Infection control measures in iv drug administration
Infection Control Measures in IV Drug AdministrationPrepared by : Dr. Ahmed Kholeif General PractitionerDate : 12th November,2012
Objective:Every member of SHHC staff involvedwith intravenous therapy will be able toapply the correct infection controlprecautions to this procedure .
Introduction:Vascular access devices is vital foradministering various fluids and drugtherapies. its critical to maintain anappropriate infection control measuresto save lives and money and reducehealthcare burdens.
Types of intravenous devices:1. Peripheral cannulas :placed into a peripheral vein2. Peripherally inserted central catheters (PICC)Central line that is placed via the peripheral vasculature. Its tipterminates in the superior vena cava
Types of intravenous devices:3. Peripheral midline catheters :Shorter version of the PICC, Its tip terminates inthe axilla
Types of intravenous devices:4. Skin tunneled cuffed central catheters(Hickman lines)Central venous catheter most often used forthe administration of chemotherapy
Expected Intravenous CatheterComplications Phlebitis:Inflammation of a blood vessel Thrombophlebitis:Similar to phlebitis but a thrombus(or clot) is in addition involved Local Infection (abscess): A microscopic organism may use the tiny hole in theskin created by the IV catheter to find its way into thebody, and cause an infection
Expected Intravenous CatheterComplications Infiltration :This occurs when the catheter unintentionally enters thetissue surrounding the blood vessel and the IV fluid go intothe tissues. Hematoma:collection of blood caused by internal bleeding. Hypothermia:When large amounts of cold fluids are infused. Rapidtemperature changes occurs and may precipitateventricular fibrillation.
Infectious Micro-organisms associatedwith IV therapy Staphylococcus epidermidis Staphylococcus aureus Enterococcus spp. Klebsiella Pseudomonas E. Coli Candida
Reservoirs Patients Skin – resident microflora Equipment IV Solutions & drugs Environment Health care provider Hands
INFECTION CONTROL MEASURES1.Collect all required equipment, checking expiry date and the correctcatheter size for the purpose and length of infusion2. Confirm patient identity and provide explanation3. Hand washingShould be performed before and after inserting, replacing , repairing, ordressing an intravascular catheter
INFECTION CONTROL MEASURES4. Wearing glovesWear clean gloves, rather than sterile gloves, for the insertion orchanging the dressing of peripheral intravascular catheters. Sterilegloves should be worn for the insertion of arterial, central, andmidline catheters.5. Patient skin preparationAlcohol swab to remove bacteria prior to insertion and allow it todry; this doesn’t protect the patient for a longer period.Chlorhexidine Gluconate with 70% alcohol gives longer duration ofprotection
6.Securing Catheter insertion site.7.Disposing of contaminated or soiled equipment and linen appropriately .8. Safe disposal of sharps .
9. Stay with your patient for 5 to 10 minutes to detect early signs andsymptoms of hypersensitivity, such as sudden fever, joint swelling, rash,urticaria (hives), bronchospasm, and wheezing.10.Documentation
Function of the dressingTo protect the site of venous accessTo stabilize the catheter in placePrevent mechanical damageKeep site clean
Catheter Site Dressing Regimens1. Use sterile, transparent, semipermeable dressing to coverthe catheter site it allows continuous visual inspection of thecatheter site and require less frequent changes.2. Replace catheter site dressing if the dressing becomesdamp, loosened, or visibly soiled3. No need to replace peripheral catheters more frequentlythan every 72 (even in the absence of signs of infection), thenew catheter should be inserted into a separate site.
Catheter Site Dressing Regimens4. For patients not receiving blood, blood products or fatemulsions, replace administration sets after 72 hours if clearfluids are used5. For short-term CVC sites change dressing every 2 days forgauze and every 7 days for transparent dressings6. Do not use topical antibiotic ointment or creams oninsertion sites.
signs of infection Redness (erythema) and warmth with some fever Pain or burning along the length of the vein Swelling (edema) Purulent discharge If any of these signs are noted, the IV catheter must be removedimmediately .
Types of Phlebitis Bacterial phlebitisis usually an indication to an infection at the insertion site. Chemical phlebitisis most commonly seen with peripheral IV devices when medicationsor solutions irritate the endothelial lining of the small peripheralvessel wall, for example: erythromycin tetracycline vancomycin Large doses of potassium chloride multivitamins
Types of Phlebitis Mechanical phlebitisoccurs when the size of the cannula is too big for the selectedvein causing unnecessary friction on the internal lining of thevein leading to inflammation
Fighting Phlebitis1 . Phlebitis is most common after continuousinfusions, developing 2 to 3 days after the vein isexposed to the drug or solution.2. Phlebitis is more common in distal veins than inveins close to the heart.
Steps to Prevent Phlebitis: Use proper venipuncture technique. dilute drugs correctly. Monitor administration rates. Observe the I.V. site frequently. Change the infusion site regularly according to policy.
ConclusionREMEMBER ! Adhering to aseptic technique during insertion, dressing changes, preparing medications will minimize the risk of infection Cannula site rotation and using the appropriate Cannula size Adequate securement of the IV device
Conclusion Patients should be closely monitored for signs of infection Patient education of the signs and symptoms of phlebitis Good documentation is essential and it should be Daily as evidence that assessment has been carried out