Infection Control: Venepuncture and Cannulation Insertion and Maintenance

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Infection ControlVenepuncture and Cannulation
Insertion and Maintenance
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Learning outcomes

• Explain the chain of infection and standard
  precautions.
• To understand the application of the chain of
  infection and standard precautions in relation to
  venepuncture and cannulation.
• Discuss the actions required to prevent/minimise
  the risk of infection in a patient having
  venepuncture and cannulation.
• Describe how vascular access device related
  infections can be prevented
• Describe how vascular access device related
  infections can be detected.

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Risky Business

• High Complication Rate
• Under reporting
• Compromises patient treatment
• Extends treatment duration
• Endangers patient survival
• Includes risks to healthcare workers
• Costs millions of pounds annually

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• One study of PVCs
• 52 Of patients had a PVC
• 33 Of PVCs were incorrectly dressed
• 52 Of PVCs were incorrectly positioned
• 46 Of PVCs were unused for 24 hours
• 23 Of PVCs had never been used
• 23 Of PVCs had no documented purpose
• 12 Of PVCs had visible phlebitis
• 6 Of PVCs had infiltration
• Thomas et al JHI 2006

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The Chain of Infection Venepuncture and
Cannulation Insertion and Maintenance
Infectious Agent/Organism
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Infectious Micro-organisms associated with
Venepuncture and Cannulation

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

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• We cannot identify all patients with BBV
• 20 of patients with AIDS present without anyone
  ever knowing they were HIV positive

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BBV The facts

• Newly diagnosed per year
• HIV 250 HBV 350 HCV 917
• Risk of transmission from sharps injury
• HIV 0.3 (1300)
• HBV 20-40 (13)
• HCV 3-5 (130)
• Incubation period
• HIV 15yrs HBV varies HCV 20yrs plus

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

• Patients Skin resident microflora
• Environment
• Equipment
• IV Solutions drugs
• HCW Hands -Transient microflora

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

• Secretions such as bodily fluids e.g. blood
• Skin such as skin scales

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

• Direct contact - on healthcare workers hands
• Indirect contact- contaminated equipment, fluids,
  parenteral drugs or infusates
• Puncture of skin (inoculation / blood borne)

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The Chain of Infection Venepuncture and
Cannulation Insertion and Maintenance
Infectious Agent/Organism
Reservoir
Means of Entry
Means of Exit
Route of Transmission
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Means of entry
Operators microflora
Contaminated fluid
Patients skin microflora
Local infection
Migration down catheter inside and out
Contaminated on insertion
Haematogenous spread
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The Chain of Infection Venepuncture and
Cannulation Insertion and Maintenance
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Susceptible Host

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

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The Chain of Infection Venepuncture and
Cannulation Insertion and Maintenance
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Preparation

• Clean Work Surface
• Hand Decontamination
• Skin prep
• Tourniquets

Remember if you are disturbed you need to
decontaminate your hands again
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Standard Precautions

• The minimal level of infection control
  precautions that apply in all situations.

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There are 9 elements to Standard Precautions
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Aseptic Non Touch Technique

• The overriding and basic principle is that the
  susceptible site should not come into contact
  with any item that is not sterile.
• What are the susceptible site(s) on these pieces
  of equipment

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Dressings

• Function of the dressing is
• To protect the site of venous access
• To stabilise the catheter in place
• Prevent mechanical damage
• Keep site clean

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Maintenance
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Detection of Infection

• Infection can present in a number of ways
• Local Site Infection
• Microbial Phlebitis
• Systemic Infection

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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 Pain along the path of the cannula, redness, swelling 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
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Inspection

• Cannula must be inspected and findings documented
  at least once per shift
• Is vascular access still necessary?
• How long has it been in ?
• Is the dressing dry and intact ?
• Is the cap on and locked ?
• 5. Check for phlebitis

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Giving Sets

• Change giving set after administration of blood
  or blood products either every 12 hours or when
  transfusion is complete
• After 24 hours of TPN administration
• After 72 hours if clear fluids are used
• All ward prepared infusions should be changed
  after 24 hours

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Infusate Sepsis
10 hours after infusion 3 commenced patient
spiked a temp. Patient pulled out
cannula. Cannula resited same infusion
recommenced. Temp spiked again, blood cultures
taken. Environmental Pseudomonas sp isolated from
blood.
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Prevention Best practice

• Do not use the top port
• SCRUB THE HUB pre and post use
• Use needle free device with extension

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Removal of the Cannula

• Wash your hands
• 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
• Wash your hands!!!!
• DOCUMENT

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Key Points

• Venepuncture/cannulation if not done properly can
  cause infection
• Hand hygiene, aseptic 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!!