuncture education was and required? cannulation successfully securing strips for catheter or tube fixation and a sterile documentation label3-5. of which concludesIV cannulation with an assessment e-learning on themodule information There• Recognise was an increasing and manage demand, any complications because both arisingregistered during and 4cm x 5cm** 4654 100 Paediatric given. The user’sis already progress being is monitored rolled outby a inpractice/ some unregisteredand from the staff procedure. can attend venepuncture and cannulation 6cmSizes* x 7cm 4007S&N code 100Quantity per cartonPeripheral Recommended indication research supervisor. NHS organisations training.Nevertheless, Now registered the e-learning staff can module complete does the note-learning certify 10cm5cm x x 12cm 6cm 400866004011 50100 CentralPaediatric The module comprises eight chapters: modulecompetence before andattending is not aa practical replacement session. for Thishands-on means training, we *Availability7cm x 9cm and product code could4006 vary per country 100 Peripheral • Chapter 1: professional and legal issues, including cana full deliver clinical a shortened assessment practical or professional session and clinical run two judgement. sessions **This product size does not include securing strips and documentation label 9cm x 12cm (oval) 66004009 50 Central accountability, consent, duty of care, negligence, per day instead of one—essentially doubling the amount of documentation, vicarious liability and confi dentiality registeredKatherine staff Hill we is area practice training. development nurse at NHS Greater Frame Delivery 11cm x 14cm 66800512 25 PICC • TheChapter venepuncture 2: anatomy and and peripheral physiology, IV cannulation including the e-learning Glasgow and Clyde, who is implementing the e-learning module in A transparent film dressing with moisture-responsive *Availability and product technology. code could vary The per frame country delivery system allows user to position the dressing over vascularmodule, system, sponsored suitable by Smith veins & for Nephew, venepuncture provides and digital Howher trust. is the She module is involved being in the rolled delivery out of in education your trust? and training, the catheter with immediate visualization of the IV site. The dressing includes two securing strips and documentation label5. peripheraltraining on cannulation, venepuncture structure and peripheral of the skin cannulation. and blood It is Allranging registered from staff clinical who skills want to specialty-specifi to attend venepuncture c training, and and talks Non-ported dressings Sizes* S&N code Quantity per carton Recommended indication3,4 vessels,based onhow the to work diff erentiateof Leeds Teachingbetween Hospitalveins and NHS arteries, Trust, cannulationabout it here: practical sessions must complete the e-learning A transparent film dressing with moisture-responsive technology with twoIMPROVED securing strips and documentation label . skinthe assessment, Royal College fl ofuid Nursing distribution Standards in the for body, Infusion pH Therapy module fi rst. The backing paper design allows6cm users x 7cm to apply the dressing59410082 using only one hand1005. Peripheral andand osmotic the Royal concentration Marsden Hospital’s manual of clinical nursing Why did you think that an alternative form 10cm x 12cm 59410882 50 Central Sizes* S&N code Quantity per carton Recommended indication • procedures.Chapter 3: siteThe selection module comprises and vein assessment, eight e-chapters, including each Howof education expensive wasis it, required? in terms of cost and nurses’ time? *Availability and product code could vary per country criteriaof which for concludessite and vein with selection, an assessment with information on the information on WeThere paid wasto upload an increasing it onto LearnPro,demand, because an NHS both e-learning registered and 4cm x 5cm** 4654 100 Paediatric visualgiven. inspection, The user’s palpation,progress is physiological monitored by considerations, a practice/ system,unregistered so there staff was canan initialattend outlay venepuncture of around and £1200, cannulation but 6cm x 7cm 4007 100 Peripheral Reinforced handle (orange-handles) keyresearch sites to supervisor. avoid and how to enhance venous access thistraining. includes Now technical registered support. staff Itcan takes complete the nurses the e-learning a few hours 10cm x 12cm 4008 50 Central • ChapterThe module 4: equipment comprises sets, eight covering chapters: selecting equipment tomodule do the module,before attending but the practical a practical session session. is shorter, This means so time we A transparent film dressing with moisture-responsive technology with edges of orange tape. These can either be torn from the edges *Availability and product code could vary per country 5 for• venepunctureChapter 1: professional and cannulation, and legal gauge issues, sizes, including use of atcan the deliverworkplace a shortened is probably practical similar session to before. and Owingrun two to sessions the of the dressing and used for extra **Thissecurity product of the size catheter does not includeor left securingin place strips as part and ofdocumentation the dressing label. smalleraccountability, cannulae, consent, haemodilution, duty of care,needle-free negligence, access clinicalper day pressures instead ofthat one—essentially many nurses have, doubling though, the theyamount might of Sizes* S&N code Quantity per carton Recommended indication systems,documentation, non-ported, vicarious ported liability and winged and confi cannuale, dentiality notregistered get time staff to complete we are training. the module in the workplace. Frame Delivery extension• Chapter sets 2: andanatomy semipermeable and physiology, transparent including dressings the A transparent film dressing with6cm moisture-responsive x 8cm technology.4923 The frame delivery100 system allows userPeripheral to position the dressing over • vascularChapter system, 5: venepuncture suitable veins and peripheral for venepuncture cannulation and HowHow can is theyou module ensure thatbeing nurses rolled will out completein your trust? the catheter with immediate visualization6cm x 8.5cm of the IV site. The 4924 dressing includes two100 securing strips and documentationPeripheral label5. insertionperipheral procedure, cannulation, with structurestep-by-step of the guides skin and and videos blood theAll e-learning registered staffmodule who training? want to attend venepuncture and 10cm x 14cm 4925 10 Central Sizes* S&N code Quantity per carton Recommended indication • vessels,Chapter how 6: potential to diff erentiate complications, between covering veins and arteries, Nursescannulation must bring practical their sessions completed must certifi complete cates thewith e-learning them, 10cm x 14cm 4973 50 Central thrombosis,skin assessment, thrombophlebitis, fl uid distribution haematoma, in the body,infi ltration pH andmodule if they fi don’t, rst. they cannot stay for the practical session 10cm6cm x x 20cm 7cm 464959410082 50100 PICC/EpiduralPeripheral andand extravasation. osmotic concentration and will not be issued with a competency book to complete 10cm x 12cm 59410882 50 Central *Availability and product code could vary per country • •Chapter Chapter 7: 3: post-insertion site selection (cannulation),and vein assessment, including including supervisedHow expensive practice is within it, in terms their clinicalof cost area.and nurses’ time?

