2015-09-18_IV_therapy_and_IV_access_Part_2.pptx

IV therapy & peripheral IV access
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Agenda
• Why IV therapy at all?
• Anatomy & physiology
• Site selection
• Device selection
• Infusion therapy
• Peripheral IV catheter
• Preparation of venipuncture
• Venipuncture process
• Flushing & locking
• Care and maintenance
• Hands-on
• Complications of venipuncture
• Phlebotomy
• Needlestick injuries

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Care maintenance of insertion site

Peripheral IVC site care
• IVC site care and dressing changes, incl. frequency of procedure and type of antiseptic and
dressing, shall be established in organizational policies, procedures and/or practice
guidelines.
• A sterile dressing shall be applied and maintained on IVCs
• IVC site care and dressing changes shall be performed at established intervals (e.g. once in
24 hours) and
• Immediately if the dressing integrity becomes compromised, if moisture drainage or blood is
present, or if signs and symptoms of site infection are present
• Transparent dressing can stay as long it is intact (dry, air free and completely closed)
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Peripheral IVC site care [1]
• Skin antiseptic:
Chlorhexidine (not recommended for children younger 2 months)
70% alcohol
1 – 2% tincture of iodine, iodophor (providone-iodine)
• Check the IVC site every day for signs of infection
• Cave: Gauze, bandages, or any dressing material that may obstruct visualization of the
catheter-skin junction and/or constrict the extremity should not be used.
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Peripheral IVC site care
One example:
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Venipuncture process
Hands-on training
• Please come together in 3 groups
• Train yourself in using the IVC
• Oberserve and coach your colleagues
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Complications during venipuncture

Puncturing an artery
• Remove device immediately
• Apply pressure until bleeding stops
• Explain what has happend to the patient
• Document in patient‘s file
• Do not reapply tourniquet to the limb
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Hitting a nerve
• Sensory reaction:
• Pain
• Reflex
• Vagus reaction:
• Syncope
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Source: http://commons.wikimedia.org/wiki/File:Reflexhammer-Dejerine.jpg

Vasovagale reaction / fainting
• Call for assistance
• Lie the patient down or help him get to the ground
• Document in the patient‘s file
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Source: http://upload.wikimedia.org/wikipedia/commons/5/54/Pietro_Longhi_027.jpg

Missed vein
• Withdraw needle to engage safety shield
• Wighdraw catheter
• Try 2nd attemp with patient‘s consent
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Haematoma
Prevention:
• Always insert catheter bevel up
• Avoid reapplying tourniquet to arm affected by recently removed catheter until all bleeding
has stopped
• Use skin traction during complete catheter insertion procedure
• Release tourniquet once flashback is seen
• Enter vein at lowest angle possible and retract stylet as catheter is advanced
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Haematoma
Management of hematoma:
• Apply pressure until bleeding stops (at least 3 minutes)
• Give the patient an explanation
• If appropriate, elvate the limb
• Apply icepack if necessary
• Do not reapply tourniquet to affected limb
• Document in patient‘s notes
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Transfixation – reason for haematoma
Transfixation means the IV catheter goes into the vein and leaves the vein at the opposite site.
A flashback can be seen in case of transfixation.
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Infiltration / Extravasation
Definition:
• Infiltration is accidental administration of a non-vesicant solution into subcutaneous tissues
• Extravasation is infiltration of a vesicant medication or solution that causes destruction by
chemical injury and / or severe vasoconstriction
Causes:
• Movement of the catheter tip outside of the vein
• Failure to secure catheter to prevent movement
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Prevention:
• Avoid choosing sites in areas of flexion
• Avoid hand, wrist and antcubital fossa sites when giving a vesicant medication
• Use appropriate catheter stabilization technique, preferably a device with big „wings“
• Take your time performing venipuncture and enter vein at lowest angle to ensure
successful cannulation into vein lumen
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Recommendation Infiltration:
• Stop infusion at once
• Remove catheter immediately
• Assess extend and volume of infused solution
• Treat according to local policy
• Document in patient´s notes
Recommendation Extravasation:
• Stop infusion at once
• Leave catheter in-situ
• If possible, withdraw the drug
• If possible, elevate limb to reduce oedema
• Advise patient to exercise joints
• Subsequent management depends on the drug involved and the
degree of damage
• Treat according to local policy
• Document in patient´s notes
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Paravasation in chemotherapy
A special case

