2017 07 12 IV Catheter Securement Tech EB Best Pract N Video

3M Health Care Academy
SM
IV catheter securement:
Technology with evidence base best practices to prevent phlebitis
Adam Low
Asia Clinical Consultant, Vascular Care
1 3M Confidential.
March 2017 13July
3M 2017. All Rights Reserved.
Intravascular (IV) devices
Short term (<10-14 days) Long Term (>10-14 days)
Peripheral IV catheters Subcutaneous central venous ports
Arterial catheters Peripherally inserted CVC
Central venous catheters (CVC) (PICC)
Non cuffed Central venous catheters
Not tunneled Cuffed
Tunneled
IDSA guidelines 2009
2 3M Confidential. 13July
Vascular access device infection remains a significant clinical
problem outside the ICU
41000 Central Line Associated

Bloodstream infections in 2009
Septimus EJ and Moody J. Prevention of device related
healthcare associated infections. (2016) F1000Res
2016Jan14;5.
Infection rate outside ICU ~4 per 1000

catheter days
Vorberg RP et al. Device associated infection rates
for the non-intensive care unit patients. Infect Control
Hosp Epidemiol (2006) 27:357-361.
ICU Outside
ICU
Peripheral catheters represent an under-recognised source of
bloodstream infection
We estimate that there may be as many as 10,028 PVC-related S.
Short term (<10-14 days) aureus bacteremias yearly in US adult hospitalized inpatients.PVC-
Central venous catheters (CVC) related S. aureus bacteremia is an underrecognized complication.
TT Trinh et al., Peripheral venous catheter related Staphylococcus aureus
Non cuffed bacteremia. Infect Control Hosp Epidemiol. 2011 Jun;32(6):579-83.
Not tunneled
Arterial catheters Seventy-seven episodes (0.19 cases/1000 patient-
days) were PVC-BSIs and 73 episodes (0.18
Peripheral IV catheters cases/1000 patient-days) were CVC-BSIs.
Pujol et al., Clinical epidemiology and outcomes of peripheral venous
catheter related bloodstream infections in a university affilitated hosptial. J
Hosp Infec (2007) 67: 22-29.
Placement complications are a function of entry site; infection is NOT.
Event Peripheral Central Significance level
Catheter tip malpositioning 9.3% 3.4% p=0.0007
Thrombophlebitis 78/10000 days 7.5/10000 days p=0.0001
Catheter dysfunction 78/10000 days 14/ 10000 days p=0.04
There was NO difference in infection rates
Pikwer A, Akeson J and Lindgren S.

Complications associated with peripheral or central routes for central venous
cannulation. Anaesthesia (2012) 67: 65-71
Recommendations, Guidelines, and Standards of care
Epic2 Guidelines UK Canadian Patient Safety Institute Inst Healthcare Improvement
Soc Healthcare Epidemiol America

Safer Healthcare Now (Canada) Natl Agency Health Surv (Brasil)
Centers for Disease Control

Registered Nurse Assn Ontario (Canada)
Infusion Nurse Society
Assn Practitioners Infec Ctrl
Infectious Dis Soc America New Zealand Assn Vascular Access
10
The evidence wedge captures relative value of clinical information
Size of the region reflects difficulty in

obtaining results.
Least valuable/clinically predictive data are

at the bottom of the wedge.
Most valuable/clinically predictive data are

at the TOP of the wedge.
3M 2017. All Rights Reserved. 11
Infusion Nurse Standards based on Evidence Quality
Strength Definition
I Meta-analysis, systematic literature review, at least 3 randomized controlled trials or guideline based on randomized controlled trials
I A/P Evidence from anatomy, physiology and pathophysiology references as understood at the time of writing
II Two well-designed randomized controlled trials, two or more multicenter, well-designed clinical trials without randomization or systematic
literature review of varied prospective study designs
III One well designed randomized clinical trial, several well-designed clinical trials without randomization, or several studies with quasi-
experimental designs focused on the same question. Includes 2 or more well-designed laboratory studies.
IV Well designed quasi-experimental study, case-control study, cohort study, correlational study, time series study, systematic literature
review of descriptive and qualitative studies, or narrative literature review, psychometric study and includes one well-designed laboratory
study.
V Clinical article, clinical/professional book, consensus report, case report, guideline based on consensus, descriptive study, well-designed
quality improvement project, theoretical basis, recommendation by accrediting bodies and professional organizations, or manufacturer
directions for use for products of servies. Includes standard of practice that is generally accepted but does not have a research basis.
May also be noted as Committee Consensus, although rarely used.
Regulatory Regulatory regulations and other criteria set by agencies with the ability to impose consequences, such as the American Association of
Blood Banks.
Centers for Disease Control use evidence quality for guidelines
CDC Category Evidence

