[Tim Spencer]

Hi Heather,The CDC Guidelines have quite bit on this issue also.https://www.cdc.gov/hicpac/pdf/guidelines/bsi-guidelines-2011.pdf
Cath Murphy posted Dr Rickards paper in the BMJ which is also a great starting point.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.Vascular Access ConsultantPresidential Advisor – Australian Vascular Access SocietyConjoint Lecturer – South West Sydney Clinical School | Faculty of Medicine | University of NSWDirector-at-Large – Vascular Access Certification Corporation (VACC)Chairperson – AVA GlobalStrategy CommitteeRepresentative – WoCoVA Global Strategic CommitteeM: +1 (623) 326 8889 (USA)M: +61 (0)409 463 428 (AU)E:tim.spencer68@icloud.com
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_____________________________

Dear colleagues

Thank you for previous responses.

Would any like to share if they have a policy/procedure for the hanging of IV lines?

At the Canberra Hospital we had a policy for length of time an iv line could be used before needing to be changed but it seems to have dropped off.

We have had the question from the wards regarding small infusions, eg antibiotics. Do the lines need to be changed with each new infusion?

Also once a bag is spiked how long can the bag be hung before being used with and without additives.

Kind regards

Heather

Heather Warfield

Infection Prevention & Control

Surgical site surveillance

Canberra Hospital

building 10, level 4

Email:heather.warfield@act.gov.au

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[Tim Spencer]

HI Helen,
Do you know if they standard or widescreen format – this is important if your template is not designed for either one..
If you use a standard template in widescreen, its aspect ratio will be incorrect.. and it will appear stretched and disproportional.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)

> On Aug 22, 2016, at 4:15 PM, Lorenz, Helen (Health) wrote:
>
> Hello all:
>
> Can anyone share some examples of ePosters? Ive had an abstract accepted as an ePoster presentation for the ACIPC 2016 conference and am looking at how the info is best displayed, but cant find much on the way of completed examples on the Internet. There are plenty of tips etc, but I would like to look at how a one minute long PPT format ePoster might look.
>
> Kind regards
> Helen
> Helen Lorenz RN BScN | Associate Clinical Service CALHN Coordinator Infection Prevention & Control Unit | Division of Acute Medicine The Queen Elizabeth Hospital | Central Adelaide Local Health Network Level 8 Tower Building | 28 Woodville Road, WOODVILLE SOUTH 5011 t: +61 8 8222 7588| p: 47758| f: +61 8 8222 6461 | DX: 465432 |e: Helen.Lorenz@sa.gov.au
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[Tim Spencer]

Hi Cath,
Sorry for the delay in replying to your email – I was work traveling.

The current INS Standards of Practice (2016), with which a lot of infusion therapy-based policies currently reference, considers a burette as an add-on device and the requirements for these are listed in the extracted text below;

Practice Criteria

Consider the use of add-on devices (eg, single- and multilumen extension sets, manifold sets, extension loops, solid cannula caps, needleless connectors, in- line filters, manual flow-control devices and stop- cocks) only for clinical indications. When indicated, preferentially use systems that minimize manipula- tion and reduce multiple components, such as inte- grated extension sets (see Standard 34, Needleless Connectors).1-4 (IV)

Clinical indications may include adding length, enabling filtration capabilities, or enhancing function of the infusion system (ie, adding an extension to decrease movement/manipulation at the short peripheral catheter hub).1,2 (V)

Consider that the potential for contamination exists with all add-on devices. Limit the use of add-on devices whenever possible to decrease the number of manipulation episodes, acciden- tal disconnections or misconnections, and costs.1-9 (IV)

Ensure that all add-on devices are compatible with the administration system to prevent the risk of leaks, disconnections, or misconnections.5-6 (V)

Change the add-on device with new vascular access device (VAD) insertion, with each administration set replacement, or as defined by the organization, and whenever the integrity of the product is compro- mised or suspected of being compromised.1,2 (V)

Avoid the use of stopcocks due to the increased risk of infection.

Propofol anesthesia may increase risk for postop- erative infection because of microorganism growth in stopcock dead spaces. Bacterial con- tamination of the patients skin, the providers hands, and the environment contribute to infec- tion risk associated with stopcocks.10,11 (IV)

Use a stopcock or manifold with an integrated needleless connection rather than a solid cap or replace the stopcock with a needleless connector to reduce stopcock contamination.12,13 (IV)

REFERENCES

1. Hadaway L. Infusion therapy equipment. In: Alexander M, Corrigan A, Gorski L, Hankins J, Perucca R. eds. Infusion Nursing: An Evidence-Based Approach. 3rd ed. St Louis, MO: Saunders/Elsevier; 2010:391-436.

2. Alexander M, Gorski L, Corrigan A, Bullock M, Dickenson A, Earhart A. Technical and clinical application. In: Alexander M, Corrigan A, Gorski L, Phillips L, eds. Core Curriculum for Infusion Nursing. 4th ed. Philadelphia, PA: Wolters Kluwer/ Lippincott Williams & Wilkins; 2014:1-85.

3. Gonzalez Lopez J, Arriba Vilela A, Fernandez del Palacio E, Olivares Corral J, Benedicto Marti C, Herrera Portal P. Indwell times, complications and costs of open vs closed safety peripheral intravenous catheters: a randomized study. J Hosp Infect. 2014;86(2):117-126.

4. Tamura N, Abe S, Hagimoto K, et al. Unfavorable peripheral intravenous catheter replacements can be reduced using an integrated closed intravenous catheter system. J Vasc Access. 2014;15(4):257-263.

5. US Food and Drug Administration. Preventing tubing and luer misconnections. http://www.fda.gov/MedicalDevices/Safety/ AlertsandNotices/TubingandLuerMisconnections/default.htm.

6. US Food and Drug Administration. Safety considerations to mitigate the risks of misconnections with small-bore connectors intended for enteral applications. http://www.fda.gov/downloads/ MedicalDevices/DeviceRegulationandGuidance/Guidance Documents/UCM313385.pdf. Published February 11, 2015.

7. Institute for Safe Medication Practices (ISMP). Stay connected program. http://ismp.org/tools/stayconnectedprogram.aspx.