Chemotherapy – some classifications & mechanism of action
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Classification Drug Mechanism of action
Alkylating agents Cisplatin, Carboplatin,
Tresulfan, Ifosfamid,
Cyclophosphamid
Prevent replication of DNA
Anti metabolites 5-Fluorouracil, Cytarabin,
Methotrexat
Inbuild in DNA  Wrong code
during DNA synthesis
Antagonists of Mitosis Placlitaxel, Vincristin,
Vinblastin
Stops mitosis
Antibiotics with cytostatic
action
Daunorubicin, Epirubicin,
Mitoxantron
Inbuild between DNA basis,
inhibits DNA synthesis

Extravasation (Paravasation)
• Paravasation = denotes inadvertent instillation or escape of a drug solution into perivascular
spaces and subcutaneous tissue during administration
• Classification of cytostatics not only in term of their various mechanism of action but also
according to the potential to cause necrosis:
• Non-vesicant
• Irritant
• Vesicant
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Source: QuapoS4, Quality Standard for the Oncology Pharmacy Service with Commentary; German Society for Oncology Pharmacy; Downloaded 2014, March 28th

Paravasation „non-vesicant“
• Non-vesicants do not cause any local
reaction in case of a paravasation,
some of them may also be applied
subcutaneously or intramuscularly
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Paravasation „irritant“
• Irritants may locally cause reddening
and burning pain up to phlebitis.
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Paravasation „vesicant“
• Vesicants may be associated with
development of ulceration or necrosis.
• The ulceration process may last for
weeks to months and affect wide areas
around the site of paravasation.
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Prevention & Symptoms of Paravasation
• Prior to any therapy the patient must be informed
• Information enables the patient to report abnormalities early
• Administration of vesicants only by skilled staff
• CVC or implantable port system ( even here a risk of paravasation can not be excluded
completely)
• If central veins are not possible:
• Critical locations (metacarpal veins, wrist or elbow flexure) are NOT to be chosen
• Steel needles and multiple punctures must be avoided
• Before application the correct position must be controlled by flushing with
10cc carrier solution (NaCl 0.9% or Glucose 5%) without resistance
• Symptoms: pain, reddening or vesication in the vicinity of the application site
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Extravasation of anthracyclines
Extravasation of Doxorubicin
Skin changes 2 days after accidental
extravasation of doxorubicin in the left cubital
fossa of a patient with advanced breast cancer.
The extravasation was left untreated initially
Same patient 6 weeks after surgical treatment
Seppo P. Langer
http://www.ascopost.com/issues/april-15,-2014/accidental-extravasation-of-chemotherapy.aspx

Extravasation of anthracyclines
Extravasational toxicity of anticancer chemotherapy
and its management
A Thakur, JS Thakur
Extravasation on the forearm leading to skin necrosis
Extravasational side effects of cytotoxic
drugs: A preventable catastrophe
Thakur , Chauhan, Diwana, Chauhan DayalC,
Thakur
Indian Journal of Plastic Surgery, Vol. 41, No. 2,
July-December, 2008, pp. 145-150

