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
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:
Routine procedure gone wrong
A patient experiences pain and inflammatory symptoms at cat puncture site the day after surgery
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.“
"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.“
Advantages and problems of routine procedures
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.
"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.“
"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
- Regularly refresh knowledge on memorised steps to avoid „routine procedure fatigue“
- Put up visual reminders in the care room, describing essential details
- Consciously follow the same logical method each time, minding every little moment
- Organise work environment prior to procedure
- Wear single-use gloves to protect yourself from accidental blood exposure
- Continually review and optimise method at all times, considering the risk of asepsis breach at each and every step
- Adequately prepare skin with antiseptic before puncturing
- Safely handle individual sterile components to preempt desterilisation
- Carefully connect tubing to catheter and apply dressing with great care
- Scrupulously respect the hand disinfection steps.