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Venflon, Friend or Foe?

Venflon, Friend or Foe?. Saranaz Jamdar Consultant Microbiologist. 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. History of IV Infusion.

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Venflon, Friend or Foe?

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  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 D+V 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? EVERYBODY’S

  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 eitherSTERILE 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 patient’s 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?

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