Paravasation – general therapeutic measures
• Stop the infusion
• Disconnect infusion and connect a 5cc syringe
• As much of the paravasate as possible must be aspirated
• Remove IVC under the condition of aspiration
• If significant amounts of liquids leaked into tissue: try to aspirate as much as possible: puncture
in a star-shape from several sides with small syringe (1-2 cc) and thin, sterile needle (new needle
used for each puncture site)
• Immobilize the limb in an elevated position
• Paravasation site must be presented to a (plastic) surgeon within 72 hours
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Paravasation
Measures specific for individual substances
Use of dry cooling:
• Prevents spreading into the surrounding tissue by reducing local perfusion.
• In case of anthracyclines in particular  toxic radicals released by dying cells may lead to
largescale ulcerations
• Location of paravasation cooled several times/day for approx. 15‘
• Recommended for:
• Anthracyclines (no cooling, if the antidote dexrazoxane is used)
• Amasacrin
• Cisplatin
• Dactinomycin
• Liposomal doxorubicin and daunorubicin
• Mitomycin C
• Mitoxantrone
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Paravasation
Use of dry warmth:
• To stimulate perfusion of the tissue to achieve better removal of the paravasated substance
• Treatment: 4 times a day for 20 minutes for up to three days
• Recommended for: vinca alkaloids
• CAVE: It must be avoided explicitly after
paravasation of taxanes!
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http://commons.wikimedia.org/wiki/File:Defense.gov_News_Photo_120723-F-HA794-
089_-_A_U.S._Air_Force_firefighter_sprays_water_at_the_fire_of_a_simulated_C-
130_Hercules_plane_crash_during_operational_readiness_exercise_Beverly.jpg

Paravasation
Hyaluronidase:
• Should be used within one hour after paravasation
• These measures may be very (!) painful for the patient
• Approx. 300 i.U. may be injected directly into the paravasate via the still positioned access
system
• Star shaped injection of hyaluronidase (up to 1500 i.U. in total) into the paravasation area:
• Dissolving the structure of the adjacent connecting and supporting tissue to achieve faster
removal of the substance to reduce contact time
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Paravasation
Dimethyl sulfoxide (DMSO):
• Anti-inflammatory, radical inactivating and vasodilating effects
• Used for:
• Anthracyclines
• Amsacrin
• Dactinomycin
• Mitoxantrone
• Mitomycin
• Cisplatin; in high concentration (>0.4mg/ml)
• DMSO (as 99% solution) is applied topically to paravasate area, 4-6 times/day,
for at least 7-14 days, application without pressure, „soaking“ of tissue must be
avoided!
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Paravasation
Dextrazoxane (Savene®)
Savene is an orphan drug, representing a novel but at the same time:
• The only approved option for the treatment of anthracycline paravasates(!)
• Until today, it is not fully understood, how the dextrazoxane prevents necrosis
• 2 mechanism of action:
• Antineoplastic effects by inhibition of an enzyme
• Binding free radicals  this reduces odixdative stress
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Phlebitis
A commonly reported complication of IV therapy is phlebitis, or inflammation of the tunica
intima.
Ethiology:
• Chemical: IV solutions can damage and inflame the tunica intima if they are overly acidic or
basic, hypertonic, hypotonic, or if any overly-high volume is infused too quickly.
• Mechanical: This phlebitis results when the catheter tip repeatedly scrapes the tunica intima
during patient movement. The likelihood increases if the catheter is located at a flexion
point or is loosely secured to the skin.
• Bacterial: Due to bacterial infection at the insertion site. Infection may be the result of
inadequate skin preparation, poor IV catheter insertion technique, or a poorly-secured
catheter.
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Phlebitis
Definition:
• Inflammation of the vein, accompanied by pain
at insertion site, redness, heat, swelling and/or
palpable cord.
Phlebitis may result in thrombosis formation.
Causes:
• Excessive catheter movement within the vein
• Choice of too large catheter for the vein lumen
• Traumatic or too-rapid advancement of the
catheter
• Infusate to concentrated or extreme in pH
• Inadequate skin disinfection prior venipuncture
• Failure to secure catheter to prevent
movement at the site, especially in flexion
area
• Contamination of any part of the fluid pathway
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Phlebitis
Prevention:
• Choose smallest catheter capable of delivering the prescribed
therapy
• Select the largest vein possible
• Rotate IV site every 72 hours
• Don‘t routinely administer infusates with pH<5 or >9, tonicities
>600mEq/l peripherally
• Use appropriate catheter stabilization technique
• Disinfection of insertion site prior venipuncture, use plenty of
friction in a back-and-forth scrubbing motion.
• Use an add-on extension set to minimize catheter hub
manipulation
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Phlebitis Score, an example for standard documentation
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IV Site appears healthy 0 No sign of phlebitis
OBSERVE CATHETER
One of the signs is evident:
• Slight pain near IV site or
• Slight redness near IV site
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Possibly first signs of phlebitis
OBSERVE CATHETER
Two of the signs are evident:
• Pain at IV site
• Redness
• Swelling
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Early stage of phlebitis
RESITE CATHETER
All of the following signs are evident:
• Pain along path of catheter
• Redness around site
• Swelling
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Medium stage of phlebitis
RESITE CATHETER
CONSIDER TREATMENT
All of the following signs are evident and extensive:
• Swelling
• Palpable venous cord
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Advantage stage of phlebitis
or the start of thrombophlebitis
RESITE CATHETER
CONSIDER TREATMENT
All of the following signs are evident and extensive:
• Swelling
• Palpable venous cord
• Pyrexia
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Advantage stage of thrombophlebitis
RESITE CATHETER
INITIATE TREATMENT

