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

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

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

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

Traditional IV Infusion Needles Traditional IV Infusion Needles

First IV Cannula 1 ST modern cannula, “Branula” u. Dr B Braun, Germany 1962 First IV Cannula 1 ST modern cannula, “Branula” u. Dr B Braun, Germany 1962

Later Models Later Models

Modern models Modern models

Complications u Extravasation Complications u Extravasation

Complications u Haemorrhage/bleeding Complications u Haemorrhage/bleeding

Complications u Infection − local − Systemic u Staph aureus (MSSA, MRSA) u Streptococcus Complications u Infection − local − Systemic u Staph aureus (MSSA, MRSA) u Streptococcus spp. u Gram negative bacteria u Candida spp.

Staphylococcus aureus Staphylococcus aureus

Streptococcus spp. Streptococcus spp.

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

Candida spp. Candida spp.

Some Examples Some Examples

Some More Some More

Infection in Forth Valley u. Local infection (5 so far this week!) u. Bacteraemia Infection in Forth Valley u. Local infection (5 so far this week!) u. Bacteraemia (1 this week!) u. Secondary site of infection (ask me in a few months) – Abscess – Osteomyelitis/septic arthritis – Endocarditis – Overwhelming sepsis – Death

BEWARE Staphylococcus aureus, RETURNS BEWARE Staphylococcus aureus, RETURNS

Situation in Forth Valley Situation in Forth Valley

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

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

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

Case 2 Case 2

Some Real Cases in FV Case 3 u. IV cannula site infection, another hospital Some Real Cases in FV Case 3 u. IV cannula site infection, another hospital u. Bacteraemia, another hospital u. Secondary site involvement, silent u. Back pain, started in SRI 6/52 later u. Discitis, psoas abscess, ? aortitis u. Loculated pulmonary empyema

Case 3, MRI Case 3, MRI

Case 3, CT Chest Case 3, CT Chest

Situation in Forth Valley and Elsewhere u Considerable morbidity and mortality associated with Cannula Situation in Forth Valley and Elsewhere u Considerable morbidity and mortality associated with Cannula site infection u Patient dies from infection of an intravascular device, how do you defend yourself?

IV Cannula, Whose Responsibility Is It? EVERYBODY’S IV Cannula, Whose Responsibility Is It? EVERYBODY’S

Prevention of Cannula Site Infection Prevention of Cannula Site Infection

Prevention of Cannula Site Infection u Does the patient need IV access for TREATMENT? Prevention of Cannula Site Infection u Does the patient need IV access for TREATMENT? u If the answer is YES, proceed to the PVC insertion bundle u Remember “bleeding the patient” does not qualify as “need” for insertion of an IV cannula

PVC Insertion Bundle u. A PVC is clinically indicated u Hand hygiene is carried PVC Insertion Bundle u. A PVC is clinically indicated u Hand hygiene is carried out u Skin is decontaminated u Aseptic (no touch) technique u Sterile dressing including date and time label

Does the Patient Need IV Access u u u u PVC Insertion Bundle and Does the Patient Need IV Access u u u u PVC Insertion Bundle and Removal Record Is PVC clinically indicated for this patient YES, WHY: IV Fluids/Blood Transfusion. IV 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: _______

Skin Decontamination u Chlora. Prep Skin Decontamination u Chlora. Prep

Adhesive Dressing u With date and time label Adhesive Dressing u With date and time label

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

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

Infected Cannula Site u Documentation alone will not cure it u Swab the site Infected Cannula Site u Documentation alone will not cure it u Swab the site for culture and sensitivity u Assess the clinical picture u Commence appropriate antibiotic treatment – choice of antibiotic – choice of mode of administration

Do NOT Think of Treating Local Infection with Local Antibiotic Ointment Do NOT Think of Treating Local Infection with Local Antibiotic Ointment

Developments in Forth Valley u Front door services, need for IV access u Documentation, Developments in Forth Valley u Front door services, need for IV access u Documentation, stickers in notes u PVC care bundle implementation u Change of skin cleansing solution u ? Change of IV cannula brand

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

New Products, any good? u Fast. Band New Products, any good? u Fast. Band

Any Questions? Any Questions?