8. American Nurses Association [position paper]. Safety issues related to tubing and catheter misconnections. http://www.nurs- ingworld.org/position/practice/tube.aspx.

9. Marschall J, Mermel LA, Fakih M, et al; Society for Healthcare Epidemiology of America. Strategies to prevent central line-asso- ciated bloodstream infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(7): 753-771.

10. Cole D, Baslanti T, Gravenstein NL, Gravenstein N. Leaving more than your fingerprint on the intravenous line: a prospective study on propofol anesthesia and implications of stopcock contamination. Anesth Analg. 2015;120(4):816-867.

11. Loftus R, Brown J, Koff M, et al. Multiple reservoirs contribute to intraoperative bacterial transmission. Anesth Analg. 2012;114(6):1236-1248.

12. Mermel L. Intraoperative stopcock and manifold colonization of newly inserted peripheral intravenous catheters. Infect Control Hosp Epidemiol. 2014;35(9):1187-1189.

13. Sandora TJ, Graham DA, Conway M, Dodson B, Potter-Bynoe G, Margossian SP. Impact of needleless connector change frequency on central line-associated bloodstream infection rate. Am J Infect Control. 2014;42(5):485-489.

I also checked the CDC Guidelines (2011) and there is only 1 reference to burettes in the guideline and its from 1987.
Replacement of Administration Sets

In patients not receiving blood, blood products or fat emulsions, replace administration sets that are continuously used, including secondary sets and add-on devices, no more frequently than at 96-hour intervals, [177] but at least every 7 days [178181]. Category IA

No recommendation can be made regarding the frequency for replacing intermittently used administration sets. Unresolved issue

No recommendation can be made regarding the frequency for replacing needles to access implantable ports. Unresolved issue

Replace tubing used to administer blood, blood products, or fat emulsions (those combined with amino acids and glucose in a 3-in-1 admixture or infused separately) within 24 hours of initiating the infusion [182185]. Category IB

Replace tubing used to administer propofol infusions every 6 or 12 hours, when the vial is changed, per the manufacturers recommendation (FDA website Medwatch) *186+. Category IA

No recommendation can be made regarding the length of time a needle used to access implanted ports can remain in place. Unresolved issue

REFERENCE (the only one cited!)

179.Snydman DR, Donnelly-Reidy M, Perry LK, Martin WJ. Intravenous tubing containing burettes can be safely changed at 72 hour intervals. Infect Control 1987; 8:1136.

Also, I did a quick literature search for any newer articles that included burette(s);

Intravascular device administration sets: replacement after standard versus prolonged use in hospitalised patients – a study protocol for a randomised controlled trial (The RSVP Trial)
Rickard, CM ; Marsh, Nm ; Webster, J ; Gavin, NC ; Mcgrail, Mr ; Larsen, E ; Corley, A ; Long, D ; Gowardman, Jr ; Murgo, M ; Fraser, Jf ; Chan, Rj ; Wallis, MC ; Young, J ; Mcmillan, D ; Zhang, L ; Abu Choudhury, M ; Graves, N ; Playford, Eg
Bmj Open, 2015, Vol.5(2)

Should we use closed or open infusion containers for prevention of bloodstream infections?
Rangel-Frausto, Manuel S ; Higuera-Ramirez, Francisco ; Martinez-Soto, Jose ; Rosenthal, Victor D
Annals of clinical microbiology and antimicrobials, 2010, Vol.9, pp.6

Bacterial colonization and endotoxin contamination of intravenous infusion fluids
Trautmann, M ; Zauser, B ; Wiedeck, H ; Buttenschn, K ; Marre, R
The Journal of hospital infection, November 1997, Vol.37(3), pp.225-36

Variance study of burette aliquot volumes
Schwartz, Lowell M.
The Analyst, 1990, Vol.115(12), pp.1581-1587

Intravenous Tubing Containing Burettes Can Be Safely Changed at 72 Hour Intervals
Gilmore E.
Nutrition in Clinical Practice, February 1988, Vol.3(1), p.33

Changing intravenous tubing containing burettes
Josephson, A
JAMA, 4 January 1985, Vol.253(1), pp.42

Intravenous tubing with burettes can be safely changed at 48 hour intervals
Gorbea, H.F. ; Snydman, D.R. ; Delaney, A. ; Stockman, J. ; Martin, W.J.
Journal of the American Medical Association, 1984, Vol.251(16), pp.2112-2115

Any publications further back are way too old (1946).
I hope this provides some help for you.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Vascular Access Consultant
E: tim.spencer68@icloud.com
M: +1 (623) 326 8889 (USA)
M: +61 (0)409 463 428 (AU)

> On Aug 3, 2016, at 5:25 PM, Aileen Moerig (Hawkesbury) wrote:
>
> Hi Cath, I too am interested in removing the burettes and using the closed system for IV administration. Would you be kind enough to post the literature that you have reviewed many thanks Aileen
>
>
> Aileen Moerig | #Infection Control Coordinator
> Hawkesbury District Health Service
> T: (02) 4560 5487 | M: | F: (02) 4560 5662 | E: Aileen.Moerig@sjog.org.au
> 2 Day Street, Windsor NSW 2756 | Locked Bag 10, Windsor NSW 2756
> http://sjog.org.au/hawkesbury | http://twitter.com/sjog_healthcare | LinkedIn | http://facebook.com/sjoghealthcare
>
>
>
> We acknowledge the Traditional Owners of Country throughout Australia and recognise their continuing connection to land, waters and community.
> We pay our respect to them and their cultures and to Elders past and present.
>
>
> From: ACIPC Infexion Connexion [mailto:AICALIST@AICALIST.ORG.AU] On Behalf Of Catherine Wade
> Sent: Thursday, 4 August 2016 9:27 AM
> To: AICALIST@AICALIST.ORG.AU
> Subject: IV fluid & drug administratioj sets – Burettes or Mini Bags. Open vs Closed Systems
>
> Hi All,
> We are currently reviewing all of our IV administration lines on contract.
> According to the IV Fluid Company Rep Burettes are not used in the UK or USA
> Burettes are still widely used by staff however the evidence based practice literature I have been able to find recommends using closed systems (mini bags) to reduce risk of bacteraemia.
> I would greatly appreciate any feedback from facilities that currently use closed systems, especially any facilities that may have converted over to closed systems in the last 1 to 2 years.
> I also would greatly appreciate any feedback about how you implemented this change, the challenges associated with this change (if any) and if you noticed any reduction of infection rates.
> Many Thanks
>
> Cath Wade
>
> Clinical Nurse Consultant | Infection Prevention and Control
> Level 1, 67 Holden Street Gosford Hospital
> Tel: (02) 4320 2664 | Internal Ext: 92664| Fax: (02) 4320 2874 | Internal Fax: 92874| Page: 18885
> Catherine.Wade@health.nsw.gov.au or CCLHD-IPAC@health.nsw.gov.au
>
>
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[Tim Spencer]

