Venflon, Friend or Foe? Saranaz Jamdar Consultant Microbiologist
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 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 2 nd Cholera pandemic, affecting UK, 1832
Traditional IV Infusion Needles
First IV Cannula 1 ST modern cannula, “Branula” u. Dr B Braun, Germany 1962
Later Models
Modern models
Complications u Extravasation
Complications u Haemorrhage/bleeding
Complications u Infection − local − Systemic u Staph aureus (MSSA, MRSA) u Streptococcus spp. u Gram negative bacteria u Candida spp.
Staphylococcus aureus
Streptococcus spp.
Gram Negative Bacteria u Enterobacteraciae u Pseudomonas sp. u Environmental organisms
Candida spp.
Some Examples
Some More
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
Situation in Forth Valley
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 (MSSA) again
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
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, CT Chest
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
Prevention of Cannula Site Infection
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 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 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
Adhesive Dressing u With date and time label
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 of insertion
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
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
New Products, any good? u Fast. Band
Any Questions?
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