Escolar Documentos
Profissional Documentos
Cultura Documentos
Key points
Perform cannulation in response to clinical need only
Cannula-associated infection is essentially avoidable
through compliance with key elements of care
The greatest opportunity for exposure to infection is at
insertion
Hand hygiene is crucial to achieve aseptic conditions for
insertion of an IV cannula
Appropriate skin preparation and sterile IV dressings
must be used to avoid the risk of IV cannula site
contamination
Cannula insertion attempts should be limited to no more
than two per inserter provided there is another suitably
qualified health care provider available
Assess the cannula site by using assessment tools such
as the visual infusion phlebitis score, which combines
observed signs and symptoms so the user can decide a
score out of 5, informing any action
Assess the cannula every shift for clinical need, ensuring
prompt removal at the cessation of treatment.
from the hand. The nurse also noted swelling and redness around the IV
cannula site, wrist and lower forearm. The IV line was unable to be flushed
and the nurse removed the cannula and took swabs, which were sent to the
laboratory. On reviewing the clinical notes, there was no documentation of
any phlebitis scores or the patency of the IV cannula.
The nurse attempted to resite the IV cannula; however, they failed to gain
access on two attempts. Further observations identified that Jonathan was
deteriorating. His temperature was now 39.1C despite cooling cares, and
his blood pressure was recorded as 84/61 with a heart rate of 116. Jonathans
level of consciousness was starting to decrease and his veins had become
increasingly difficult to cannulate.
The medical registrar was paged and arrived immediately to assess
Jonathan. She identified that Jonathan had likely septicaemia and
requested IV fluid and antibiotics to be drawn up while she attempted
to insert an IV cannula. After three failed attempts an IV clinical nurse
specialist (CNS) was called to attempt insertion. The IV CNS was able to
gain access and a new IV cannula was secured. Further blood samples,
including blood cultures, were taken and Jonathan was administered the IV
antibiotics and fluids.
Jonathans observations remained unstable and he was transferred to the
intensive care unit. After 24 hours his condition stabilised; however, he
spent a further four days in intensive care and required an intensive course
of IV antibiotics. Jonathans blood and swab culture results identified
methicillin-resistant Staphylococcus aureus (MRSA). Jonathans doctor
determined that he had developed septicaemia secondary to an IV cannula
site infection.
Jonathan had a prolonged hospital stay of two weeks due to the infection.
The medical registrar who was part of the team looking after Jonathan
completed a treatment injury claim form and lodged this with Jonathans
consent with ACC. Jonathan eventually made a full recovery and returned
to work.
ACC accepted a treatment injury claim for an IV cannula infection resulting
in septicaemia. ACC was able to assist Jonathan with compensation for
some of his lost income from his prolonged hospital stay.
Expert commentary
Case study
2. assess all cannulas every shift for clinical need, ensuring prompt
removal at the cessation of treatment.
1 OF:
2 OF:
0
1
Pain at IV site
Erythema
Swelling
ALL OF:
To achieve asepsis, insertion (key) sites must be prepared using 0.52% chlorhexidine gluconate and 70% alcohol or 10% povidine iodine
preparations (if chlorhexidine sensitivity exists). Cleaning applications must
include the use of friction and an allowance for drying. Care must be taken to
not re-touch key parts and sites after cleaning.
Erythema
Induration
ALL OF:
Contamination can occur from the patients resident flora via the skin or
through haematogenous spread. Equally, cross-contamination can occur
through poor aseptic manipulation of sterile equipment.
Palpable
venous cord
Induration
ALL OF:
Palpable
venous cord
Pyrexia
no signs of phlebitis
Observe Cannula
possible first signs
Observe Cannula
early stage of phlebitis
Resite Cannula
mid-stage of phlebitis
Resite Cannula
Consider Treatment
advanced stage of phlebitis
or start of thrombophlebitis
Resite Cannula
Consider Treatment
Initiate Treatment
Resite Cannula
References/Websites
1. Centers for Disease Control. (2011). Guidelines for the Prevention of
Intravascular Catheter-related Infections. Retrieved from www.cdc.gov/
hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
2. Department of Health. (2011). High Impact Intervention: Peripheral
Intravenous Care Bundle. Retrieved from: http://webarchive.
nationalarchives.gov.uk/20120118164404/hcai.dh.gov.uk/whatdoido/
high-impact-interventions/
3. Goosens, G. & Hadaway, L. (2014). Key strategies for improving
outcomes of patients with peripheral venous catheters: Report of an
international panel discussion. Journal of Advanced Vascular Access. 19 (3),
135-137.
4. McCallum, L. (2012). Care of peripheral venous cannula sites. Nursing
Times. 108 (34-35), 13-15.
5. Moureau, N. (2009). Are your skin-prep and catheter maintenance
techniques up to date? Nursing (May), 15-16.
6. Rowley, S. & Laird, H. (2006). Aseptic non touch technique in practice. In
E. Trigg & T.A. Mohammed (Eds.) Childrens Nursing: Guidelines for hospital
and community. Churchill Livingstone: Edinburgh.
7. Webster, J., Osborne, S., Rickard, C.M. & New, K. (2015). Clinicallyindicated replacement versus routine replacement of peripheral venous
catheters (Review). The Cochrane Library, 8, 1-45.
8. World Health Organization. (2009). WHO Guidelines on Hand Hygiene
in Health Care: First global patient safety challenge, clean care is safer care.
Retrieved from http://www.ncbi.nlm.nih.gov/books/NBK144013/
Claims information
Between July 2005 and the end of June 2015 ACC made 4127 decisions
relating to venous access claims. These claims involved the following
events: venous puncture, IV cannulation and venous catheterisation. Of
these decisions, 3291 (80%) were accepted.
The most common injuries caused by venous access events related to
infection, which accounted for 47% of all accepted venous access claims.
Other injuries included haematoma (20%) and nerve injury (13%).