*Availability and product code could vary per country insertion,criteria for observation, site and vein dressing selection, the device,with information maintaining on We paid to upload it onto LearnPro, an NHS e-learning Wound Management www.smith-nephew.com/wound References

patencyvisual inspection,and removal. palpation, physiological considerations, Forsystem, further so details, there was please an initial email: outlay [email protected] of around £1200, but - 62550 October 2015 Acknowledged All Trademarks & Nephew. of Smith ™ Trademark Smith & Nephew www.iv3000.com 1. H. Loveday and et al., epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections MedicalReinforced Ltd handle (orange-handles) in NHS Hospitals in England, Journal of Hospital Infection, pp. S1-S70, 2014. 2. A. Jones, Dressings for the key sites to avoid and how to enhance venous access this includes technical support. It takes the nurses a few hours 101 Hessle Road ™Trademark of Smith & Nephew Management of Catheter Sites, JAVA, vol. 9, pp. 26-33, 2004. 3. Smith & Nephew, Technical Study Report W11437/ HullA HU3 transparent 2BN film dressing© Smith & Nephew with Julymoisture-responsive 2015 technology with edges of orange tape. These can either be torn from the edges S17 British• Chapter Journal 4:of Nursingequipment 2015, Volsets, 24 coveringNo 14 selecting equipment to do the module, but the practical session is shorter, so time R21, 2013. (in-vitro). 4. Smith & Nephew, Technical Study Report W11437/R22, 2013. (in-vitro). 5. Smith & Nephew. 61509 5 for venepuncture and cannulation, gauge sizes, use of at the workplace is probably similar to before. Owing to the T +44of the(0)1482 dressing 225181 and used for extra security of the catheterLaboratory or leftReport in DS/07/224/R1A. place as part (in-vitro) of the. dressing . F +44 (0)1482 328326 smaller cannulae, haemodilution, needle-free access clinical pressures that many nurses have, though, they might Sizes* S&N code Quantity per carton Recommended indication systems, non-ported, ported and winged cannuale, not get time to complete the module in the workplace. S&N-IV3000_13July_Final.inddextension 18 sets and semipermeable transparent dressings 17/07/2015 09:22 6cm x 8cm 4923 100 Peripheral • Chapter 5: venepuncture and peripheral cannulation How can you ensure that nurses will complete 6cm x 8.5cm 4924 100 Peripheral insertion procedure, with step-by-step guides and videos the e-learning module training? 10cm x 14cm 4925 10 Central • Chapter 6: potential complications, covering Nurses must bring their completed certifi cates with them, 10cm x 14cm 4973 50 Central thrombosis, thrombophlebitis, haematoma, infi ltration and if they don’t, they cannot stay for the practical session 10cm x 20cm 4649 50 PICC/Epidural and extravasation. and will not be issued with a competency book to complete *Availability and product code could vary per country • Chapter 7: post-insertion (cannulation), including supervised practice within their clinical area.

