Management of Peripheral Intravascular Devices - Essay Example

Management of Peripheral Intravascular Devices & Management of Peripheral Intravascular Devices Introduction Intravascular devices are the implements that are useful during the practice of healthcare administration, especially where the target points of administration are the blood vessels. In the management of these devises, there are five areas of central importance – these including skin preparation before the insertion of intravascular devices; administrator practices – these including hand hygiene and the obstructive precautions to be employed during the insertion of intravascular devices. Other chief areas include the dressing systems – related to the areas where intravascular devices are inserted, the time to be taken before intravascular devises are checked or changed; and the favorable hang time for the devices used during the administration. During the practicum session, there are points when different reasoning areas were used, these including the application of a personal point of view and operating on the basis of initial anxiety related to clinical practice. Others included the attempts at bridging the theory-practical application gap which often calls for clinical supervision by experienced staff and the nurture of professional role and mode of practice. These different focal areas were also significant in determining the learning models that would be most helpful towards the development of the best clinical practicum experience. From the practicum, I also realized that the exposure gained at educational component of nursing. This was easy to tell, because getting easy tasks implemented could raise the feelings of anxiety and incompetence. However, with continued exposure, there was a set of knowledge accumulated and increased mastery of practice (The Joanna Briggs Institute, 2008). Literature review on the management of peripheral intravascular devices Intravascular device insertions are one of the commonly performed invasive healthcare techniques. From practice reviews, this technique has been used more than 14 million times in Australia every year, as reflected from the data available at the 2008 Australian Bureau of Statistics. Despite the high frequency of use and the crucial nature of these practices in healthcare administration, the improper administration of these creates a highly potent source of healthcare services related infections (Collignon, 1994; Maki, Kluger and Crnich, 2006; Australian Bureau of Statistics, 2008). The most severe of these is IVD based blood stream infectivity. From an evaluation of healthcare service administration in the U.S, approximately 250,000 – 500,000 intravascular devices related – bloodstream infections occur. In Australia, at least 5,000 BSIs take place every year which account for an increased mortality and a significant increase in the hospitalization time by 20 days, thus, treatment costs approximately 56,000 USD (Maki, Kluger and Crnich, 2006). In an attempt to prevent these IVD related complications and infections, researchers and clinicians have established a body of literature addressing these practice areas and the vulnerabilities expected. Some of the recommendations and the models of safety recommended have been tested thoroughly, while others have not on a wide range of devices. Further, updates and editions of these standards have been offered in the areas of the prevention and infection in IVDs use since the 1970s to date. The more recent version of the guidelines has emphasized on evidence-related practice where the assessment of quality and evidence levels are given priority. There is a wide range of infection prevention techniques proposed for use with IVD care. However, five of these are the most important in everyday practice in the lines of duty. These include the preparation of the skin before the insertion of IVDs, the barrier safety measures employed during the insertion of IVDs, the mode and number of insertion site dressing, the number of replacements to be done on the IVDs, and the time fit for use for administration sets. However, all the standards adopted in this area need to be in line with the provisions of Society of Healthcare Epidemiology of America (SHEA) and those of the Center for Disease Control (CDC). The SHEA guidelines focus on the health devices used on the central venous system (Wong and Wong, 1987). The observation made on the management of peripheral intravascular devices from the NHIH202 clinical practicum During the administration and application of IVDs, hand washing is of great importance as it helps reduce the instances of IVD related infections. In this area, a practitioner should ensure that they observe effective hand hygiene measures. These include hand washing with antiseptic-containing detergents, namely water. Furthermore, waterless washing liquids like alcohol-based foams or gels can be used. Hand hygiene should be maintained before and after the palpation of catheter insertion areas as well as before and after the administration of intravascular catheters, these including insertions, accessing, replacement, repairing and the dressing of these areas. However, the palpation of the insertion site should not be done after the administration of an antiseptic, unless the use of aseptic methods is maintained. Most importantly, the usage of gloves during service administration does not render hand hygiene insignificant. In exercising the barrier safety measures during the insertion and care administration to catheter areas, the administrator should use latex or non-latex gloves during the insertion of any intravascular devices as per the recommendations of OSHA (Occupation Safety and Health Administration) regarding blood-related pathogen care. The administrator should also use latex or non-latex gloves during the changing of the dressing on the IVDs (Wong and Wong, 1987). During Catheter Insertion an administrator should not habitually employ cut down processes as the mode of catheter insertion. Among adult patients, upper extreme insertion areas should be preferred to lower ones. Among pediatric patients, catheters should be inserted at the sites at the scalp, foot or hands as opposed to those at the legs and arms among others. During catheter administration, the date, cannula size and the details of the patient should be recorded. In administering catheter area care, cleansing the skin area before the insertion of the catheter a 2% chlorhexidine-based antiseptic should be highly preferred. The antiseptic should be left at insertion area for some time before the catheter is inserted. The tincture of iodine is used as the antisepsis before the insertion of the catheter and it should be allowed to remain at the site for at least 2 minutes or more so that it can dry before the insertion is done. The insertion site should not be palpated after it has been cleansed using an antiseptic, unless the area is a sterile field. During the process of catheter dressing, an administrator should utilize sterilized gauze or a transparent dressing material to