Venflon, Friend or Foe?

1
Venflon, Friend or Foe?

• Saranaz Jamdar
• Consultant Microbiologist

2
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

3
History of IV Infusion

• William Harvey, explained blood circulation, 1628
• 1st book on application
• of intravenous
• infusion in humans,
• Major 1664 and
• Elsholtz 1667

4
History of IV Infusion

• 1st proper IV infusion
• Dr Thomas Latta
• 2nd Cholera
• pandemic, affecting
• UK, 1832

5
Traditional IV Infusion Needles
6
First IV Cannula

• 1ST modern cannula, Branula
• Dr B Braun, Germany 1962

7
Later Models
8
Modern models
9
Complications

• Extravasation

10
Complications

• Haemorrhage/bleeding

11
Complications

• Infection
• local
• Systemic
• Staph aureus (MSSA, MRSA)
• Streptococcus spp.
• Gram negative bacteria
• Candida spp.

12
Staphylococcus aureus
13
Streptococcus spp.
14
Gram Negative Bacteria

• Enterobacteraciae
• Pseudomonas sp.
• Environmental organisms

15
Candida spp.
16
Some Examples
17
Some More
18
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

19
BEWARE
Staphylococcus aureus, RETURNS
20
Situation in Forth Valley
21
Some Real Cases in FV

• Case 1
• Patient admitted with DV
• IV fluids
• IV cannula site inflamed
• Grew Staph aureus (MSSA)
• Clinical deterioration despite antibiotic therapy

22
Case 1

• Theatre for debridement and drainage of abscess
• Grew S.aureus (MSSA) again

23
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

24
Case 2
25
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

26
Case 3, MRI
27
Case 3, CT Chest
28
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?

29
IV Cannula, Whose Responsibility Is It?

• EVERYBODYS

30
Prevention of Cannula Site Infection
31
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

32
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

33
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
  _____________

34
Skin Decontamination

• ChloraPrep

35
Adhesive Dressing

• With date and time label

36
Follow Up

• Regular monitoring of the site by the staff on
  the ward
• Documentation in patients notes
• When to replace the cannula, 72 hrs
• When to remove the cannula, clinical need
• When is a cannula site infected

37
What to Watch for?

• Sometimes the first clue is pain at the site of
  insertion

38
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

39
Do NOT Think of Treating Local Infection with
Local Antibiotic Ointment
40
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

41
? The Future in Forth Valley

• BD Venflon with safety device

42
New Products, any good?

• FastBand

43
Any Questions?