Hi Daniela,I have several protocols and guidelines for declotting CVADs.Please feel free to email me offline.
Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.Vascular Access ConsultantPresidential Advisor – Australian Vascular Access SocietyConjoint Lecturer – South West Sydney Clinical School | Faculty of Medicine | University of NSWDirector-at-Large – Vascular Access Certification Corporation (VACC)Chairperson – AVA GlobalStrategy CommitteeRepresentative – WoCoVA Global Strategic CommitteeM: +1 (623) 326 8889 (USA)M: +61 (0)409 463 428 (AU)E:tim.spencer68@icloud.comABN: 51 606 547 370
Sent from Outlook for iPhone

_____________________________

Dear colleagues,Does anyone have a guideline or advicethey would be happy to share regarding the structured management ofPICCs with one or both lumens blocked- including nursing, medical and/or radiology responsibilities?Many thanks in advance,DanielaDaniela Karanfilovska
Clinical Nurse Consultant
Infection Prevention & Healthcare Epidemiology
t 03 90762819 m0427 703769e D.Karanfilovska@alfred.org.au

Alfred Health
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Melbourne VIC 3004
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[Tim Spencer]

Hi Michelle,

Here is the link to the cleaning instructions that are available on the
website –

http://www.autexacoustics.com/assets/Uploads/documents/IA-NA-IN-Wallcovering
s-Cleaning-Guide-JUL14-JR.pdf

And here is the link to the composition datasheet –

http://www.autexacoustics.com/assets/Uploads/documents/IA-US-DS-Composition-
Datasheet-Mar15-CP-web.pdf

I have also attached the cleaning PDF for your convenience.

Many professional recording studios use similar acoustic treatments and I
would expect that these tiles/panels would be required to be cleaned often.

They are often secured to surfaces using Velcro tabs.

It should be fairly easy to remove these from the walls of your MRI room and
have them cleaned outside of the room if needed.

I would check the backing of the panels/tiles and see if they can be removed
– you should see a number of adhesive tabs on the walls behind the tiles.

Regards,

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Michelle E. Kennedy

Hi All, it has come to our attention we are using a product called
“Quietspace- Autex” in our MRI rooms. The purpose of the product is to
minimise extreme noise levels in these areas. The fabric is polyester and
recommended cleaning is using professional cleaners such as ChemDry. On
questioning our technicians, no metal devices can be used in these rooms.
Could you please advise me if this product is used in your MRI rooms, and
method of cleaning used?

Thank you

Michelle Kennedy

CNC | Infection Prevention Service

John Hunter Hospital Campus
Lookout rd, New Lambton
Tel 02 4921 3129 | michelle.kennedy@hnehealth.nsw.gov.au

http://www.health.nsw.gov.au

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[Tim Spencer]

Hi Joe-Anne,

You can find the VIP score here..

http://www.vipscore.net/

I dont have any forms for shift checks, here but there were some printed forms at my old office @ Liverpool that we did at an old Smith+Nephew IV forum quite a few years ago..

Im sure there is someone out there who may have something.

If not, do a search for the PIV guidelines for NSW Health (and QLD) you should find something with them..

Regards,

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected. Steve Jobs

Good morning everyone

Does anyone have a form they use for insertion of IV cannula(s), shift checking sign off, recording of VIP score and removal dates? Are you will to share the form?

Thanks

Joe-Anne Bendall

Joe-Anne Bendall

Clinical Nurse Consultant Infection Prevention and Control

Monday Friday 0730 – 1600
Sydney Hospital and Sydney Eye Hospital

8 Macquarie St

SYDNEY NSW 2000

|* ph +61 2 9382 7199 |*page 22070 via switch 9382 7111| 7 Fax 93827510 |

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[Tim Spencer]

Hi Michelle,

Have you asked them for what reasons they have changed their current
practice?

Maybe they can supply you with the evidence they used to stop using
antiseptic hand wash.

This is currently NOT the recommendations of both a number of Australian and
international guidelines and recommendations.

Currently CDC, SHEA, APIC, EPIC, ACI, INS , CNSA and NSW MoH CVAD guidelines
support the use of antiseptic handwashing in all aspects of vascular access.

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Michelle E. Kennedy

Morning All, I recently found our PICC team no longer use antiseptic hand
wash pre PICC insertion and use neutral soap. Can anyone tell me where to
find evidence of using antiseptic hand wash prior to invasive procedures?

Thank you

Michelle Kennedy

CNC | Infection Prevention Service

John Hunter Hospital Campus
Lookout rd, New Lambton
Tel 02 4921 3129 | michelle.kennedy@hnehealth.nsw.gov.au

http://www.health.nsw.gov.au

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[Tim Spencer]

Hi Lindy,

From a quick review of the INS guidelines, I think if the bag has been
spiked, it must be used within 24hrs (also in line with the current RCN
standards of practice). Page S55 addresses the Primary Intermittent
Infusions, Practice Criteria A & B.

In regards to the ACSQHC guidelines, I believe you are correct in its
reference to being attached to a patient – 96hr maximum dwell time.

IVNNZ Provisional Infusion Therapy Standards of Practice March 2012
guidelines (pp43-44) also make the same recommendations as INS – 25hrs max.

As long as there is a new, sterile cover over the luer connection after the
administration set has been opened to protect the connection, these
pre-prepared administration sets should be ok to be used based around
current reviews.

