3M Health Care Academy

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Asia Best practice sharing

Adam Low
August
SM
2016
3M Health Care Academy 3M 2015. All Rights Reserved
 PIVs are failing around the globe
43%
51%
53% 38% 43%
26% 58% 27%
100%

42% 26%

34%
54%

Incidence from published PIV studies are not directly comparable

since definitions & study questions have varied, butwe do
seem to have a problem!!
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Status of IV Nursing in Philippines
Located at the heart of the countrys primary central business district, MakatiMed
with 600-bed capacity delivers quality and compassionate service.

63.5 %
of the patients
receive Infusion Therapy

Ratio of Central Catheter v.s.

1:6 Peripheral used

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Philippines Standards of Practice for IV Nursing
Each hospital has their own set of Standards of Practice for IV
Nursing . MakatiMed and other JCI Hospital adopted
International standards.

Institutionalized standards are reinforced thru conduction of

Skills Training, Scientific Updates, and Quality measures

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Best Practices

Medication Management CVAD Education

for Pediatrics Program
Training Program Quarterly
Quarterly Conduction for Conduction for RNs
RNs

Basic Intravenous
Therapy
Scheduled during
CARE Nurse
Residency Program

Intravenous
Therapy Update Intensive Chemotherapy
Monthly Education Program
Conduction for RNs Quarterly Conduction for RNs

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Philippines Challenges to Establish an IV
Nursing Specialty
What are the challenges or obstacles to doing this?
There is no national standard, policies and guidelines.
Each institution benchmark from either national or international guidelines
Resources and management
Leadership through professional organization

What are the top 3 concerns related to the practice of IV therapy in your
country?
NO standards: Different techniques and practices
Available Resources and innovations.
Data and Monitoring

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 China Overview
1904
Established in 1904 Shanghai Sixth Peoples
Hospital


General Teaching Hospital
Affiliated with Shanghai Jiao Tong
University School of Medicine
1965
1965 beds
2968
2968 full-time staffs
1362
1362 nurses

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Infusion Nursing in China

Chinese Infusion Nurses Society , CINS
1990 Established in 1990

Most influential society in IV nursing in China

National infusion nursing conference held annually
199910
Published the first guideline for IV practice in China in Oct. 1999

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IV Team in Hospital

IV Team Members of Shanghai Sixth Peoples Hospital
Team Member33

Clinical Department19
15%
Head Nurse28
Clinical Nurse5

85%

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Outcomes

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 Outcomes
: ,
Systematic Training

PICC 1% PICC 8% Steel Needle
CVC 5%
23%
CVC 9%
PVC 17%

Steel Needle 77%

PVC 60%
2010
2015

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 Outcomes
: ,
Systematic Training:

Central Line 33% PVC 16%

PVC 67%
Central Line 84%

2010 2015

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Trends and Challenges

How to improve nurses compliance?

Change Nursing Management method, focus on the process

Optimize the SOPs to meet the clinical needs

Make related Checklists

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 Singapore

155 Inpatient 2,396 Outpatient 454 Emergency Attendances

Admissions Attendances 94 Ambulance Cases

1,958 Therapy Attendances

300 Operations 1,188 Radiological
30% Inpatient Investigations
70% Day Surgeries 13,140 Lab Tests

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 Status of IV Nursing For RN
Governance on Scope of IV Nursing Practice at three levels:
MOH
SNB
TTSH

No national IV Nursing Association

IVM Training for Registered Nurses through:

Formal training in Nursing schools;
Compulsory in-house course to train & certify competent to practice

IV peripheral cannulation training through in-house courses

Peripheral catheter e.g. PICC, insertion by interventional radiologist

Care of PICC by respective dept. nurses (taught during IVM course)

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 Possible sources for MRSA Bacteraemia
from Case Review

Perm Catheter
Peripheral catheter

Central line

Intra Arterial catheter

Peripherally Inserted Central Catheter (PICC)

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Points of Contamination
3. Contaminated Infusate
Rare but possible

1. During
Insertion

2. Contaminated
catheter hub &
inadequate site care

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How to prevent infection Before insertion of vascular catheter

Peripheral Catheter Hand Hygiene

Cleansing of skin Aseptic Technique

Central Line

Hand Hygiene

Cleansing of skin Sterile Aseptic Technique

Procedure

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Hand Hygiene
Before and after
Palpating catheter insertion sites
Inserting catheter
Accessing catheter site
Dressing of catheter

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 Aseptic Technique
Before opening of package
Hand Hygiene
Hands are dry
Check package integrity & expiry date
Open without contamination
Insert without contaminating IV cannula

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Cleansing of Skin
Cleansing Solution
Peripheral IV Cannulation
Alcohol Swab

Central Catheter
Chlorhexidine 2% with Alcohol 70%

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Cleansing of Skin
Contact / Chemical
Sufficient amount of cleansing solution
Cover appropriate surface area
Antiseptic should be allowed to DRY

Friction / Physical
Remove the dirt, surface contaminants and micro-organisms

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Insertion of Central Lines
Staff performing the insertion
Cap
Mask
Sterile gown
Sterile gloves

Patient
Full Drape

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How to prevent infection After insertion of
vascular catheter

SCRUB the HUB

Daily Review Dressing

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Scrub the Hub
Scrub the hub with alcohol swab at least:
10 times on the septum
10 times on the thread
(using luer locked syringe)

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 Scrub the Hub

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 Insertion Site Care
Daily review of:
line necessity

insertion site

Change dressing when:

soiled

wet

loose

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How to prevent infection Before insertion of vascular catheter

Peripheral Catheter Hand Hygiene

Cleansing of skin Aseptic Technique

Central Line

Hand Hygiene

Cleansing of skin Sterile Aseptic Technique

Procedure

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Preventing CLABSI
Requires Teamwork

Inter-professional collaboration
Nurses

Physicians

Pharmacists

Other using CVADs

Support from administration

Staff involvement at all levels

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Thank you

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