Catheter-related Bloodstream Infection, CRBSI
• Definition: CRBSI is the presence of systemic infection along with evidence implicating the
venous access device as source of infection.
• An estimated 250tsd. cases of CRBSI occur each year (in the US) among all hospitalized
patients with an estimated mortality rate of 12 to 25% [2].
• CRBSI can lead to death through complications such as sepsis.
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PIVCs and Staph. aureus bacteraemia (SAB)
• 23.5% of health care-associated SAB episodes were deemed to be PIVC related
• PIVC dwell time range: 0.25 – 9 days
• 45.2% SABs occured with a dwell time ≥4 days
PIVC associated SAB episodes:
• 39.6% PIVCs inserted in the ED
• 39.6% PIVCs inserted on the ward
• 20.8% PIVCs inserted by the ambulance service
PIVC-associated SAB were associated with a 30-day-all-cause mortality rate of 26.5%.
Conclusion: PIVC-associated SAB is an under-recognised complication. The high incidences of
SAB associated with PIVCs inserted in emergency locations and with prolonged dwell times
support recommendations in clinical guidelines for routine removal of PIVCs.
Source: Stuart et al.; Peripheral intravenous catheter- associated SAB: More than 5 years of prospecitive data from two tertiary health services; Med. J. Aust. 2013 198:10
(551-553)
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Biofilm:
• Biofilm is created, when the body‘s own defences attack the catheter
• This process leads to biofilm: blood proteins, leukocytes and fibrin proteins attach to the
IVC, the body‘s immune response recognized the IVC as foreign
This forms a layer of host cells called fibrin sheath.
• Biofilm is a place for pathogens to attach an grow
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Fibrin sheath:
• Itself is not a problem, but unfortunately provides receptor binding sites for invading
microorganism
• Pathogens can adhere more securely to the catheter
• The added pathogen layer is the beginning of the formation of biofilm
• It takes only a few minutes, bacteria alter the proteins in the fibrin sheath, forcing them to to
make more binding sites
• Secures pathogens even more and the invading cells divide and grow
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• The microcolony making up the biofilm: 10-25% bacterial cells and 75-90% blood proteins,
leukocytes and fibrin, that together forms the fibrin sheath.
• This biofilm forms a physical barrier and is very good in protecting the bacteria against
• Antibiotics
• White blood cells
• Other anti-infective substances
• Phagocyte cells (produced by the immune response) are physically barrred from entry due
to the biofilm and cannot penetrate the bacteria inside and ingest it.
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• CRBSI can lead to death through
complications such as sepsis.
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CRBSI – Signs, Symptoms and Diagnosis
The signs and symptoms can vary in type and severity.
Clinical signs and symptoms associated with CRBSI may be local or systemic or both, including:
• Inflammation, pain and purulence arround the insertion site
• Fever
• Chills
• Hypotension (systolic blood pressure < 90 mmHg)
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Diagnosis:
• Clinical symptoms (fever, chills, hypotension)
• History
• Blood culture results
Blood culture:
• Microorganisms grow from blood on a special nutrient to identify the species and the
number of colonies formed
• Advantage: germ specific antibiotic therapy is possible
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How to perform a blood culture (BC)?
• BC are to be drawn from a site away from the IV access site and from the venous catheter
itself.
• BC must be done properly so they do not yield a false positive (sterile handling of container
and blood draw set, skin disinfection, …)
To confirm a diagnosis of CRBSI
• The pathogen identified by the blood culture and the signs and symptoms the patient is
having, can not be related to another site of possible infection.
• Several blood cultures may be required to confirm
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Management of CRBSI:
There is no standard treatment of CRBSI, because of many varying factors, different policies
of healthcare facilities and treating physicians recommendations.
• Broad spectrum antimicrobial treatment is started before blood culture results are
completed
• Antibiotics, that specially target the pathogen will then be prescribed (when BC result is
available)
• IVC or CVC line removal must be considered (bacteria that are present in the biofilm)
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Sepsis – a consequence of CRBSI
• Treatment needs a lots of time: ICU bed is blocked for many days
• Ressources consuming:
- Increase work-load for doctors and nurses
- In medical equipment (e.g. mechanical ventilators,
- Organ replacement therapies,
- Diagnostics ( e.g. laboratory, x-ray),
- Surgical therapy
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Catheter Embolism
What‘s that?
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Catheter Embolism
What‘s that?
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Catheter Embolism
This may happen to the catheter, when re-
inserting the needle and the catheter was kinked
before, due to e.g. arterio sclerotic plaques at
the vein wall.
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General consequence of particles burden thrombogenesis:
Encapsulation of foreign particles by the immune system  thrombus formation.
The thrombus may block blood vessels and lead to embolism.
Catheter Embolism

