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Infection Prevention in IV Therapy

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Infection Prevention in IV Therapy 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 Nursing 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 patient’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 patients 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 circulatory system 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).
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