IA Strongly recommended for implementation and strongly supported by well-designed experimental, clinical or
epidemiologic studies.
IB Strongly recommended for implementation and supported by some experimental, clinical or epidemiologic
studies and a strong theoretical rationale, or an accepted practice (eg aseptic technique) supported by limited
evidence.
IC Required by state or federal regulations, rules or standards
II Suggested for implementation and supported by suggestive clinical or epidemiologic studies or a theoretical
rationale.
Unresolved Evidence is insufficient or no consensus regarding efficacy exists.
Education is a critical component of CLABSI reduction.
Socio-Technical Theory may provide balanced middle ground to
technology vs behavior
Goals/Visions/Values People
Processes/Procedures Buildings/Infrastructure
Culture Technology
Socio Technical Theory: The design and performance of any organisational
system requires a balance of both social and technical features and they
are interdependent parts of a complex system.
Culture change results in improved outcomes
Power Distance Index
South Africa
Costa Rica India
Argentina France Venezuela

Israel Sweden Germany Turkey
Mexico
Indonesia
Low High
Denmark US Chile Brazil China

Austria Japan
The Philippines
Colombia
Egypt
United Kingdom
Slide Source: Laraine Kaminsky Lebanon

President
Global LK
Guidelines for Prevention of intravascular catheter related infections
(CDC)
Prepare clean skin with a >0.5%
chlorhexidine preparation with alcohol
before central venous catheter and
peripheral arterial catheter insertion and
during dressing changes. If there is a
contraindication to chlorhexidine, tincture This study supports the recommendation of
of iodine, an iodophor, or 70% alcohol can a chlorhexidine in alcohol product. Indeed, the
in vitro results suggest that 2% (w/v) CHG in 70%
be used as alternatives Category IA (v/v) IPA offers an improved antimicrobial effect
compared with all three standard preparations of
CHG currently available in the UK [0.5% (w/v)
aqueous CHG, 2% (w/v) aqueous CHG and 0.5% (w/v)
OGrady NP et al, Am J Infec Ctrl (2011) 39:S1-S34.
CHG in 70% (v/v) IPA] when challenged with S.
epidermidis RP62A in a biofilm in the presence of
10% human serum (P<0.0001).
18 3M Confidential.
18 13July
Completed biofilm contains live bacteria within a polysaccharide
polymeric matrix
Organisms at the insertion site (extraluminal) are source
of infection in the majority of cases in early infections.
60%
21%
Days 4-7 Days 7-

Hematogenous
14
Indeterminate
Intraluminal
Extraluminal
Mermel L, Clin Infect Dis (2011) 52: 211-212
Organisms introduced via intraluminal route produce
majority of infection after 4-7 days.
28%
77%
Days 4- Days 7-
7 Hematogenous
14
Indeterminate
Intraluminal
Extraluminal
Mermel L, Clin Infect Dis (2011) 52: 211-212
3M Tegaderm Transparent Film Dressings
Highly breathable transparent film to cover and protect IV sites while providing
continuous observation.
"Picture-frame" delivery
Provides secure adhesion that is gentle to the skin
Supports infection prevention goals by providing a barrier

to external contaminants
Available in smaller sizes and in a non-sterile roll
Components of 3M Tegaderm Transparent Film Dressings
Tape Removal Surface
Polyurethane
Film
50um {
Hypoallergenic
Adhesive
Bacteria bouncing off
the film
Enhanced site protection
Breathable
Moisture vapor out, allowing