Consequence catheter embolism for patient

Phlebotomy
Phlebotomy or blood sampling via vascular access shall be performed upon the order for
laboratory tests.
The blood samples shall be identified at the time of collection and clearly labeled with patient
identifiers.
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Phlebotomy via Direct Venipuncture
• The HCW should assess the patient for anxiety, understanding of purpose for venipuncture
and any history of vasovagal reactions.
The HCW should be prepared to manage a vasovagal reaction in patients at risk.
• The blood should be drawn from the opposite extremity of an infusion. Should it be required
on the same extremity, it should be performed in a vein below the device or infusion.
• The big diameter veins in the arm are prefered.
• Minimal tourniquet times are necessary to avoid hemoconcentration and hemolysis.
• Only the volume of blood needed for accurate testing should be obtained.
• Pressure should be applied with a sterile dressing following the venipuncture and
maintained until bleeding stops.
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Phlebotomy via Direct Venipuncture
• Preferred vein: V. mediana cubiti (red box)
• Big vessel, rarely used for IVC (because of wrist area),
high blood flow for easy withdrawn
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Hand side
Shoulder side
right arm

Blood Sampling via a Vascular Access Device
• Sampling of blood through short peripheral catheters has been found to be reliable for many
routine blood tests, including coagulation studies, and may be considered for pediatric
patients, those who require multiple laboratory tests including patients with risk for bleeding
and those, who have difficult vascular access.
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Therapeutic phlebotomy
Orders should include:
• Frequency of phlebotomy and amount of blood to be withdrawn
• Orders for fluid replacement may also be included
Patient education should address:
• Potential side effects such as syncope and nausea/vomiting
• Need for increased fluid intake postprocedures unless contraindicated
• When to resume normal activities
Catheter size:
• Adequate blood flow is based upon size of vein and catheter
• G18 and G20 are acceptable and cause less insertion pain and less bleeding after catheter
removal.
• In patients, who require multiple phlebotomies, a apheresis catheter may be used.
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Needlestick injury - complication for
the HCW