insertion, observation, dressing the device, maintaining Wound Management www.smith-nephew.com/wound References

patency and removal. For further details, please email: [email protected] - 62550 October 2015 Acknowledged All Trademarks & Nephew. of Smith ™ Trademark Smith & Nephew www.iv3000.com 1. H. Loveday and et al., epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections Medical Ltd in NHS Hospitals in England, Journal of Hospital Infection, pp. S1-S70, 2014. 2. A. Jones, Dressings for the 101 Hessle Road ™Trademark of Smith & Nephew Management of Catheter Sites, JAVA, vol. 9, pp. 26-33, 2004. 3. Smith & Nephew, Technical Study Report W11437/ S17 British Journal of Nursing 2015, Vol 24 No 14 Hull HU3 2BN © Smith & Nephew July 2015 61509 R21, 2013. (in-vitro). 4. Smith & Nephew, Technical Study Report W11437/R22, 2013. (in-vitro). 5. Smith & Nephew. T +44 (0)1482 225181 Laboratory Report DS/07/224/R1A. (in-vitro). F +44 (0)1482 328326

S&N-IV3000_13July_Final.indd 18 17/07/2015 09:22 IV3000 product range

Selection of the correct dressing for insertion sites is advised as a best practice to prevent infections1. IV3000 offers an extensive range of dressings designed to meet the most common IV therapy practices. Our range includes four types of dressings in various sizes2:

Ported dressings A transparent film dressing with moisture-responsive technology that incorporates non-woven wings which reinforce fixation around the catheter site. The dressing has an opening designed to host the cannula’s port. The dressing also includes two sterile IMPROVED securing strips for catheter or tube fixation and a sterile documentation label3-5.

Sizes* S&N code Quantity per carton Recommended indication 5cm x 6cm 66004011 100 Paediatric 7cm x 9cm 4006 100 Peripheral 9cm x 12cm (oval) 66004009 50 Central 11cm x 14cm 66800512 25 PICC *Availability and product code could vary per country

Non-ported dressings A transparent film dressing with moisture-responsive technology with twoIMPROVED securing strips and documentation label3,4. The backing paper design allows users to apply the dressing using only one hand5.

Sizes* S&N code Quantity per carton Recommended indication 4cm x 5cm** 4654 100 Paediatric 6cm x 7cm 4007 100 Peripheral 10cm x 12cm 4008 50 Central *Availability and product code could vary per country **This product size does not include securing strips and documentation label

Frame Delivery A transparent film dressing with moisture-responsive technology. The frame delivery system allows user to position the dressing over the catheter with immediate visualization of the IV site. The dressing includes two securing strips and documentation label5.

Sizes* S&N code Quantity per carton Recommended indication 6cm x 7cm 59410082 100 Peripheral 10cm x 12cm 59410882 50 Central *Availability and product code could vary per country

Reinforced handle (orange-handles) A transparent film dressing with moisture-responsive technology with edges of orange tape. These can either be torn from the edges of the dressing and used for extra security of the catheter or left in place as part of the dressing5. Sizes* S&N code Quantity per carton Recommended indication 6cm x 8cm 4923 100 Peripheral 6cm x 8.5cm 4924 100 Peripheral 10cm x 14cm 4925 10 Central 10cm x 14cm 4973 50 Central 10cm x 20cm 4649 50 PICC/Epidural *Availability and product code could vary per country

Wound Management www.smith-nephew.com/wound References Smith & Nephew www.iv3000.com 1. H. Loveday and et al., epic3: National Evidence-Based Guidelines for Preventing Healthcare-Associated Infections Medical Ltd in NHS Hospitals in England, Journal of Hospital Infection, pp. S1-S70, 2014. 2. A. Jones, Dressings for the 101 Hessle Road ™Trademark of Smith & Nephew Management of Catheter Sites, JAVA, vol. 9, pp. 26-33, 2004. 3. Smith & Nephew, Technical Study Report W11437/ Hull HU3 2BN © Smith & Nephew July 2015 61509 R21, 2013. (in-vitro). 4. Smith & Nephew, Technical Study Report W11437/R22, 2013. (in-vitro). 5. Smith & Nephew. T +44 (0)1482 225181 Laboratory Report DS/07/224/R1A. (in-vitro). F +44 (0)1482 328326

S&N-IV3000_13July_Final.indd 19 17/07/2015 09:22