Infection from peripheral venous catheterisation can threaten healing process
Case Study

Preventing Infection from Peripheral Venous Catheterisation

The story of a patient whose healing after surgery was severely threatened after developing an infection at the puncture site of her venous access.

Small puncture, severe consequences

Frequent culprit: Asepsis breach

A hospital stay is stressful enough. Contracting an infection while in stationary care adds undue agony and can jeopardise the healing process. The culprit is often asepsis breach during peripheral venous catheterisation. The story of a patient who developed an infection that ended in pain, sorrow and an extended hospital stay.

Setback infection

An added burden for patients and their families

Virtually every patient admitted to the hospital requires venous access — a small, flexible tube placed into a peripheral vein, typically on the back of the hand or the inner forearm. Even a minor procedure that should get the patient in and out of the hospital in no time involves this step. If the puncture site gets infected, the consequences can be far more detrimental to the patient’s health than the initial cause for hospitalisation.

An infection from peripheral venous catheterisation could mean a major setback in the patient’s healing and recovery process. The added pain and suffering, perhaps even an extended stay in the hospital due to the infection, tremendously burden the patient physically and emotionally.

In pursuit of M:IP, we examine what typically causes an infection from peripheral venous catheterisation and what can be done to prevent it.

A case study on infection from peripheral venous catheterisation:

Setting venous access — a routine procedure
Setting venous access is often one of the first steps when a patient is admitted to the hospital

Routine procedure gone wrong

A patient experiences pain and inflammatory symptoms at cat puncture site the day after surgery

A patient at the Strasbourg University Hospital in France suffered an infection from peripheral venous catheterisation required for her gynaecological procedure. A surgical nurse set the venous access above the wrist prior to the four-hour surgery. The next day, the 32-year-old experienced pain around the puncture site. Her skin turned red and hot, symptoms that soon radiated to the forearm. „It became very painful for my wife to flex her wrist,“ recalls husband Philippe R., an OR nurse himself, who spoke to us on the basis of anonymity. „I saw signs of inflammation emerge, swelling, redness, overheating of the skin, which extended up the entire arm within hours.“

Agonising uncertainty

The fear of an infection escalating into septicaemia is agonising
An infection from a cat procedure can escalate into septicaemia

Waiting for answers: Patient fears allergic reaction to antibiotics and septicaemia

„To learn that the infection consequently forced the doctors to administer antibiotics scared us tremendously,“ Philippe shares, elaborating that his wife was severely allergic to antibiotics and, in fact, had suffered from Quincke’s edema (angioedema) after being given antibiotics when she was 18 years old. Another concern was that the infection would escalate into septicaemia. Thankfully, neither happened.

„She was extremely worried about the infection’s effects on her general state of health and her healing process,“ Philippe describes his wife’s unforeseeable added stress during her hospital stay. As a medical professional, he was excruciatingly aware of the risk infections like this bare. He remembers feeling helpless in the situation. The uncertainty was agonising for both of them. „She was nervous and anxious because no one would give us specific information on the potential aftermath of this infection.“ For one thing, Philippe’s wife had to remain in the hospital two days longer than anticipated. Finally back at home, she needed to rest for an additional ten days. Eventually, the antibiotics treatment proved successful, and she made a full recovery.

The luring danger of asepsis breach

Little moments of inattention can have serious consequences

At first, Philippe, who had personally not been part of his wife’s surgical team but is a medical adviser specialising in infection prevention, did not notice anything out of the ordinary. The dressing was in place. The tubing appeared to be effective. Still, he reckons, an asepsis breach must have occurred at some point during his wife’s cat procedure. „The biggest challenge with venous peripheral catheterisation is indeed infection prevention,“ the expert explains. „So, when I puncture, I take a logical approach and follow specific steps.“

Philippe R., OR nurse and patient’s husband
Philippe R., OR nurse and patient’s husband
"The biggest challenge with venous peripheral catheterisation is indeed infection prevention."

Infection is preventable

Disinfecting hands and keeping all components sterile are important details

To effectively prevent infections from peripheral venous catheterisation, Philippe recommends the healthcare professional must organise her work environment, continually review and optimise her method and consider the risk of asepsis breach at each and every step. What typically goes wrong? „There is a specific technique to puncture a vein, otherwise you risk provoking asepsis breach,“ Philippe says: Inadequate skin preparation before puncturing is often responsible for an asepsis breach, as well as mistakes in handling individual components, which can easily become desterilised in an inattentive moment. Diligently connecting the tubing to the catheter is also important. Lastly, the dressing has to be put on with great care. From the nurse’s professional experience, his wife’s infection was absolutely preventible.

