Julie Flynn

Securement methods for peripheral venous catheters to prevent failure: a randomised controlled pilot trial

Purpose To assess the effectiveness of four securement methods to prevent peripheral intravenous catheter (PIVC) failure. Methods A single-centre, four-arm, randomised, controlled, non-blinded, superiority pilot trial was conducted in a tertiary referral hospital in Queensland (Australia), between November 2012 and January 2013. Adult patients, with a PIVC expected to remain in situ for ≥24 hours and admitted to general medical or surgical wards, were randomly allocated to standard polyurethane dressing (control, SPU), tissue adhesive (TA) with an SPU, bordered polyurethane dressing (BPU) or sutureless securement device (SSD) with an SPU, experimental groups. The primary endpoint was PIVC failure, defined as premature device removal before the end of therapy because of pain, blockage, leaking, accidental removal and local or catheter-related bloodstream infection. Results PIVCs were used for an average of 2.6 days across all study groups (n = 85). Catheter failure was lowest in the TA group (3/21, 14%) and highest in the control group (8/21, 38%), with BPU and SSD failure at 5/20 (25%) and 5/23 (22%), respectively. The adjusted hazard ratio of catheter failure was lowest in the TA group (0.50, 95% CI: 0.13-1.98), and then the BPU (0.52, 95% CI: 0.15-1.78) and SSD (0.61, 95% CI: 0.20-1.91) groups. No patient was suspected of a local or catheter-related bloodstream infection. Conclusions Current SPU dressings alone do not prevent many cases of PIVC failure. TA appears promising as an innovative solution, but may not be suitable for all patients. A larger Australian National Health and Medical Research Council (NHMRC)-funded trial has commenced.

Infection risks associated with peripheral vascular catheters

Background: Peripheral vascular catheters (PVC) are the most frequently used invasive medical devices in hospitals, with 330 million sold each year in the USA alone. One in three UK inpatients at any one time has at least one PVC in situ according to the Scottish National Prevalence survey. Method: A narrative review of studies describing the infection risks associated with PVCs. Results: It is estimated that 30–80% of hospitalised patients receive at least one PVC during their hospital stay. Despite their prevalence, PVCs are not benign devices, and the high number of PVCs inserted annually has resulted in serious catheter-related bloodstream infections and significant morbidity, prolonged hospital stay and increased healthcare system costs. To date, PVC infections have been under-evaluated. Most studies focus on central venous catheter rather than PVC-associated bloodstream infections. Risks associated with PVC infection must be addressed to reduce patient morbidity and associated costs of prolonged hospital admission and treatment. Discussion: This article discusses the sources and routes of PVC-associated infection and outlines known effective prevention and intervention strategies.

Nursing and midwifery practice for maintenance of vascular access device patency. A cross-sectional survey

BACKGROUND Up to 85% of hospital in-patients will require some form of vascular access device to deliver essential fluids, drug therapy, nutrition and blood products, or facilitate sampling. The failure rate of these devices is unacceptably high, with 20-69% of peripheral intravenous catheters and 15-66% of central venous catheters failing due to occlusion, depending on the device, setting and population. A range of strategies have been developed to maintain device patency, including intermittent flushing. However, there is limited evidence informing flushing practice and little is known about the current flushing practices. OBJECTIVE The aim of the study was to improve our understanding of current flushing practices for vascular access devices through a survey of practice. METHOD A cross-sectional survey of nurses and midwives working in the State of Queensland, Australia was conducted using a 25-item electronic survey that was distributed via the local union membership database. RESULTS A total of 1178 surveys were completed and analysed, with n=1068 reporting peripheral device flushing and n=584 reporting central device flushing. The majority of respondents were registered nurses (55%) caring for adult patients (63%). A large proportion of respondents (72% for peripheral, 742/1028; 80% for central, 451/566) were aware of their facilitys policy for vascular access device flushing. Most nurses reported using sodium chloride 0.9% for flushing both peripheral (96%, 987/1028) and central devices (75%, 423/566). Some concentration of heparin saline was used by 25% of those flushing central devices. A 10-mL syringe was used by most respondents for flushing; however, 24% of respondents used smaller syringes in the peripheral device group. Use of prefilled syringes (either commercially prepared sterile or prefilled in the workplace) was limited to 10% and 11% respectively for each group. The frequency of flushing varied widely, with the most common response being pro re nata (23% peripheral and 21% central), or 6 hourly (23% peripheral and 22% central). Approximately half of respondents stated that there was no medical order or documentation for either peripheral or central device flushing. CONCLUSIONS Flushing practices for vascular access device flushing appear to vary widely. Specific areas of practice that warrant further investigation include questions about the efficacy of heparin for central device flushing, increasing adherence to the recommended 10mL diameter syringe use, increased use of prefilled flush syringes, identifying and standardising optimal volumes and frequency of flushing, and improving documentation of flush orders and administration.