I agree with you that there is not enough supportive evidence in this
practice and needs further investigation.

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Vascular Access Consultant
Founding President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Ryan, Lindy

Hello

I have been asked the following question from an operating theatre NUM

‘How long do you recommend IV fluids be kept once they have been attached to
a giving set and the line primed. Both for IVs and arterial lines?”

They are telling me the lines are being set up for use but not connected
to any pt & just being set up as part of resuscitation / or urgent need &
then left untouched in case of another emergency to prevent wastage &
time in reality .some staff discard straight away and others think they can
be kept for a few hours .so they just want to establish a time frame
potentially around infection risk if not used how long they can keep them
for???.does anyone have any evidence based information I could guide them
with .I could say if not used straight away discard (common-sense)..but
wondered if anyone had anything with more substance given this may not be
useful feedback for them to just follow if I have no idea and the
information I have found is a bit unclear ..

I checked the following

1. CDC Guidelines for the prevention of IVCRI’s 2011 but it had no
recommendations

2.Our national 2010 NHMRC ACSQHC IC guidelines (pg 144) recommend that they
may be left for intervals of up to 4 days (if not containing lipids) however
I am under the impression that this is a line that is currently in use &
connected to a patient and not waiting to be used???

3.2010 RCN Infusion standards recommends

2.6 Expiry dates

The maximum expiry date for any injection/ infusion prepared in a clinical
area is 24 hours or less in accordance with the manufacturer’s specification
of product characteristics (NPSA, 2007b).

appreciate any other leads or advice to provide staff

many thanks in advance

Lindy

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs
Harbour Health Campus

Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au

http://www.health.nsw.gov.au

“Wise and human management of the patient is the best safeguard against
infection”

(Florence Nightingale Circa 1860)

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[Tim Spencer]

Hi Louise,
I established and ran the nurse-led CVAD insertion service for 21yrs at Liverpool Hospital.
Please email me off the list if you need.
Regards,
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
Presidential Advisor, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Representative – WoCoVA Global Strategic Committee
M: +1(623)326.8889 (USA)
M: +61(0)409463428 (AU)
E: tim.spencer68@icloud.com

Sent from my iPhone

> On Apr 17, 2015, at 5:33 PM, Hobbs, Louise wrote:
>
> Dear All
>
> Our organisation is working toward expanding our current nurse led central line insertion service.
>
> I would be interested to know whether other organisations have adopted this model and what indicators you use to assess the service and report complications and infections.
>
> I would also be interested in what role you as IPC professionals have with monitoring, collating and reporting infection/complication data for the service.
>
> Look forward to hearing your responses either on or off line.
>
> Kind regards
>
> Louise Hobbs PhD | Manager Infection Prevention and Surveillance Service
> Melbourne Health | Royal Melbourne Hospital – City Campus | Level 9 Royal Melbourne Hospital
> Grattan Street, Parkville Victoria 3052
> T: + 61 3 9342 8328 | F: + 61 3 9342 7277 | e: louise.hobbs@mh.org.au
>
> MESSAGES POSTED TO THIS LIST ARE SOLELY THE OPINION OF THE AUTHOR, AND DO NOT REPRESENT THE OPINION OF ACIPC.
>
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>
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>
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>
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[Tim Spencer]

That’s a great idea Claire!
Show them the evidence!!
Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.
Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW
Representative – WoCoVA Global Strategic Committee
M: +1(623)326.8889 (USA)
M: +61(0)409463428 (AU)
E: tim.spencer68@icloud.com

Sent from my iPhone

> On Mar 18, 2015, at 9:22 PM, Claire Rickard wrote:
>
> HI Rosie
>
> I would recommend you do a small quality improvement/research study and culture some of the used cannula. It would be great to get the ports cultured (and also check the tip culture (internal and external)). Have a talk to your micro lab senior scientist and ID physician, they might be interested in helping you and collaborating on a study? And I would get the anaesthetists on board with it too, – if they think they are good to use, let us get data and find out!!?? You would also need some control catheters (non-ported) also used in theatre for similar number of hours/accessed. And some no-used controls (from straight out of the packet).
>
> Would be exciting and useful research to present at ACIPIC!!
>
> PM me if you would like any advice 😀
>
>
> —
>
> Dr Claire Rickard, Professor, NHMRC Centre of Research Excellence in Nursing Interventions in Hospitalised Patients, Menzies Health Institute Queensland
> Alliance for Vascular Access Teaching and Research (AVATAR)
> Visiting Scholar at the Princess Alexandra, Prince Charles, and Royal Brisbane & Women’s Hospitals
> Assistant: Jo.Wright@griffith.edu.au Tel: +61 7 3735 4886
>
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[Tim Spencer]

Thanks for your reply Jenny.

If anaesthetics are placing a device for the specified case, then it
shouldn’t be ‘dodgy’ if it’s a new insertion – unless they are using an
existing cannula, which could be non-functional, contaminated/infected or at
the very least, past its used-by (dwell) date! Not recommended.

Ported cannula are very problematic – from infectious and disinfection
complications as previously noted.

It’s also the reason why ported cannula are not used at all in the USA and
are not addressed by the current INS Guidelines.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Jenny McCarthy

Hi Tim

B Braun have a similar product which is used in our Operating Room. I have
been aware of the difficulty in decontaminating the hub – the anaesthetists
say it is better as they know the drug is going straight into the vein – as
opposed to using the injection port which can be an issue if the IV is a bit
dodgy! Thanks for your references and suggestions,

Jenny

Jenny McCarthy

OR Manager/Infection Prevention and Control Coordinator

Maryvale Private Hospital

_____

Of Tim Spencer

Hi Rosie,

You are correct. The BD Venflon IV cannula has been widely used throughout
Europe and the UK (well it was when I was there many years ago). Is it the
Pro Safety or the standard ported cannula?

This style of ported cannula has been around since the early 1980’s, so
despite the recent addition of a safety aspect, it is still old technology
(in regards to the port aspect).

A ported cannula has significantly increased infection rates due to the
inability to correctly scrub the hub or decontaminate the injection port, as
well as port cap failure.