the skin to function normally.
The sterile film barrier is

impervious to liquids,
bacteria, and viruses,*
providing an effective
barrier to external
contaminants
Pressure Sensitive Adhesives -PSA
Transparent film dressings:
Use pressure sensitive adhesives (PSA)
PSAs are soft, allowing them to:
Conform to the irregular surface of the skin and to the contours of the body
Why is this important?
Pressure must be applied upon dressing application to enhance skin adhesion
The adhesion for Tegaderm Diamond Dressing builds with time, but initial adhesion can be maximized by applying
pressure to dressing and dressing edges
Dressing application without pressure
IV Site Evolution: Moving up the Value Stream
CHG Dressings
IV Advanced Securement Dressing with Comfort
Adhesive Technology Antimicrobial protection with site
visibility
Advanced Dressings Added securement
Advanced Securement
Comfort Adhesive Technology
Standard Dressings Added securement Excellent Moisture Handling
Extended wear time Improved Patient Care
Waterproof, sterile barrier
Tape and Gauze Specialty designs
Transparent for daily site
monitoring
Gentle adhesive
Easy to apply
26
3M Confidential. 13July
Components of 3M Tegaderm Transparent Film Dressings with
Borders
Tape Removal Surface
Polyurethane
Film
Adhesive
Border
Border Adhesive
Features and Benefits of Advanced IV Dressings
Secure. Protect. Stabilize.
Secure the catheter, preventing accidental dislodgement
Protect the insertion site from external contaminants with viral and bacterial barrier
Protect the skin from trauma with gentle adhesive
Stabilize the catheter, minimizing catheter movement
Tegaderm Advanced IV dressings are a securement device
They meet the FDA classification, INS and CDC guideline of a catheter securement device
Advanced IV dressings are designed to provide better securement than the hospitals standard film
dressings
Tegaderm Advanced IV dressings provide a large window to visualize the insertion site
supports CDC guidelines to visualize the insertion site daily to monitor for signs of complications
29 3M Confidential.
29 13July
The BIG Question
Is there a correlation between the MVTR of a dressing and catheter-related blood stream infections?
Study results do not demonstrate a correlation between higher MVTR and lower incidence of
infection
Maki (1994) study in Clinical Outcomes..
Presentation available on the Tegaderm website
Competitive dressing manufacturers continue to use MVTR as a marketing strategy
3M has conducted research studies to investigate the effect of MVTR
Computerized evaporimetry- measures actual evaporation through the film on skin and moisture build up underneath
the dressing
When MVTR is measured with this device dressings with significant differences in bench MVTRs show no significant
difference in actual moisture accumulation on the skin
Clinical Acceptability
Tegaderm brand dressings have proven the clinical acceptability of the use of transparent adhesive dressings
for protecting catheter sites
We have worked with health care professionals to promote the highest standard of care
Tegaderm dressing clinical studies provide the basis for the CDC recommendation for a 7-day CVC dressing
change
2011 Centers for Disease Control / HICPAC Guidelines for the Prevention of Intravascular Catheter-Related Infections:
Use either sterile gauze or sterile, transparent, semi-permeable dressing to cover the catheter site. Category IA.
Replace dressings used on short-term CVC sites at least every 2 days for gauze dressings. Category II
Replace dressings used on short-term CVC sites at least every 7 days for transparent dressings, except in
those pediatric patients in which the risk for dislodging the catheter may outweigh the benefit of changing the
dressing. Category IB
Extensive clinical documentation
31
The greatest risk for contamination of
the catheter after insertion is the NC
with 33-45% contaminated, and
compliance with disinfection as
low as 10%.
3M Curos Disinfecting Port Protectors
Current practice
Do you really scrub for 15 seconds and let it dry?
3313 3M 3M
July Confidential.
2017 . All Rights Reserved. 3M Confidential. 13July
3M Curos Disinfecting Port Protectors
Product description
70% Isopropyl Alcohol (IPA) in a cap
Caps: place on any needleless connector
Tips: place on male luers
To disinfect and act as a physical barrier between accesses when not
in use
1 minutes for disinfection
May stay in place for up to 7 daysas long as its not removed
Single use only
Bundles http://www.ihi.org/IHI/Topics/CriticalCare/Intensive
Care/Changes/ImplementtheCentralLineBundle.ht
m
Proper hand hygiene
Maximal barrier precautions upon
insertion of catheter
Optimal Catheter Site Selection, with
Avoidance of the Femoral Vein for Central
Venous Access in Adult Patients
Chlorhexidine skin antisepsis
Daily review of the line necessity with
prompt removal of unnecessary line.
Image courtesy of Dr Mauro
Pittiruti, Catholic University,
Rome
Standardized approaches to IV site care
Use of bundles reduces overall rate of CRBSI
38 3M Confidential.
38 13July
Vascular Access Care & Maintenance
Product categories that help address clinical needs
Solution Skin Protection

