Download Administration of IV Therapy

Infection Control:
IV Drug Administration
Learning outcomes
• Explain the chain of infection and standard
precautions.
• To understand the application of the chain of
infection and standard precautions in relation
to IV therapy.
• Discuss the actions required to
prevent/minimise the risk of infection in a
patient receiving IV drug/fluid therapy.
• Describe how vascular access device related
infections can be detected.
Chain of Infection –
Administration of IV Therapy
Infectious Agent/Organism
Susceptible Host
Reservoir
Means of Entry
Means of Exit
Route of Transmission
Infectious Micro-organisms
associated with IV therapy
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•
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Staphylococcus epidermidis
Staphylococcus aureus
Enterococcus spp.
Klebsiella
Pseudomonas
E. Coli
Serratia
Candida
Reservoirs
• Patients Skin – resident microflora
• Environment
• Equipment
• IV Solutions & drugs
• HCW Hands -Transient microflora
Means of Exit
• Secretions such as bodily fluids e.g.
blood
• Skin such as skin scales
Route of Transmission
• Direct contact - on healthcare workers hands
• Indirect contact- contaminated equipment,
fluids, parenteral drugs or infusates
• Puncture of skin (inoculation / blood borne)
Means of entry
Operator’s
microflora
Patient’s skin
microflora
Local
infection
Migration down
catheter inside and out
Contaminated
on insertion
Haematogenous
spread
Contaminated
fluid
Susceptible Host
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Extremes of age
Surgery
Extended length of stay in hospital
Compromised immune system
Chronic disease
Antibiotics
Vascular access device in-situ
Standard Precautions
The minimal level of infection
control precautions that apply in
all situations.
PPE
Hand Hygiene
Clinical waste
There are 10 elements to
Standard Precautions
Patient Care
Equipment
Linen
Isolation
Environment
Occupational
Exposure
Cough etiquette
Spillages
Preparation
• Clean Work Surface
• Hand
Decontamination
• Reconstitution
• Patient Preparationexplanation/skin
• Venous access
preparation
Remember if you are disturbed you need to
decontaminate your hands again
Administration
Additive/solutions
Always check:
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Packaging Intact
Expiry date
Particulate Matter
Glass for cracks
Bolus/flushes
Always:
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Clean the port
thoroughly
Where possible use
needle free connector
Detection of Infection
Infection can present in
a number of ways:
• Local Site Infection
• Microbial Phlebitis
• Systemic Infection
Inspection
At set Intervals, inspect for signs of
local infection & phlebitis:
1.
2.
3.
4.
5.
Tenderness
Erythema
Swelling
Purulent Discharge
Palpable Venous cord
Suspected Cannula Infection/
Phlebitis
Local• stop infusion,
• swab site if discharge visible
• if central or arterial line - send tip to microbiology for
culture.
• Inform medics
Systemic• as above,
• Vital Signs observations
• inform medics.
Treatment dependent on individual, presentation, and
causative organisms isolated.
Phlebitis Scale (Jackson 1998)
IV site appears healthy
0
One of the following is evident:
•Slight pain near IV site
OR
•Slight redness near IV site
1
TWO of the following signs are evident:
•Pain at IV site
•Erythema
•Swelling
22
ALL of the following signs are evident:
•Pain along path of cannula
•Erythema
•Induration
ALL of the following signs are
evident & extensive:
•Pain along path of cannula
•Erythema & Induration
•Palpable Venous Cord
ALL of the following signs are evident
& extensive:
•Pain along path of cannula
•Erythema & Induration
•Palpable venous cord & Pyrexia
No Signs of Phlebitis
OBSERVE CANNULA
Possibly first signs of Phlebitis
OBSERVE CANNULA
Early Stage of Phlebitis
RESITE CANNULA
Medium stage of Phlebitis
3
RESITE CANNULA
CONSIDER TREATMENT
Advanced stage of phlebitis or the start of thrombophebitis
4
45
RESITE CANNULA
CONSIDER TREATMENT
Advanced stage of Thrombophebitis
INITIATE TREATMENT
RESITE CANNULA
Giving sets
• Change giving set after administration
of blood or blood products either every
12 hours or when the transfusion is
complete
• After 24 hours of TPN administration
• After 72 hours if clear fluids are used
• All ward prepared infusions should be
changed after 24 hours
Infusate Sepsis
10 hours after infusion 3
commenced patient spiked a
temp.
Patient pulled out cannula.
Cannula resited same
infusion recommenced.
Temp spiked again, blood
cultures taken.
Environmental
Pseudomonas sp isolated
from blood.
Treatment
• Stop the infusion - inform medical staff
• Send the infusate to microbiology for
culture.
• Send blood cultures & swab from site.
• Monitor vital signs.
• Remove the line - send tip to
microbiology for culture.
Dressings
Function of the dressing is:
• To protect the site of venous access
• To stabilise the catheter in place
• Prevent mechanical damage
• Keep site clean
Documentation
• Document all IV sites daily
• Nursing Notes
• Care Plans
• Daily documentation is evidence that
assessment has been carried out
Key Points
• Intravenous drug administration if not done
properly can cause infection
• Hand hygiene, aseptic technique, correct
preparation and administration of
iv.drugs/solutions and line changes will
minimise the risk of infection
• Patients should be closely monitored for
signs of infection
• Good documentation is essential