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Infection Control: Venepuncture and Cannulation Insertion and Maintenance

Infection Control: Venepuncture and Cannulation Insertion and Maintenance. 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

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Infection Control: Venepuncture and Cannulation Insertion and Maintenance

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

  2. 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

  3. 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 Updated February 2012

  4. 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. 5 stages at which a needlestick injury can occur This data is based on a study of 322 NSIs over 27 months at Glasgow Royal Infirmary 2004-2005 Updated February 2012

  6. 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 Updated February 2012

  7. 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

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

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

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

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

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

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

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

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

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

  17. Means of entry Operator’s microflora Contaminated fluid Patient’s skinmicroflora Local infection Migration down catheter inside and out Contaminated on insertion Haematogenous spread Updated February 2012

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

  19. 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

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

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

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

  23. Updated February 2012

  24. Updated February 2012

  25. 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 Updated February 2012

  26. 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

  27. 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

  28. Maintenance of PVC’s Updated February 2012

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

  30. Updated February 2012

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

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

  33. 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

  34. 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

  35. 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!! Updated February 2012

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