Bacterial and Catheter Antimicrobial Antimicrobial Antimicrobial
Category Viral Barrier Securement Protection Protection Protection
Purpose Protect skin as Protect insertion site from Protect venous access from Protect from Protect from Protect from
natural infection barrier contaminants motion complications extra-luminal contamination extra-luminal contamination intraluminal
contamination
Product line Transparent film dressings Securement dressings CHG securement
Barrier films CHG skin preps Disinfecting port protectors
examples & devices dressings & devices
Clinically related care approach to help reduce the risk of vascular access
related complications
3913 3M 3M
July Confidential.
2017 . All Rights Reserved. 3M Confidential. 13July
Get the right people involved
Members of Change Management Team
Nursing Staff &

Auxiliaries Chief Nurse/ Clinical
Department Managers
Head Nurses/ Individuals/
Senior Staff groups
Top Management
Project
Leader
People
Commitment Change Change
Agents Sponsor Engagement
Implementation Strategies for VAD management
Have a dedicated person
Establish a steering committee
Provide educational sessions and ongoing support for implementation.
Provide organizational support
having the structures in place to facilitate the implementation.
Develop new assessment and documentation tools (Davies & Edwards, 2004)
Identify and support designated champions on each unit to promote and support
implementation.
Celebrate milestones and achievements, acknowledging work well done (Davies & Edwards,
2004).
RNAO , 2016

2017 07 12 IV Catheter Securement Tech EB Best Pract N Video

Diunggah oleh

Informasi Dokumen

Judul Asli

Hak Cipta

Format Tersedia

Bagikan dokumen Ini

Bagikan atau Tanam Dokumen

Opsi Berbagi

Apakah menurut Anda dokumen ini bermanfaat?

Apakah konten ini tidak pantas?

Hak Cipta:

Format Tersedia

2017 07 12 IV Catheter Securement Tech EB Best Pract N Video

Diunggah oleh

Hak Cipta:

Format Tersedia

3M Health Care Academy

IDSA guidelines 2009

41000 Central Line Associated

Infection rate outside ICU ~4 per 1000

Event Peripheral Central Significance level

Catheter tip malpositioning 9.3% 3.4% p=0.0007

Thrombophlebitis 78/10000 days 7.5/10000 days p=0.0001

Catheter dysfunction 78/10000 days 14/ 10000 days p=0.04

There was NO difference in infection rates

Pikwer A, Akeson J and Lindgren S.

Epic2 Guidelines UK Canadian Patient Safety Institute Inst Healthcare Improvement

Soc Healthcare Epidemiol America

Centers for Disease Control

Infectious Dis Soc America New Zealand Assn Vascular Access

Size of the region reflects difficulty in

Least valuable/clinically predictive data are

Most valuable/clinically predictive data are

CDC Category Evidence

Argentina France Venezuela

Denmark US Chile Brazil China

Slide Source: Laraine Kaminsky Lebanon

Days 4-7 Days 7-

Provides secure adhesion that is gentle to the skin

Supports infection prevention goals by providing a barrier

Available in smaller sizes and in a non-sterile roll

Tape Removal Surface

Moisture vapor out, allowing

The sterile film barrier is

Dressing application without pressure

Extensive clinical documentation

Do you really scrub for 15 seconds and let it dry?

Solution Skin Protection

Members of Change Management Team

Nursing Staff &

Anda mungkin juga menyukai