Here is an Australian publication from NT in 2013 that may help in product
purchase changes – Tay, S et al. Functional evaluation and practice survey
to guide purchasing of intravenous cannulae, BMC Anesthesiology 2013, 13:49
http://www.biomedcentral.com/1471-2253/13/49

There has also been reports from the UK of the ports failing – H. Adler, R.
Cunningham, R. Parimkayala Valve failure in an injection port, Irish Journal
of Medical Science June 2011, Volume 180, Issue 2, p 615

http://link.springer.com/article/10.1007/s11845-010-0622-z

These ported styles of cannula were likely introduced due to the higher
number of UK physicians coming to work in WA (possibly due to clinician
preference only) and have high infection and poor compliance rates, due to
the difficult nature of port location. These are primarily placed in OT only
(as you describe) and are not used in the general wards areas as far as I am
aware.

Although this may be a ‘convenient option’ for clinicians, it is not in the
best interest of the patient, due to the higher risks associated with these
types of cannulae.

From the BD Europe website;
http://www.bd.com/europe/safety/en/products/infusion/bdv_prosafety.asp

* BD VialonT – Proven easy insertion and longer in dwell times1-4

1) Maki D, Ringer M. Risk Factors for Infusion-related Phlebitis with
Small Peripheral Venous Catheters. Annals of Internal Medicine. (1991); 114:
845-854.

2) Gaukroger PB, Roberts JG, Manners TA. Infusion Thrombophlebitis: A
Prospective Comparison of 645 VialonR and TeflonR Canulae in Anesthetic and
Postoperative Use. Anesthesia and Intensive Care.August (1988); 16(3).

3) Stanley M, Meister E, Fuschuber K. Infiltration During Intravenous
Therapy in Neonates: Comparison of TeflonR and VialonR Catheters. Southern
Medical Journal.September (1992); 85(9); 883-886.

4) McKee JM, Shell JA, Warren TA, Campbell VP. Complications of
Intravenous Therapy: A Randomized Prospective Study–Vialon vs. Teflon.
Journal of Infusion Nursing. September (1989); 12: 288-2.

Considering the ongoing changes in technology and increased focus on device
and patient outcomes, these references are very old and dated. I agree with
you that this as a huge risk for contamination and a breach of AT
principles.

The BD Nexiva cannula would seem to be a far better alternative (for patient
and clinician), and still offering a safety option, various access points
and improved securement.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Lee, Rosie

Hello

Recently I have been made aware of this practice following implementation of
Aseptic Technique Policy. It appears in our theatres the Anaesthetists use
the BD VenflonT intravenous catheter with integrated injection port and
valve for medication and this stays in the patient. I am told the caps are
either being left open in Theatres for quick access by Anaesthetists or they
popp off very frequently. In recovery nurses are observed continuing to use
this to administer medication. I see this as a huge risk for contamination
and a breach of AT principles.

The BD representative states that this type of catheter is not used in other
states of Australia but is common in UK and Europe. Is this correct?

Have you come across this in your hospitals? If so have you ceased the use
or do you advocate using the side extension tubing which has a hub that can
be scrubbed?

Regards

Rosie Lee | Coordinator | Infection Prevention & Management
Royal Perth Hospital

Level 6, South Block, Wellington Street PERTH WA 6000
T: (08) 9224 2805 | F: (08) 9224 1989
E: rosie.lee@health.wa.gov.au
http://www.rph.health.wa.gov.au |
http://www.healthywa.wa.gov.au

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[Tim Spencer]

Hi Rosie,

You are correct. The BD Venflon IV cannula has been widely used throughout
Europe and the UK (well it was when I was there many years ago). Is it the
Pro Safety or the standard ported cannula?

This style of ported cannula has been around since the early 1980’s, so
despite the recent addition of a safety aspect, it is still old technology
(in regards to the port aspect).

A ported cannula has significantly increased infection rates due to the
inability to correctly scrub the hub or decontaminate the injection port, as
well as port cap failure.

Here is an Australian publication from NT in 2013 that may help in product
purchase changes – Tay, S et al. Functional evaluation and practice survey
to guide purchasing of intravenous cannulae, BMC Anesthesiology 2013, 13:49
http://www.biomedcentral.com/1471-2253/13/49

There has also been reports from the UK of the ports failing – H. Adler, R.
Cunningham, R. Parimkayala Valve failure in an injection port, Irish Journal
of Medical Science June 2011, Volume 180, Issue 2, p 615

http://link.springer.com/article/10.1007/s11845-010-0622-z

These ported styles of cannula were likely introduced due to the higher
number of UK physicians coming to work in WA (possibly due to clinician
preference only) and have high infection and poor compliance rates, due to
the difficult nature of port location. These are primarily placed in OT only
(as you describe) and are not used in the general wards areas as far as I am
aware.

Although this may be a ‘convenient option’ for clinicians, it is not in the
best interest of the patient, due to the higher risks associated with these
types of cannulae.

From the BD Europe website;
http://www.bd.com/europe/safety/en/products/infusion/bdv_prosafety.asp

* BD VialonT – Proven easy insertion and longer in dwell times1-4

1) Maki D, Ringer M. Risk Factors for Infusion-related Phlebitis with
Small Peripheral Venous Catheters. Annals of Internal Medicine. (1991); 114:
845-854.

2) Gaukroger PB, Roberts JG, Manners TA. Infusion Thrombophlebitis: A
Prospective Comparison of 645 VialonR and TeflonR Canulae in Anesthetic and
Postoperative Use. Anesthesia and Intensive Care.August (1988); 16(3).

3) Stanley M, Meister E, Fuschuber K. Infiltration During Intravenous
Therapy in Neonates: Comparison of TeflonR and VialonR Catheters. Southern
Medical Journal.September (1992); 85(9); 883-886.

4) McKee JM, Shell JA, Warren TA, Campbell VP. Complications of
Intravenous Therapy: A Randomized Prospective Study–Vialon vs. Teflon.
Journal of Infusion Nursing. September (1989); 12: 288-2.

Considering the ongoing changes in technology and increased focus on device
and patient outcomes, these references are very old and dated. I agree with
you that this as a huge risk for contamination and a breach of AT
principles.