Liver infection Hepatitis B
Incidence: 2 billion people infected; 10 – 30 million people infected new each year
350 million people with chronic infection
Vaccination is available
Post Exposure Prophylaxis (PEP) should be given within 24 h after exposure to an
unprotected person
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www.tropeninstitut.de

Liver infection Hepatitis B
Consequences for infected individual:
~ 600 tsd. persons die each year due to acute or chronic consequences
5 - 10% of patients develop chronic infection
chronic infection carries an estimated 20% lifetime risk of death from cirrhosis and 6% from
liver cancer
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Liver infection Hepatitis C
Incidence: ~ 120 – 170 million people infected, 3
– 4 million new infections / year (increasing)
Vaccination is not existing
PEP : is currently not available
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www.gastricliverhealth.com

Liver infection Hepatitis C
Consequences for infected individual:
75 – 85 % of patients develop chronic infection
~ 70 % of chronically infected develop active
liver desease
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out of the chronically infected patients with active liver disease,
10 – 20 % (up to 30%) develop cirrhosis,
while 1-5 % develop liver cancer

Human Immunodeficiency Virus (HIV)
Immune system infection
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Time course of HIV infection :
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T-lymphocyte is part of
the immune system and
is part of the acquired
immune response.

• Incidence: ~ 33,2 million people have been infected
• Vaccination is not existing
• Severe and persistent impairment of cellular immunology associated with immunodeficiency
described as AIDS (Acquired immunodeficiency syndrome)
• ~ 2,1 million people died of AIDS in 2007 worldwide
• PEP with antiviral drugs as soon as possible within 72 hours
with uncertain effectiveness and many adverse effects
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Most common causes
• Lack of equipment: disposable syringes, safety needle devices, and
sharps disposal containers
• Lack of procedures
• Lack of hazard awareness
• Poorly trained staff
• No access to sharps disposal containers
• Shortage of staff
• Re-capping needles after use
• Passing sharp devices from hand to hand in the operating suite
• Failure to use sharps disposal containers immediately after use
• Unpredictable medical incidents
• Unexpected patient reactions
[Niosh 1999, The Centers for Disease Control and Prevention (CDC) 2008]
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NSI ... possible everywhere and anytime !

Needle-Stick Injuries are not the same

Safety devices effectively reduce NSIs
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UK: Guidance on needlestick management
NHS Blue Book, 2005
France: Code du travail; Decret 2001-1016 du 05/11/2001
Decret no 94-352 du 05/ 1994
Spain: Order 827/ 2005 dd. May 11th by the Council of Health
and Consumer Goods of the Community of Madrid.
Germany: TRBA 250
Biostoffverordnung Neueste Fassung 2007.
USA: Needlestick Safety and Prevention Act (2000).
Brazil: NR 32: Work Safety and Health in Health Services
ADMINISTRATIVE RULE No. 485, November 2005
Europe: Directive on prevention from sharps injury in the hospital and
health care sector was published and must be implemented May
2013.

Safety Devices “active” and “passive”
Active devices require the worker to activate the
safety mechanism. Failure to do so leaves the
worker unprotected.
Passive Safety features remain in effect before,
during, and after use; workers do not have to
activate them.
Active and passive safety devices
 Passive Safety features enhance safety and are more likely to have a greater impact on
needlestick prevention
User benefits

EU Directive 2010/32/EU
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Content of Directive 2010/32/EU
Comments
Stakeholders Agreement between “Social Partners”:
HOSPEEM (“European Hospital and Healthcare Employers'
Association”) and EPSU (“European Federation of Public
Service Unions”) and the EU Commission
Aim Create the safest possible working environment for
healthcare workers through the prevention of sharp injuries
Scope Applies to all workers in the health care sector (incl.
trainees, apprentices, sub-contracted or agency staff)
Timeline Has to be implemented until end of May 2013

