Van Boxtel - Management of the infusion line

The management of the infusion line: a

missing issue in many ‘bundles’

Ton van Boxtel, RN, MSc,

Trainer & consultant for Infusion Innovations President of the Dutch Society of Infusion Technology

President of World Congress on Vascular Access (WoCoVA)

environment

hands

touch contamination

access sites

Catheter hubs stopcock hubs Injection ports Needleless connectors

connector hub cath segment flush 6 5 4 3 2 1 0 le ast sq ua re me an (l og (C F U /fl ush ) 3.6 2.2 3.1 5.4 1.5 4.6 1.9 0.7

…..which component is the predictor of bacterial transfer ?

Bundles

• 

_{Insertion bundle CVC}

• 

_{Insertion bundle PIVC}

Central line Associated Blood

Stream Infections (CLABSI)

© The Joint Commission Preventing Central Line–Associated

Where does an IV catheter end?

End Cap

•  Use of passive disinfection caps containing

disinfecting agents (eg, isopropyl alcohol) has been shown to reduce intraluminal microbial contamination and reduce the rates of central

line-associated blood- stream infection (CLABSI)

CVC C&M bundle

• 

_{A CVC daily maintenance care bundle includes}

procedural guidelines for hygiene, dressing

changes, and access as well as specific

timeframes. Failure to complete one of the

components of the care bundle predisposes

the patient to a bloodstream infection.

RESULTS

flushes: bacterial transfer

What comes next?

healthcare workers hands

What comes next?

What comes next?

•

 

How is preparation of drugs performed?

Tubing

•  DEHP (diethylhexylphthalate, plasticizer) exposure? •  Until 2010, (DEHP) was the most frequently used plasticizer to soft PVC medical devices •  The increasing knowledge of the effects of phthalate exposure, which can be teratogenic, carcinogenic or induce reproductive toxicity, has led to the development of alternative plasticizers. •  Phthalates –  DIDP (di-isodecyl-phthalate) –  DINP (di-isononyl-phthalate) –  DBP (dibutylphthalate)

Guidelines / Protocols

•  EPIC3 guideline (NHS, 2014)

•  Guidelines for the prevention of intravascular Catheter Related Infections, (CDC, 2011)

Guidelines

•  Minimize the use of add-on devices for administration sets as each device is a potential source of contamination, misuse, and disconnection; when feasible use an administration set with devices as an integral part of the set •  Avoid disconnecting primary continuous adminis- tration sets from the VAD hub or access site. (V, Committee Consensus)

Guidelines

•  When an intermittent infusion is repeatedly disconnected and reconnected for the infusion, there is increased risk of contamination at the spike end, catheter hub, needleless connector, and the male luer end of the administration set, potentially increasing risk for catheter-related bloodstream infection (CR-BSI). There is an absence of studies addressing administration set changes for intermittent infusions (Committee Consensus)

Evidence

•  13 RCTs with 4783 patients concluded that there is no evidence that changing intravenous administration sets more often than every 96 h reduces the incidence of bloodstream infection. •  There were no differences between participants with central vs peripheral catheters, nor between participants who did and did not receive parenteral nutrition, or between children and adults.

What comes next?

•

 

How is preparation of drugs performed?

•

 

What happens with the administration set?

Check patency

• 

_{Not needed every time}

• 

_{Clinician needs to be sure and take}

responsibility for administration

strategies for prevention of bacterial transfer

ELD 96 hr (0.22 micron) low bacterial transfer needleless connector bacteria retentive endotoxin retentive air eliminating particilate retentive access site disinfection catheter hub disinfection antimicrobial anticoagulant lock flush

Infusion team

• 

_{Team goals:}

accuracy, efficiency, and consistency and/or

elimination of complications

• 

_{Meeting these goals will:}

reduce liability, lower costs, and decrease length

of stay, while promoting vascular preservation,

greater patient satisfaction, and better

outcomes