Updated June 2011 Infection Control: Venepuncture and Cannulation Insertion and Maintenance

Updated June 2011

Infection Control:Venepuncture and Cannulation

Insertion and Maintenance

Updated February 2012

Learning outcomes

• To understand the application of the chain of infection and standard precautions in relation to venepuncture and cannulation.

• Describe how vascular access device related infections can be prevented

• Describe how vascular access device related infections can be detected.


Risks associated with venepuncture and cannulation

• Includes risks to healthcare workers e.g.needlestick injuries

• High complication rate• Under reporting of phlebitis, catheter related sepsis• Compromises patient treatment• Extends treatment duration• Endangers patient survival• Costs millions of pounds annually for the NHS

• BBV could be transferred from the patient to the member of staff undertaking venepuncture/cannulation

• Is that likely to occur?

• When is it likely to occur?

• How can it be prevented?


5 stages at which a needlestick injury can occur

Stage % risk of needlestick injury

Preparation 6%

In use 42%

After use, before disposal

28%

During disposal 11%

After inappropriate disposal

13%


This data is based on a study of 322 NSIs over 27 months at Glasgow Royal Infirmary 2004-2005


Risk of transmission from sharps injury:HIV = 0.3% (1:300) HBV = 20-40% (1:3)HCV = 3-5% (1:30)

Incubation period:HIV = 15yrs HBV = varies HCV = 20yrs

plus

We cannot identify all patients with BBV

When a needlestick incident occurs:

• Follow the NHSGGC policy

• Two important reasons to report a needlestick injury

• To make sure you get the right treatment and advice.

• So that we can learn from how incidents occurred and help prevent them in the future.



The Chain of Infection –Venepuncture and Cannulation Insertion

and Maintenance

Infectious Agent/Organism


• Staphylococcus epidermidis • Staphylococcus aureus• Enterococcus spp. • Klebsiella• Pseudomonas• E. Coli• Serratia• Candida

Micro-organisms associated with Venepuncture and Cannulation related

infections



and Maintenance

Reservoir



Reservoirs

• Patients skin – resident microflora• Environment• Equipment• IV solutions & medicines• HCW hands -transient microflora



and Maintenance

Reservoir


Means of Exit


Means of Exit

• Secretions such as bodily fluids e.g. blood

• Skin e.g. skin scales



and Maintenance

Reservoir


Means of Exit

Route of Transmission



• Direct contact - on healthcare workers hands

• Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates



and Maintenance

Reservoir


Means of Exit


Means of Entry


Means of entry

Contaminated on insertion

Contaminated fluid

Patient’s skin

microflora

Local infection

Operator’s microflora

Haematogenous spread

Migration down catheter inside and out



and Maintenance

Reservoir


Means of Exit


Means of Entry

Susceptible Host


Susceptible Host

• Extremes of age• Surgery• Extended length of stay in hospital• Compromised immune system• Chronic disease• Antibiotics• Vascular access device in-situ



and Maintenance

Reservoir


Means of Exit


Means of Entry

Susceptible Host


Standard Precautions

The minimal level of infection control precautions that apply in

all situations.

Updated February 2012Isolation

There are 10 elements to Standard Precautions

Hand Hygiene PPE

Clinical waste

Linen

SpillagesOccupational ExposureEnvironment

Cough etiquette

Patient Care Equipment

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Preparation• Clean near patient tray and sharps bin

• Hand decontamination

• Skin prep

• Tourniquets

Remember if you are interrupted you need to decontaminate your hands again

Skin Preparation

• Clean visibly soiled skin with soap and water

• Apply alcohol based skin cleanser for 30 seconds

• Allow to dry

• Avoid touching the skin once the skin has been cleaned/disinfected



Dressings

Function of the dressing is:

• To protect the site of venous access

• To stabilise the device in place

• Prevent mechanical damage

• Keep site clean


Maintenance of PVC’s


Detection of Infection

Infection can present in a number of ways:

• Local site infection • Phlebitis• Systemic infection


IV site healthy 0 No phlebitis, observe cannula

1 of the following is evident•Slight pain, Slight redness

1 Possibly early phlebitis, observe cannula

2 of the following are evidentPain, erythema, swelling

2 Early stage of phlebitis, resite cannula

all of the following are evident: 3 Medium phlebitis, resite cannula,

consider treatment

All of the following are evident and extensive

Pain along the cannula, swelling, induration, palpable venous cord

4 Advanced phlebitis, or possible thrombophlebitis

resite cannula, consider treatment

All of the following are evident and extensive

Pain along the cannula, swelling, induration, palpable venous cord,

pyrexia

5 Advanced thrombophlebitis initiate treatment,

resite cannula


Inspection

Cannula must be inspected and findings documented in Adult PVC care plan at least once per day

1. Continuing clinical indication for PVC2. VIP Score3. PVC dressing dry and intact ?4. Was PVC dressing renewed ?5. Was PVC removed6. Reason for removal


PVC Insertion Information Affix patient label Name: Address: D.O.B: CHI number: Hospital: Ward:

Ensure the PVC dressing has date and time of insertion written on it. This implies that appropriate technique has been used for insertion.

PVC Maintenance Information

Modified V.I.P (Visual Infusion Phlebitis) Score

IV site appears healthy 0 No Phlebitis Observe Cannula

ONE of the following is evident: - slight pain or redness near site 1 Possible first signs Observe Cannula

TWO of the following are evident: - pain -redness - swelling 2 Early stage of phlebitis Re-site Cannula

ALL of the following are evident: - pain - redness - hardening of the surrounding tissue 3

As above including: - palpable venous cord 4 As above including: - pyrexia 5

Phlebitis / Thrombophlebitis

Re-site Cannula & Seek Further Advice

Day 1 (24 hours after insertion) Day 2 All 5 questions below MUST be answered

The PVC must be monitored at least once per day

All 5 questions below MUST be answered The PVC must be monitored at least once per day

1. Continuing clinical indication for PVC? Yes / No 1. Continuing clinical indication for PVC? Yes / No

2. VIP Score? 2. VIP Score?

3. PVC Dressing dry & intact? Yes / No 3. PVC Dressing dry & intact? Yes / No 4. Was PVC dressing renewed? Yes / No / NA 4. Was PVC dressing renewed? Yes / No / NA 5. Was PVC Removed? Yes / No 5. Was PVC Removed? Yes / No Removal Reason: ____________________________

Removal Reason: ____________________________

Comments/Actions Taken: Date: Initials:

Comments/Actions Taken: Date: Initials:

After Day 3 consider removal, if there is still a clinical reason justify rationale for PVC to remain insitu: Date: Initials:

Day 3 Day 4 All 5 questions below MUST be answered

The PVC must be monitored at least once per day

All 5 questions below MUST be answered The PVC must be monitored at least once per day

1. Continuing clinical indication for PVC? Yes / No 1. Continuing clinical indication for PVC? Yes / No

2. VIP Score? 2. VIP Score?

3. PVC Dressing dry & intact? Yes / No 3. PVC Dressing dry & intact? Yes / No

4. Was PVC dressing renewed? Yes / No / NA 4. Was PVC dressing renewed? Yes / No / NA

5. Was PVC Removed? Yes / No 5. Was PVC Removed? Yes / No Removal Reason: ____________________________

Removal Reason: ____________________________

Comments/Actions Taken:

Date: Initials:

Comments/Actions Taken:

Date: Initials:

L R Date: __________________ (See IV Dressing)

Time: __________________ Reason for Insertion:___________________ Flushed on insertion (if known)

Other Site: __________________

Adult Peripheral Venous Cannulation (PVC) ChartPlease use 1 chart per PVC


Prevention – Best practice

• Do not use the top port of PVC unless no other access

• “SCRUB THE HUB” pre and post use -using an alcohol wipe to clean

• Use needle free device with extension


Removal of the Cannula

• Perform hand hygiene• Wear gloves• Use sterile gauze• Apply pressure for approx 2-3 minutes• Inspect the cannula to ensure it is complete and

undamaged• Dispose of cannula into sharps bin• Perform hand hygiene

• DOCUMENT in Care plan or in notes


Key Points

• Venepuncture/cannulation if not undertaken properly can result in infection

• Hand hygiene, aseptic non-touch technique and correct preparation will minimise the risk of infection

• Patients should be closely monitored for signs of infection

• Good documentation is essential

• If it is not documented it is not done!!

Documents

Updated June 2011 Infection Control: Venepuncture and Cannulation Insertion and Maintenance