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.

Updated February 2012 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? Updated February 2012

5 stages at which a needlestick injury can occur Stage% risk of needlestick injury Preparation6% In use42% After use, before disposal 28% During disposal11% After inappropriate disposal 13% Updated February 2012 This data is based on a study of 322 NSIs over 27 months at Glasgow Royal Infirmary

Updated February 2012 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. Updated February 2012

The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Infectious Agent/Organism

Updated February 2012 Staphylococcus epidermidis Staphylococcus aureus Enterococcus spp. Klebsiella Pseudomonas E. Coli Serratia Candida Micro-organisms associated with Venepuncture and Cannulation related infections

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism

Updated February 2012 Reservoirs Patients skin – resident microflora Environment Equipment IV solutions & medicines HCW hands -transient microflora

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism Means of Exit

Updated February 2012 Means of Exit Secretions such as bodily fluids e.g. blood Skin e.g. skin scales

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism Means of Exit Route of Transmission

Updated February 2012 Route of Transmission Direct contact - on healthcare workers hands Indirect contact- contaminated equipment, fluids, parenteral drugs or infusates

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism Means of Exit Route of Transmission Means of Entry

Updated February 2012 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

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism Means of Exit Route of Transmission Means of Entry Susceptible Host

Updated February 2012 Susceptible Host Extremes of age Surgery Extended length of stay in hospital Compromised immune system Chronic disease Antibiotics Vascular access device in-situ

Updated February 2012 The Chain of Infection – Venepuncture and Cannulation Insertion and Maintenance Reservoir Infectious Agent/Organism Means of Exit Route of Transmission Means of Entry Susceptible Host

Updated February 2012 Standard Precautions The minimal level of infection control precautions that apply in all situations.

Updated February 2012 Isolation There are 10 elements to Standard Precautions Hand Hygiene PPE Clinical waste Linen Spillages Occupational Exposure Environment Cough etiquette Patient Care Equipment

Updated February 2012

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 Updated February 2012

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

Updated February 2012 Maintenance of PVC’s

Updated February 2012 Detection of Infection Infection can present in a number of ways: Local site infection Phlebitis Systemic infection

Updated February 2012 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 evident Pain, 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

Updated February 2012 Inspection Cannula must be inspected and findings documented in Adult PVC care plan at least once per day 1.Continuing clinical indication for PVC 2.VIP Score 3.PVC dressing dry and intact ? 4.Was PVC dressing renewed ? 5.Was PVC removed 6.Reason for removal

Updated February 2012 Adult Peripheral Venous Cannulation (PVC) Chart Please use 1 chart per PVC

Updated February 2012 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

Updated February 2012 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

Updated February 2012 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!!