„It has changed the way we see cat procedures,“ Philippe says, confirming the venous peripheral catheterisation procedure is the same whether the patient is having major surgery or a minor procedure. Thus, the risk of infection is equally great. The incident has made Philippe’s entire family extremely vigilant not only about peripheral venous catheterisations but also blood sampling and any form of injection: „Today, we don’t hesitate to ask about a nurse’s approach to hand disinfection, skin antisepsis, wearing single-use gloves or the way she plans to handle sterile components.“

Infection prevention most challenging part of cat peripheral venous catheterisation
Skin preparation and handling sterile components require attention to detail

Advantages and problems of routine procedures

IV therapy requires peripheral venous catheterisation
Hospital nurses typically perform multiple cat procedures every day, such as for IV therapy

Knowing too well what you are doing

Puncturing a peripheral vein and setting venous access via small tubing is one of the most routine procedures healthcare professionals perform — an advantage and a problem all the same. Why? Nurses technically know what they are doing and may no longer think about each and every step. „Peripheral venous catheterisation is so routine, nurses may forget what major consequences even the smallest mistake can have,“ says Agathe Borni, who is part of HARTMANN’s infection prevention program and responsible for creating content on the subject matter.

In her role as communications expert, Agathe Borni explores different ways to relay information about infection prevention to healthcare professionals, e.g., how to prepare components needed for peripheral venous catheterisation without desterilising them. Using prepackaged single kits, for instance, is an immensely effective way to mitigate the risk of asepsis breach.

— Agathe Borni, communications expert on M:IP
Opening sterile packaging is a moment of risk for asepsis breach
Opening sterile packaging is a moment of risk for asepsis breach
"Peripheral venous catheterisation is so routine, nurses may forget what major consequences even the smallest mistake can have."

Adequate training and easily accessible information

Visual step-by-step reminders can help to curb asepsis breach

Training medical staff adequately is an essential part of infection prevention. „Nurses are really well educated in the technical steps of peripheral venous catheterisation,“ Agathe Borni emphasises. „Because the procedure is so routine, however, they may forget about details, like where to put the products after you open the packaging. Or that you have to disinfect your hands once again after opening the kit because the packaging is not sterile on the outside.“

Agathe Borni suggests little training modules or reminders at the workplace to help staff keep consistency in following the advised steps. The communications expert knows that when in doubt, a nurse doesn’t have the time to google or reference a ten-page manual. „Instead, nurses need something very visual,“ Agathe Borni points out. „A poster in the care room illustrating each step of a procedure or a short video clip would be more helpful. „We all know how to puncture,“ Philippe agrees. „Most of the time, asepsis breach in peripheral venous catheterisation occurs in the little moments around the technical steps of the procedure.“

Adequate training helps prevent little mistakes during routine procedures
Quick visual refreshers help nurses stay vigilant when performing routine procedures
Philippe R., OR nurse
"Most of the time, asepsis breach in peripheral venous catheterisation occurs in the little moments around the technical steps of the procedure."

M:IP with peripheral venous catheterisation

10 tips for healthcare professionals

  1. Regularly refresh knowledge on memorised steps to avoid „routine procedure fatigue“
  2. Put up visual reminders in the care room, describing essential details
  3. Consciously follow the same logical method each time, minding every little moment
  4. Organise work environment prior to procedure
  5. Wear single-use gloves to protect yourself from accidental blood exposure
  6. Continually review and optimise method at all times, considering the risk of asepsis breach at each and every step
  7. Adequately prepare skin with antiseptic before puncturing
  8. Safely handle individual sterile components to preempt desterilisation
  9. Carefully connect tubing to catheter and apply dressing with great care
  10. Scrupulously respect the hand disinfection steps.
Nurse performing peripheral venous catheterization on patient in hospital bed
Break down every cat procedure into little logical steps to prevent missing a detail, which could lead to asepsis breach.

Infection is preventable by following logical steps

Conclusion

Infection from peripheral venous catheterisation is almost always preventible. The procedure is so routine, however, nurses may not consciously think about each and every step. Mistakes leading to asepsis breach and consequently to an infection typically happen in little inattentive moments. Adequate training, quick refreshers on each individual step of the procedure and brief, visual material can help reassure healthcare professionals they are not putting the patient at risk of infection.

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