The BD Nexiva cannula would seem to be a far better alternative (for patient
and clinician), and still offering a safety option, various access points
and improved securement.

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Lee, Rosie

Hello

Recently I have been made aware of this practice following implementation of
Aseptic Technique Policy. It appears in our theatres the Anaesthetists use
the BD VenflonT intravenous catheter with integrated injection port and
valve for medication and this stays in the patient. I am told the caps are
either being left open in Theatres for quick access by Anaesthetists or they
popp off very frequently. In recovery nurses are observed continuing to use
this to administer medication. I see this as a huge risk for contamination
and a breach of AT principles.

The BD representative states that this type of catheter is not used in other
states of Australia but is common in UK and Europe. Is this correct?

Have you come across this in your hospitals? If so have you ceased the use
or do you advocate using the side extension tubing which has a hub that can
be scrubbed?

Regards

Rosie Lee | Coordinator | Infection Prevention & Management
Royal Perth Hospital

Level 6, South Block, Wellington Street PERTH WA 6000
T: (08) 9224 2805 | F: (08) 9224 1989
E: rosie.lee@health.wa.gov.au
http://www.rph.health.wa.gov.au |
http://www.healthywa.wa.gov.au

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[Tim Spencer]

Seems like all Australian states have a regulation in regards to Healthcare
Practitioner legislation..

Interesting..

Thanks for highlighting Jo..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Joe-Anne Bendall
PRACTITIONER REGULATION (NEW SOUTH WALES) REGULATION 2010 – SCHEDULE 1 ??

Hi

I did find it in the old NSW Regulations

http://www5.austlii.edu.au/au/legis/nsw/num_reg/na1991rrtics1995221601.pdf

I did not remember it being in the NSW legislation from the 90s!

Thanks

Joe-Anne Bendall

Joe-anne Bendall

Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital

8 Macquarie St

SYDNEY NSW 2000

|* ph +61 2 9382 7199 |*page 22070 via switch 9382 7111| 7 Fax 93827510 |

*Mobile 0418984255 | *
Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

Of Montague, Cathi (Health)
PRACTITIONER REGULATION (NEW SOUTH WALES) REGULATION 2010 – SCHEDULE 1 ??

Not in SA regulations current version on
http://www.legislation.sa.gov.au/LZ/C/A/Health%20Practitioner%20Regulation%2
0National%20Law%20(South%20Australia)%20Act%202010.aspx unless buried in
subsequent gazette.

I thought the intent of these legislations was that they would all be the
same across Australia??

Great amendment tho.

Would be even stronger if point one went both ways (staff to patient and
vice-versa transmission)

Will be interested to see others point of view / other states responses.

Best regards,

Cathi

Cathi Montague, RN,(Midwife), ENB998, MClinNsg, FCENA

High quality, compassionate healthcare | Infection Prevention and Control is
everyones’ business

Nurse Management Facilitator | Clinical Care Systems Co-ordination
SA Prison Health Service – Corporate Office
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5 Darley Road (first floor), Paradise SA 5075
Postal address: PO Box 101, 620 Lower North East Road, Campbelltown SA 5074
70023199 | DX 191

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Of Joe-Anne Bendall
REGULATION (NEW SOUTH WALES) REGULATION 2010 – SCHEDULE 1 ??

Does anyone know when this went into the legislation?

Is it in other states and territories legislation?

Part 2 – General standards applying to relevant health practitioners

2 General precautions and aseptic techniques

(1) Precautions must be taken to avoid direct exposure to a patient’s blood
or body substance.

(2) The requirement in subclause (1) applies regardless of whether there is
any perceived risk of infection.

(3) Aseptic techniques must be used in the course of complying with the
requirements of this Schedule.

http://www5.austlii.edu.au/au/legis/nsw/consol_reg/hprswr2010580/sch1.html

Thanks

Joe-Anne Bendall

Joe-anne Bendall

Clinical Nurse Consultant Infection Prevention and Control
Sydney Hospital and Sydney Eye Hospital

8 Macquarie St

SYDNEY NSW 2000

|* ph +61 2 9382 7199 |*page 22070 via switch 9382 7111| 7 Fax 93827510 |

*Mobile 0418984255 | *
Joe-anne.Bendall@SESIAHS.HEALTH.NSW.GOV.AU

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[Tim Spencer]

Hi Lindy and Lincoln,

It is interesting to ask what and who determines what a ‘transient
controlled disconnection’ is? The problem is that these disconnections are
performed by a large variety of clinicians (non-nursing colleagues also) who
do not always know or understand IV best practices.

I would definitely NOT recommend a disconnection just for removing a sleeve
or a sling at all – this is a high risk opportunity for contamination and is
an unnecessary disconnection. It takes the same time to feed the IV
administration set through the patients sleeve as it does to disconnect and
re-connect, less the infection/contamination risk.

The key point I would consider here is that if an IV administration set
disconnection is required (for whatever procedure), the hubs must be
correctly disinfected after the disconnection and before re-connection of
the original administration set.

The administration set luer connector also must be covered with a sterile
device (blunt cannula and cover) during the investigative procedure.

When reconnection occurs, then the needle free device should be
decontaminated with 70% IPA.

I have cut and pasted from the current INS Guidelines & CDC (2011) state in
regards to peripheral IV administration sets and disconnection;

26. ADD-ON DEVICES

Standard

26.1 The use of add-on devices shall be established in organizational
policies, procedures, and/or practice

guidelines and according to manufacturers’ directions for use.

26.2 The nurse shall be competent in the use of the add-on device and shall
be knowledgeable about the

risk of misconnection and potential disconnections.