Needleless connector decontamination: To use, or not to use, chlorhexidine?

To the Editor: Since the introduction in the early 1990s of a needleless connector (NC) on vascular access devices to minimize the risk of needle stick injuries to healthcare workers, their use is now well established. Unfortunately, intermittent reports from facilities have shown an increase in bloodstream infections (BSIs) thought to be associated with NC use.

Alcohol Caps or Alcohol Swabs With and Without Chlorhexidine: An In Vitro Study of 648 Episodes of Intravenous Device Needleless Connector Decontamination

The incidence of central venous access device (CVAD)–associated bloodstream infection (CABSI) has been reported to be as high as 21%.1 Inadequate needleless connector decontamination can result in microbial contamination of the CVAD internal lumen, resulting in device colonization and CABSI.2 Guidelines vary in recommendations for antiseptic type and duration of application to needleless connectors.3 Scrubbing needleless connectors with chlorhexidine in alcohol swabs is recommended by some guidelines to prevent infection.2,4 However, lack of consistent needleless connector decontamination prior to use may negate the effectiveness of this approach. There is a need to define the most effective needleless connector decontamination techniques, including the antiseptic type and the duration of application. In this study, we investigated the comparative efficacy of 3 needleless connector decontamination methods and 3 connector types with different durations of application to prevent microbial contamination.

Sterile v aseptic non-touch technique for needle-less connector care on central venous access devices in a bone marrow transplant population: A comparative study

PURPOSE The aim of this study was to determine whether a variation in practice from an aseptic non-touch technique (ANTT) to a sterile technique when changing needleless connectors on central venous access devices (CVAD) was associated with any change in catheter related bloodstream infection (CRBSI) rates in the bone marrow transplant (BMT) population. METHODS A two group comparative study without concurrent controls using a retrospective cohort was conducted in a large metropolitan hospital in Brisbane, Australia. INCLUSION CRITERIA haematological malignancy, Hickman catheter inserted, age ≥18. A tool was developed to extract historical data from medical records and pathology results. PRIMARY OUTCOME CRBSI. SECONDARY OUTCOMES laboratory confirmed bloodstream infection, mucosal barrier injury laboratory confirmed bloodstream infection and skin contaminants. RESULTS One hundred and fifty patients were assessed, 73/150 (49%) in the ANTT group. DEMOGRAPHICS males 95/150 (63%), with 71/150 (47%) receiving an autologous BMT. No difference in CRBSI rates between groups was observed (ANTT n = 3 (4%) vs Sterile n = 1 (2.7%), p = 0.357 Fishers Exact Test). Infection by skin contaminants were identified in a similar number of cases across both groups (ANTT n = 9 (12.3%) vs Sterile n = 6 (7.8%)). CONCLUSIONS No causal effect can be deduced from this small study; nevertheless results imply that an ANTT was not associated with increased CRBSI. Poor hand hygiene and ANTT were perceived across both groups. Quality and consistent ANTT is a safe method for managing intravascular devices, however education and awareness of pathogen transfer from healthcare worker and patient to their device is required.