A part of our safety portfolio
Introcan Safety®
Non-ported safety IVC
Vasofix® Safety
Safety IVC with injection port
Venofix® Safety
Safety Winged Needle
Hypodermic NeedlePro
Safety Injection Needle
Surecan® Safety II
Safety Access Port Needle
Solofix® Safety
Single Use Safety Lancet
Aesculap® Safety Scalpel
Single Use Safety Scalpel
Diacan® S
Safety Hemodialysis Cannula
Sterican® MIX
Safety Admixture Needle

For needle-free processes
Closed Discofix® C
Safeflow Discofix® C
Caresite®
Mini-Spike® Ecoflac® Mix
Ecoflac® Connect Dispensing Connector
Sterifix® filter straw Stopper and Caps
Micro Pin 1000
Transofix

Prevention of needlestick injuries
• Continuous education in safe use and disposal of sharp devices
• Mandatory reporting of all sharps and NSIs
• Use of needle-free systems where possible
• Use of safety devices
• Suitable access to and correct use of sharps containers
• Immediate disposal of sharps into appropriate containers
• Frequent collection and proper disposal of sharps container
• Ban recapping of needles
• Elemination of unnecessary injections
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Luer Access Devices – perfect
addition to IVCs

Luer Access Device
Common aspects of LADs
LADs benefits: accessable with all
• Luer lock and luer slip syringes
• Infusion and transfusion sets
• All stopcock systems
• Fits to all Central venous catheters and
peripheral IV catheters
Common safety features of the LADs are:
• The escape of fluid is prevented reliable
• Air entry is avoided
• Needle-free
• No punching-out of particles

Luer Access Device
Common aspects of LADs
Common safety features of the LADs are:
• Latex free
• PVC free
• Plasticizer free
• Lipid resistant
• Non hemolytic

Luer Access Device
Negative vs. positive displacement
Negative displacement means:
1.4 cm

Luer Access Device
Negative vs. positive displacement
Positive displacement means:
Moment of disconnection After disconnection
Flush solution Catheter tip

Caresite® - a new LAD family member
Caresite features:
• Clear design helps verify proper flush
• Smooth surfaces permit easy cleaning
• Quick, effortless access with LuerGuide top
• Easy-grip barrel designed to minimizes slips and touch
contamination
• Acceptable for high-pressure use with power injectors
• Open fluid path designed to minimize areas where bacteria can
collect

Luer Access Device
Caresite® - Is the valve really flushed?
1st step
2nd step
3rd step
It is helpfull to verify proper flushing.

Luer Access Device
Summary
Needle-stick injuries are a big issue in the hospitals and due to the
idea, avoiding the usage of needles, we can reduce the amount of
needle-stick injuries.

Is there an open questions I may answer?
Source: http://commons.wikimedia.org/wiki/File:Q4.png

More information on riskprevention in infusion therapy
www.safeinfusiontherapy.com

INS Standard 7: Evidence-based practise and research
International Council of Nurses. Closing the gap: From evidence to action. Geneva, Switzerland. 2012: 5-7, 20, 39.
Murthy L, Shepperd S, Clarke MJ, Garner SE, Lavis JN, Perrier L, Roberts NW, Straus SE. Interventions to improve the use of systematic
reviews in decision-making by health system managers, policy makers and clinicians. Cochrane Database Syst Rev. 2012 Sep
12;9:CD009401.
Wallace J, Byrne C, Clarke M. Making evidence more wanted: a systematic review of facilitators to enhance the uptake of evidence from
systematic reviews and meta-analyses. Int J Evid Based Healthc. 2012;10(4):338-346.

Used abbreviations
AV – Arterial venous (fistulae)
BW – Bodyweight
CRBSI – Catheter related bloodstream infections
CVC – Central venous catheter
E.g. – For example
G – Gauge, indicates size of an IVC
HCW – Health Care Worker, doctor, nurse
ICU – Intensive Care Unit
IRS – Incident reporting system
IV – Intravenous, in the vein
mmHG – Millimeter mercury column, unit for pressure
NSI – Needlestick injury
PICC – Peripheral inserted central venous catheter
PIVC; PVK – Intravenous catheter (peripheral)

2015-09-18_IV_therapy_and_IV_access_Part_2.pptx

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