Aseptic Technique and Insertion of Peripheral Venous Catheters

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Aseptic Technique and Insertion of Peripheral
Venous Catheters

• Reducing the risk of Staphylococcus Aureus
  Bacteraemias (SABs)

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Learning Outcomes

• On completion of this resource you should be able
  to
• Describe how Peripheral Venous Catheters (PVC)
  can cause bloodstream infections and
  Staphylococcus Bacteraemia
• Explain the implications of PVC related
  bloodstream infections and how PVC Insertion and
  Care and Maintenance Bundles can improve PVC care
• Describe how to apply an effective Aseptic
  Non-Touch Technique to inserting a PVC

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Peripheral Venous Catheters

• PVC can cause blood stream infections by enabling
  micro-organisms to gain direct access to the
  blood stream.
• Micro-organisms come from hands of healthcare
  workers, the patients skin at the insertion
  site, contaminated hubs/ connections,
  contaminated drugs/ infusions.
• Risk factors for increasing the risk of blood
  stream infections include-
• 1. Use of a PVC
• 2. Use of a PVC for drugs that irritate
  the vein and causing phlebitis
• 3. Having a pre-existing infection
• 4. Excess duration of PVC use longer
  than 72hours

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Peripheral Venous Catheters and asepsis

• PVC are inserted directly into the circulatory
  system, it is essential that the principles of
  asepsis are maintained while inserting and
  manipulating the device.
• Development of PVC Insertion and Care Bundles to
  assist practitioners deliver more reliably safe
  patient care
• Patient groups more susceptible to developing a
  bloodstream infection include the
  immuno-compromised, elderly and those with
  invasive devices
• National HEAT targets have been developed to
  drive a reduction in the number of Staphylococcus
  Aureus Bacteraemia by at least 30

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PVC Care Bundle - Insertion

• The PVC Insertion Bundle outlines the key
  elements-
• A PVC is clinically indicated for this patient
• Hand Hygiene is performed prior to and following
  touching the patient
• Alcohol based antiseptic is applied to the skin
  and is allowed to dry
• Dont touch critical parts
• Date and time of insertion recorded

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PVC Care Bundle - Maintenance

• The PVC Care Bundle outlines the key elements -
• Perform hand hygiene prior to and following all
  interventions with PVC
• Is the PVC insitu still required?
• Are there signs of inflammation or extravasation?
  Is so remove the PVC
• Consider removing PVC which has been insitu for
  72 hours or longer
• Check that PVC dressing is dry and intact
  consider replacing

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Aseptic Non-Touch Technique for PVC Insertion

• Following explanation of the procedure to the
  patient, prepare a clean dry surface
• Gather the following equipment-
• PVC Insertion pack (if available)
• Tourniquet (disposable/ single patient use if
  available)
• Antiseptic wipe (alcohol based)
• PVC if not available in a pack
• Non-sterile gloves
• Sterile IV dressing
• Sharps box
• Waste disposal bag

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Aseptic Non-Touch Technique for PVC Insertion(1)

• Perform Hand Hygiene
• Create a sterile field
• Open and prepare the sterile equipment without
  touching the critical parts
• Ensure patients skin is visibly clean if not
  wash with soap and water and wash your hands
  again.

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Aseptic Non-Touch Technique for PVC Insertion(1)

• Don non-sterile gloves
• Apply tourniquet and palpate vein you will not
  be able to palpate following disinfection
• Apply alcohol-based antiseptic to patients skin
  and allow to dry for 30 seconds DO NOT
  RE-PALPATE
• For complicated PVC insertion you may
  require to re-palpate the vein. It is therefore
  essential that you ensure that sterility of the
  insertion site is maintained.
• Hold the PVC without touching the part of the
  catheter that is inserted into the patient, or
  underneath the cap

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Aseptic Non-Touch Technique for PVC Insertion(1)

• Following insertion release tourniquet, remove
  insertion needle and secure PVC with sterile
  dated and timed IV dressing
• Discard sharps in sharps box, discard gloves in
  appropriate waste bag
• Perform hand hygiene
• Complete PVC insertion sticker/ documentation and
  place in patients case notes

Date time
Transparent dressing
Parallel securing tapes
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Bibliography

• NHS Quality Improvement Scotland, Health
  Protection Scotland.
• Peripheral Vascular Catheter Insertion. Driver
  Diagram, Implementation Framework, Priority
  Elements Checklist, Data measurement tool and
  Measurement Plan. Working Draft. Scotland NHS
  QIS/HPS. 2011 version 1.0
• 2. World Health Organisation (2009) WHO
  Guidelines on Hand Hygiene in Health Care. Fist
  global Patient Safety Challenge Clean Care is
  Safer Care. WHO, Geneva
• Further references and bibliography can be found
  in the teaching notes