Introduction IV lines. What do we know about them, about the proper use and maintenance of IV lines, best practice to prevent patient events related to IV lines, and staying abreast of new technologies? New challenges?
This education session addresses these issues and more. Today we look at VASCULAR ACCESS DEVICES….. You will encounter pre-tests throughout the education session. At the conclusion of the session, you will complete the post-test. So let’s begin. Remember that: Saving lines, saves lives…… Then read or highlight the bullet points above.
While vascular access devices are patient lifelines, they also present serious risk every individual with one. Then read or highlight the bullet points above.
An embolus, or a plug, composed of a detached thrombus or vegetation, mass of bacteria, or other foreign body, may occlude an IV line. Some non-thrombotic emboli Air, Catheter and Wire. Insertion or changing of a central venous catheter over a guide wire potentially can cause an acute pulmonary embolism as shown here.
For severe, life-threatening pulmonary embolism, treatment may consist of dissolving the clot with thrombolytic therapy. Anticoagulant therapy prevents the formation of more clots and allows the body to re-absorb the existing clots faster. Clot-dissolving medication (thrombolytic therapy) t-PA is most commonly used. Clot-preventing medication (anticoagulation therapy) consists of heparin by IV infusion initially, then oral warfarin (Coumadin). Subcutaneous low-molecular weight heparin is substituted for intravenous heparin in many circumstances. Patients who have reactions to heparin or related medications may need other medications.
Asepsis is the first step in protecting patients from complications related to vascular access. The majority of blood stream infections related to central lines are caused by improper care and accessing, and are intraluminal (from inside the line). You are the gatekeeper between bacteria and a potentially life-threatening infection for each of your patients, EVERY time you use a vascular access device.
The majority of blood stream infections related to central lines are caused by improper care and accessing, and are intraluminal (from inside the line). You are the gatekeeper between bacteria and a potentially life-threatening infection for each of your patients, every time you use a vascular access device.
Principles of asepsis are the foundation for providing safe care during patient interventions, particularly if they are invasive. Medical asepsis is used during non-sterile interventions. Surgical aseptic technique is used for procedures that significantly interrupt the patient’s integumentary defense. The placement, and subsequent management of, central vascular access devices is one of those interruptions. Maximum barrier precautions must be used for placement of all central lines, for example. Question: after you disinfect a needleless connector – how sure are you that you haven’t recontaminated it with your non-sterile gloved finger, or by brushing it or the male luer end of the administration set against a contaminated object like the bed linen? This is probably the single most common manner that catheters become contaminated, other than insufficient disinfection of needleless connectors.
Biofilm – it’s in rivers and streams, known there as “Didymo - didymosphenia geminata”, or “rock snot”, AND - it’s all over any medical device that is inside a patient’s body. Nearly 100% of bacteria form communities that attach to surfaces like catheters as opposed to being free flowing in the bloodstream. While the study of it is relatively new, it clearly has major significance in relation to it’s impact upon patient safety.
Here are a few examples of where biofilm will reside. Biofilm is pernicious, and largely resistant to all known forms of antimicrobials.
Almost all micro-organisms are embedded in matrices of these complex biofilm communities, or colonies. The biofilm allows the micro-organisms to adhere to any surface, living or nonliving. The adaptive and genetic changes of the micro-organisms within the biofilm make them resistant to all known antimicrobial agents. Biofilm begins forming on vascular access devices almost immediately upon contact with the patient’s bloodstream. Microbial biofilms are responsible for 65% of infections treated in the developed world. Vascular catheter-related bloodstream infections are the most serious and costly healthcare-associated infections – and the most life threatening. 87% of bloodstream infections are associated with an intravascular device. 1 1 Richards MJ, Edwards JR, Culver DH, Gaynes RP. Nosocomial infections in medical intensive care units in the United States. National Nosocomial Infections Surveillance System. Crit Care Med. 1999;27:887-892 .
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Zero infection rates for central line associated blood stream infections are attainable. Keeping patient vascular access functional and safe is attainable. It’s a team approach, and the bedside clinician is the captain.
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