Intravenous Drug Administration

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Intravenous Drug Administration

• Infection Control
• NHS Greater Glasgow and Clyde
• Glasgow Royal Infirmary

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Learning Outcomes

• discuss the way intravenous drug administration
  can cause infection
• identify potential entry points where organisms
  may gain access to the system
• state how line/infusate sepsis can be detected.
• describe how risks of infection in intravenous
  drug administration and line use can be minimised

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IV Drug Administration

• Potentially the most life threatening of all
• nursing interventions.
• Be aware of all potential hazards.
• Take great care to prevent complications.

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Potential Implications

• Pain
• Infection
• Delay in further intervention
• Side effects of antibiotics
• Delay in discharge
• Death

Patient
5
Potential Implications

• Division
• Sundries
• Increased medical and nursing intervention
• Delay in discharge/next admit
• Resistant organisms
• Litigation

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Where organisms gain entry
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From the infusate

• Through contamination of the infusate
• Most at risk are long term (gt10 hour) infusates
• Specifically those made up in-house
• Time for small numbers of organisms to grow
  profusely.
• Direct infusion of organisms severe sepsis
• Particularly some Gram negative organisms which
  grow well in solutions.

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Solutions which increase growth potential

• TPN
• Blood and blood products
• Lipid emulsions/drugs

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Complications

• Phlebitis
• Catheter related sepsis
• Infusate Contamination

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Preparation

• Have a clean trolley/surface area
• Prepare
• alcohol hand gel
• drug required
• alcohol wipes
• needle, syringe and if required new
• connection
• gloves
• sharps bin

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• Never reuse single use vials
• Never prepare drugs in advance

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• Hand hygiene
• Check solution is clear
• Disinfect ampoule
• Disinfect the hub
• Put on gloves
• Administer drug

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• Use non-touch technique of equipment/drugs in
  contact with the internal lumen of the cannula.
• Avoid infusing drugs into the port on top of the
  venflon.

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After Care

• Discard sharps immediately.
• Remove gloves and wash hands.
• Record as necessary.
• Watch for signs of sepsis.
• If on a pump/TPN, central line - four hourly temp
  chart.
• Venflon care plan.

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Giving sets

• Change giving set after administration of blood
  or blood products
• After 24 hours of TPN administration
• After 72 hours if clear fluids are used
• Use filters if infusing in-house prepared
  infusions lasting longer that 12 hours
• All in-house infusion should be changed after 24
  hours

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Infusate Sepsis

• 10 hours after infusion 3 commenced patient
  spiked a temp.
• Patient pulled out venflon.
• Venflon resited same infusion recommenced.
• Temp spiked again, blood cultures taken.
• Environmental Pseudomonas sp isolated from blood.

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Treatment

• Stop the infusion - inform medical staff
• Send the infusate for culture.
• Send blood cultures swab from site.
• Monitor vital signs.
• Remove the line - send tip.

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Dressings

• Not the most important factor.
• Dry dressings - do not alter skin flora
• Film dressings can increase skin flora
• Non-sterile tape - no evidence against for
  peripheral veins.
• Dont store tape in pockets.

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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

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Most Important Factor

• Remember
• What have you just done?
• What are you going to do?
• Hand Hygiene