26.3 All add-on devices shall be of luer-lock design to ensure a secure
junction.

Practice Criteria

A. Add-on devices may include, but are not limited to, stopcocks, single and
multi lumen extension sets,

manifold sets, extension loops, solid cannula caps, needleless systems,
in-line filters, and manual flow control

devices.1 (V)

B. All add-on devices should be compatible with the administration system to
prevent the risk of leaks,

disconnections, or misconnections.2,3 (V)

C. The nurse should be aware that the potential for contamination exists
with all add-on devices. In

an effort to decrease the risk of contamination, the number of manipulation
episodes, accidental

disconnections or misconnections, and costs, there should be limited use of
these devices.1 (V)

D. To determine the appropriate placement of the selected add-on device, the
nurse should trace the

administration set from the patient to the point of origin before attaching
the device.2,4,5 (IV)

E. The nurse should disinfect the ports of the add-on device using friction,
with an appropriate disinfectant

such as 70% alcohol before accessing. Specific guidelines directing the
appropriate technique,

disinfectant, or amount of time required to- clean devices prior to access
are unresolved. The

access port should be accessed only with sterile devices.6,7 (V)

F. The nurse should change the add-on device with the catheter, with each
administration set replacement,

or as defined by the organization, and whenever the integrity of the product
is compromised

or suspected of being compromised.1 (V)

G. The use of stopcocks is not recommended due to the increased risk of
infection. When a stopcock is

attached as an add-on device, the nurse should attach sterile caps to the
ports of the stopcock to

provide a closed system when not in use and access sites that will allow
cleaning prior to accessing.1 (V)

REFERENCES

1. Hadaway L. Infusion therapy equipment. In: Alexander M, Corrigan A,
Gorski L, Hankins J, Perucca R. eds. Infusion

Saunders/Elsevier; 2010:391-436.

2. The Joint Commission. Tubing misconnections: a persistent and potentially
deadly occurrence. Joint Commission Sentinel Event

Alert.
http://www.jointcommission.org/SentinelEvents/SentinelEventAlert/sea_36.htm.
Accessed December 5, 2009.

3. US Food and Drug Administration. 2009 medical device safety calendar on
luer misconnections. http://www.fda.gov/medicaldevices/

Safety/AlertsandNotices/ucm134863.htm. Accessed July 8, 2009.

4. Institute for Safe Medication Practices (ISMP). Problems persist with
life-threatening tubing misconnections. Medication Safe

Alert! June 17, 2004.

5. American Nurses Association [position paper]. Safety Issues Related to
Tubing & Catheter Misconnections. http://www.nursingworld.org/

position/practice/tube.aspx. Accessed February 13, 2010.

6. Kaler W, Chinn R. Successful disinfection of needleless mechanical valve
access ports: a matter of time and friction. J Assoc

Vascular Access. 2007;12(3):140-142.

7. Marschall J, Mermel L, Classen D, et al. Compendium of strategies to
prevent central line-associated bloodstream infections in acute care

hospitals. Infect Control Hosp Epidemiol. 2008;29(S1):S22-S30.

43. ADMINISTRATION SET CHANGE

Standard

43.1 Administration set changes shall be performed routinely, based on
factors such as type of solution administered,

type of the infusion (continuous versus intermittent), immediately upon
suspected contamination, or when the

integrity of the product or system has been compromised.

43.2 The administration set shall be changed whenever the peripheral
catheter site is rotated or when a new

central vascular access device is placed.

43.3 Add-on devices used as part of the administration set, such as single
and multi lumen extension sets and filters,

shall be changed at the same time as the administration set.

43.4 The frequency of performing administration set changes and the system
used to promote adherence to

administration set change (eg, labeling/electronic) shall be established in
organizational policies, procedures,

and/or practice guidelines.

43.5 A vented administration set shall be used for solutions supplied in
glass or semi-rigid containers, and a nonvented

administration set shall be used for plastic fluid containers.

43.6 All administration sets shall be of luer-lock design to ensure a secure
junction.

Practice Criteria

I. General

A. The use of add-on devices for administration sets should be minimized as
each device is a potential

source of contamination, misuse, and disconnection; it is preferable to use
an administration set with

devices as an integral part of the set (see Standard 26, Add-on Devices).1
(V)

Practice Criteria

II. Primary and Secondary Continuous Infusions

A. Primary and secondary continuous administration sets used to administer
fluids other than lipid, blood,

or blood products should be changed no more frequently than every 96 hours.
There is strong evidence

that changing the administration sets more frequently does not decrease the
risk of infection.2-3 (I)

B. Extending the administration set change to every 7 days may be considered
when an anti-infective

central vascular access device (CVAD) is being used or if fluids that
enhance microbial growth

are not administered through the set.3,4 (II)

C. If a secondary administration set is detached from the primary
administration set, the secondary

administration set is considered a primary intermittent administration set
and should be changed

every 24 hours (see Practice Criteria III, Primary Intermittent Infusions).1
(V)

D. When compatibility of infusates is verified, use of secondary
administration sets that use back-priming

infusion methods are preferred due to reduced need for disconnecting
secondary intermittent

administration sets.1 (V)

Practice Criteria

III. Primary Intermittent Infusions

A. Primary intermittent administration sets should be changed every 24
hours. When an intermittent

infusion is repeatedly disconnected and reconnected for the infusion, there
is increased risk of contamination

at the catheter hub, needleless connector, and the male luer end of the
administration set, potentially

increasing risk for catheter-related bloodstream infection. There is an
absence of studies addressing administration

set changes for intermittent infusions. In a meta-analysis of 12 randomized,
controlled trials that supported

increasing the time interval for administration set changes to 96 hours, at
least 2 of the studies

excluded administration sets used for heparin locked catheters and in sets
disconnected for more

than 4 hours. In several others, exclusions were not stated.1,5 (V)

B. A new, sterile, compatible covering device should be aseptically attached
to the end of the administration

set after each intermittent use. The practice of attaching the exposed end
of the administration

set to a port on the same set (“looping”) should be avoided.1,5 (V)

The CDC 2011 Guidelines are also unresolved on this point of disconnection,
but strong on the decontamination process;

Replacement of Administration Sets

1. In patients not receiving blood, blood products or fat emulsions, replace
administration sets that are continuously used, including secondary sets and
add-on devices, no more frequently than at 96-hour intervals, [177] but at
least every 7 days [178-181]. Category IA

2. No recommendation can be made regarding the frequency for replacing
intermittently used administration sets. Unresolved issue

Needleless Intravascular Catheter Systems

1. Change the needleless components at least as frequently as the
administration set. There is no benefit to changing these more frequently
than every 72 hours. [39, 187-193]. Category II

2. Change needleless connectors no more frequently than every 72 hours or
according to manufacturers’ recommendations for the purpose of reducing
infection rates *187, 189, 192, 193]. Category II

3. Ensure that all components of the system are compatible to minimize leaks
and breaks in the system [194]. Category II

4. Minimize contamination risk by scrubbing the access port with an
appropriate antiseptic (chlorhexidine, povidone iodine, an iodophor, or 70%
alcohol) and accessing the port only with sterile devices [189, 192,
194-196]. Category IA

5. Use a needleless system to access IV tubing. Category IC

The CDC document doesn’t really provide any concrete information on the set
change issue as it was unresolved (surprisingly), but provides Cat 1A
support for decontaminating devices.

