Venflon, Friend or Foe? Saranaz Jamdar Consultant Microbiologist 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 History of IV Infusion William Harvey, explained blood circulation, 1628 1st book on application of intravenous infusion in humans, Major 1664 and Elsholtz 1667 History of IV Infusion 1st proper IV infusion Dr Thomas Latta 2nd Cholera pandemic, affecting UK, 1832 Traditional IV Infusion Needles First IV Cannula 1ST modern cannula, “Branula” Dr B Braun, Germany 1962 Later Models Modern models Complications Extravasation Complications Haemorrhage/bleeding Complications Infection − local − Systemic Staph aureus (MSSA, MRSA) Streptococcus spp. Gram negative bacteria Candida spp. Staphylococcus aureus Streptococcus spp. Gram Negative Bacteria Enterobacteraciae Pseudomonas sp. Environmental organisms Candida spp. Some Examples Some More 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 BEWARE Staphylococcus aureus, RETURNS Situation in Forth Valley Origin of SAB 14 SAB Numbers 12 10 Other 8 Unknow n 6 Skin & Soft Tissue 4 Device associated 2 0 Apr- May10 10 Jun10 Jul10 Aug- Sep10 10 Oct10 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 Case 1 Theatre for debridement and drainage of abscess Grew S.aureus (MSSA) again 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 Case 2 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 Case 3, MRI Case 3, CT Chest 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? IV Cannula, Whose Responsibility Is It? EVERYBODY’S Prevention of Cannula Site Infection 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 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 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: _____________ Skin Decontamination ChloraPrep Adhesive Dressing With date and time label 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 What to Watch for? Sometimes the first clue is pain at the site of insertion 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 Do NOT Think of Treating Local Infection with Local Antibiotic Ointment 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 ? The Future in Forth Valley BD Venflon with safety device New Products, any good? FastBand Any Questions?