cover the catheter area. Catheters should be replaced every week for adolescent and adult patients, and more frequently when catheter devices are replaced or removed, in the cases the dressing becomes damp, soiled or loosened. Dressings should be changed more regularly for diaphoretic patients. Touching the catheter insertion area should be avoided especially after the replacement of the dressing. Moreover, to be avoided in different cases is the application of topical antimicrobial ointment at the peripheral venous catheter insertion area (The Joanna Briggs Institute, 2008). In monitoring IVD areas, the site should be checked frequently for the proof of cannula-transmitted complications and the situation of the area documented extensively. The evaluation process should involve the palpation of the insertion area through the applied dressing material. In the case the patient feels tenderness, pain or fever at the area, the dressing material should be replaced and the IV area examined. In the case that the area shows warmth, redness, drainage, pain or tenderness – the site should be shifted. In selecting and replacing IVDs, the device selected should pose the least risk of complication and cost for the IV procedure. The type of device to be used as well as the frequency of change should be based on a patient’s evaluation. Any IVD should be removed as soon as their use is not clinically indicated. Catheters planted under a crisis situation should be removed in less than 48 hours, especially where splits in aseptic processes are expected to have taken place. Among adult patients, heparin lock devices should be replaced every 96 hours (Maki, Kluger and Crnich, 2006). In replacing the administration sets, IV tubing and bottles or bags should be changed after every 72 hours. The needleless parts and the administration set should be changed after 72 hours or according to the Manufacturer’s recommendations. The tubing used for the administration of lipid emulsions, blood or blood products must be replaced after every 24 hours of usage. 70% of alcohol should be used for the disinfection of injection tubing before accessing the system. In the case of suspected infections, the discontinuation of an IV system, for instance, bacteremia or thrombophlebitis, the skin area at the junction areas should be cleansed using alcohol before the removal of the cannula. The removal of the cannula should be done aseptically and the cannula sent to the laboratory for culture and analysis. In the case that a septicemia linked to IV therapy is suspected, the remainder of the fluid at the IV bag should preserved, as the infection control department notified. The bottle or the bag is to be sent to a microbiology laboratory with a clear communication of the lot number and the nature of the solution (Hart and Rotem, 1994). The weaknesses of this clinical practice include the following: infection levels are higher among the patients under treatment at overcrowded hospitals, especially those who are very ill; among the patients with surgical wounds, burns and those that are immune-compromised or malnourished. Also, certain devices increase the chances of infection, for example, non-tunneled CVCs; the type of fluid under administration, for example, parental dietetic products as well as the length of time when the catheter is left in place. The usage of contaminated equipment and liquids is also another weakness of this practice as it can lead to bloodstream infection. The strengths of this clinical practice include the hygiene introduced through hand washing and glove usage; the solutions offered on site care and dressing; the knowledge offered on site selection and rotation which greatly influence the success levels of the therapy (Dunn and Burnett, 1995). From the information drawn from the Best Practice Information Sheet, suggestions on the improvement of the information for better usability are noted below. Based on the importance of peripheral IVDs, the education offered to administrative staff should be intensified so as to reduce the incidences of catheter-linked infections. Due to the vital nature of the patient, regarding the area of insertion and the decision to insert, the patient should be offered information on the importance of the administration as well as the significance of certain parts of the body as compared to the others. The role of the patient in reporting any discomfort like pain, swelling, bleeding and burning should be given more attention as it may have implication in the case the patients are not prudent in reporting such. Lastly, the history of the health of the patient and the welfare of the patient should be given principal attention as this may vary from one patient to another (Collignon, 1994). Conclusion Intravascular devices are the implements used during the administration of solutions to blood vessels. The chief areas of importance in the administration of these services include skin preparation, hand hygiene and obstruction measures, the dressing of intravascular insertion areas, the time to be taken before the devices are to be checked and changed. From literature review, IVD services, which form a substantial aspect of healthcare service administration – are a source of blood-related infections. For example, in Australia, blood related infections stand at 5000 every year. This shows that the administration of these services should be administered with absolute care. In managing IDV sites, the dressing, the condition of the site and the experience of the patient should be given central attention. The weaknesses of IDVs include the infection chances that come with it, while the strengths include the attention given to hygiene for the patients’ conditions. From the information in the best practices information sheet further attention should be offered to the history and the interests of the patient as these may affect the service administration to a great extent. References Australian Bureau of Statistics. 2008. Australian Historical Population Statistics. Accessed 18th April 2012. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3105.0.65.001. Collignon, P., 1994. Intravascular catheter associated sepsis: a common problem. The Australian study on intravascular catheter associated sepsis. Med J Australia, 161 (6), pp. 374-378. Dunn, S. and Burnett, P., 1995. The development of a clinical learning environment scale. Journal of Advanced Nursing, 22, pp. 1166–1173. [PubMed]. Hart, G. and Rotem, A., 1994. The best and the worst: Students experience of clinical education. The Australian Journal of Advanced Nursing, 11, pp. 26–33. [PubMed] Maki, D., Kluger, D. and Crnich, C., 2006. The risk of bloodstream infection in adults with different intravascular devices: a systematic review of 200 published prospective studies. Mayo Clinic Proceedings, 81 (9), pp. 1159-1171. The Joanna Briggs Institute. 2008. Management of peripheral intravascular devices. Best Practice, 12 (5), pp. 1-4. Wong, J. and Wong, S., 1987. Towards effective clinical teaching in nursing. Journal of Advanced Nursing, 12, pp. 505–513. [PubMed]. Read More