If you need a copy, please let me know and I can provide one.

Regards,

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine |
University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)

Representative – WoCoVA Global Strategic Committee
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

“Be a yardstick of quality. Some people aren’t used to an environment where
excellence is expected.” – Steve Jobs

Of Ryan, Lindy

Dear Lincoln

I have attached NSW CEC PIVC guidelines. The development of this document
was a very hotly debated & commented on (& still is).

Anyhow our NSW state guidelines recommend as per below

Guideline for PIVC Insertion and Post Insertion Care in Adult Patients

GUIDELINE

GL2013_013 Issue date: December-2013 Page 8 of 16

9.3.2 IV tubing sets should not be disconnected for routine care, but may be
disconnected for transient, controlled disconnections such as changing IV
infusions, removing a sling or sleeve, or access in Operating Theatres,
Medical Imaging or Radiology Departments.

9.3.3 Except for transient controlled disconnections as above, if the IV
giving set is disconnected, replace the entire IV tubing.

Hope this information useful

Regards

Lindy Ryan

Lindy Ryan

Infection prevention & Control Clinical Nurse Consultant (CNC) | Coffs
Harbour Health Campus

Pacific Hwy Coffs Harbour NSW 2450
Tel (02) 6656 7770 | lindy.ryan@ncahs.health.nsw.gov.au

http://www.health.nsw.gov.au

Of Lincoln Fowler

Hi all

In trying to implement a no disconnection policy for our IV lines. I have
had some opposition from Medical Imaging:

“IV lines need to be disconnected only for a few reasons. . whilst the
patient was in the fluoroscopy machine as there is a risk of getting the
line caught in the equipment. For these types of procedures the table
rotates vertically and horizontally so that the patient can be standing or
lying down to assess the upper GI tract. Other occasions where we need to
disconnect the line is when there is no access for CT IV contrast whilst the
line is connected.” I believe the last point is that they want to use the in
use IV cannula so they disconnect it and attach their device.

I am interested in what guidelines are in place in other organisations to
assist in situations like these.

Cheers

Lincoln Fowler

Infection Prevention Consultant

Bairnsdale Regional Health Service

http://www.brhs.com.au

Bairnsdale Regional Health Service is located on the traditional land of the
Gunaikurnai people.

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[Tim Spencer]

Hi James,

Current literature I could find

American Institute of Ultrasound in Medicine

Guidelines for Cleaning and Preparing External- and Internal-Use Ultrasound Probes Between Patients

Approved 4/2/2014

http://www.aium.org/officialstatements/57

Society of Radiographers, UK

https://www.sor.org/system/files/article/201410/ultrasound_probe_cleaning_decontamination_disinfection_and_sterilisation.pdf

Friday, October 17, 2014, Issue 12

CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 (old reference but they havent updated the guidelines as far as I can see)

http://www.cdc.gov/hicpac/pdf/guidelines/Disinfection_Nov_2008.pdf

This seems to all thats currently new.

Hope this provides some help with your search.

Regards,

Tim..

Timothy R. Spencer, RN, APN, DipAppSci, Bach.Health, ICCert, VA-BC.

Independent Vascular Access Consultant
President, Australian Vascular Access Society
Conjoint Lecturer, South West Sydney Clinical School | Faculty of Medicine | University of NSW

Director-at-Large, Vascular Access Certification Corporation (VACC)
M: +1 (623) 326 8889 (USA)

M: +61 (0)409 463 428 (AU)
E: tim.spencer68@icloud.com

Be a yardstick of quality. Some people aren’t used to an environment where excellence is expected. Steve Jobs

Dear Team,

I am a member of the Standards of Practice Committee for the Australasian Society for Ultrasound in Medicine.

There remains a great deal of heterogeneity in recommendations regarding cleaning of ultrasound transducers, and conflicting recommendations by various bodies. We also receive pressure from vendors to support their products, usually backed by a host of complicated and difficult to interpret evidence.

I wondered whether you had specific up to date evidence based references you would recommend us reviewing regarding:

1. Regular cleaning of ultrasound transducers used on closed skin.

2. Cleaning of transducers used for intracavity scanning.

For those of you wishing to read further:

Currently most ultrasound users are aware they should perform:

1. Regular cleaning of ultrasound transducers used on closed skin.

*Clean as you would your hands – wash with warm mild detergent and running water between each patient.
*Some would use Chlorhexidine wash or alcohol impregnated wipes – although these are not recommended by manufacturers as they may damage the face of the transducer.
*Where there is contact with body fluids clean as per intracavity transducer.

2. Cleaning of intracavity transducers – high level disinfection

*Wash removing all visible gel / residue – running water, mild detergent, wipe dry.
*Use one of the approved agents according to manufacturer guidelines
*Including hydrogen peroxide, glutaraldehyde, ortho-phthalaldehyde (OPA)
*Opinion on chlorine dioxide delivered via the wipe system, and paracetic acid seems divided.
*The concern regarding the wipes is based on inter user variability.
*There has been some literature describing paracetic acid damage to endoscopes.

Your advice is again much appreciated.

Just want to ensure we remain up to date.

Sincerely

James Rippey

—

Associate Professor James Rippey

Emergency Physician

University of Western Australia

Sir Charles Gairdner Hospital

King Edward Memorial Hospital for Women

Emergency Medicine Lead for the Kimberley

Mobile 0400990186

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The use of trade/product/commercial brand names through the list is discouraged by ACIPC. If you wish to discuss specific reference to products or services by brand or commercial names, please do this outside the list.

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