Becton, Dickinson and Company · NYSE:BDX
Becton, Dickinson and — Technical Presentation (April 2020)
25 slides from Becton, Dickinson and's technical presentation, April 2020
Slide 1: Presenter views disclaimer
These presentations were developed by the respective presenter(s), and the findings, interpretations, and conclusions contained or expressed with them do not necessarily reflect the views of BD. To the extent these presentations relate to specific products, such products should always be used in acc
Slide 2: Vascular access services: a vision for the future
Vascular access services: a vision for the future Liz Wilson OPAT Lead Nurse Wythenshawe Hospital Manchester University NHS Foundation Trust
Slide 3: Overview
Overview Vascular OPAT access Patient Vascular access services: a vision for the future
Slide 4: The perfect vascular access service?
The perfect vascular access service? Insert VAD • Assess • Follow-up • Consent • Right device • Audit • Plan • Bedside/IR? • Removal • Infection status? Refer Review
Slide 5: Stage 1: Refer
Stage 1: Refer Assess Guideline • Referral for specialist review Infection status MRSA / CPE / CDI / VRE / MSSA etc • Patient assessment by expert practitioners Temperature >36̊̊ <37.5 C → continue (outside of above range → D/W team/microbiology • Risk v Benefit Early warning score ≥3 → D/W team/mic
Slide 6: Patient assessment
Patient assessment • Relevant drug history • consider anti-coagulants i.e. aspirin, LWMH, rivaoxaban, warfarin etc • Relevant medical history Allergy review: • upper limb DVT or #’s, breast surgery +/- lymphoedema, OA, PPM/AF etc • Latex? • Chlorhexidine? • Known liver disease? • Local anaesthetic?
Slide 7: Vessel Health & Preservation
Vessel Health & Preservation Consider: 1. Reason for the vascular access request e.g. • Abx, TPN, Chemo, • For TPN patient must be apyrexial for at least 48 hours pre line insertion 2. Planned duration of treatment 3. pH & osmolarity of the prescribed medications Vascular access services: a vision f
Slide 8: Device selection (Hallam et al 2016)
Device selection (Hallam et al 2016) Duration of therapy <10 days >10 days – <4 weeks >4 weeks - <6months >4 months - <6 years ↓ ↓ ↓ ↓ Midline / PICC line Midline / PICC line PICC / tunnelled CVC / Tunnelled CVC / TIVAD TIVAD pH <5 or >9 PICC / tunnelled CVC / Osmolarity >600 Osm/l TIVAD Vascular ac
Slide 9: Stage 2: Insertion
Stage 2: Insertion • Collaborative / MDT approach • Bedside / interventional radiology / theatres • Bedside placements: USS & ECG • IR placements: USS & fluoroscopy • Evidence based practice Vascular access services: a vision for the future
Slide 10: Bedside placement
Bedside placement • PICC & Midlines • USS • ECG guided insertion • CXR free • Evidence based practice Vascular access services: a vision for the future
Slide 11: Radiology Placement
Radiology Placement • For PICC, tunnelled CVC & TIVAD • For complicated patients, where Benefits of an MDT approach: visualisation is required • Fluoroscopy is used • Standardises care • Allows a vascular service to be • Provided by Consultant radiologists sustainable / robust & interventional radio
Slide 12: Stage 3: Review
Stage 3: Review • Every patient followed up at 48 hours • Ward support Audit: • Care plan • Compliance with care plan • Weekly visits • Blood Stream Infections • Education & training • Line removal Vascular access services: a vision for the future
Slide 13: VAD infection definitions
VAD infection definitions • Systemic infection plus evidence implicating CVC as source of infection CRBSI • Systemic infection often occurs with a normal exit site • Peripheral BC & line BC have same isolates • Causes inc: bio-film, contaminated infusates/valve, seeding out from other infection sour
Slide 14: Vascular access services: a vision for the future
Vascular access services: a vision for the future
Slide 15: Outpatient Parenteral Antimicrobial Therapy (OPAT)
Outpatient Parenteral Antimicrobial Therapy (OPAT) • Provide ‘hospital standard’ care to patients in the community • Specialises in infection management 3 pathways: • Can enable an early discharge 1. Hospital • Or prevent a hospital admission 2. Community 3. Self-administration Vascular access servi
Slide 16: Why OPAT?
Why OPAT? • Reduced length of hospital stay • Reduce patient/family costs • Reduce incidence of HCAI • (emotional, financial etc) • Reassurance of MDT : • Return to ‘normal life’ (school, work etc) • Infectious Disease Consultant, OPAT CNS, antimicrobial • Support of OPAT team (24/7) pharmacist • Ac
Slide 17: Hospital pathway / Infusion Suite
Hospital pathway / Infusion Suite • 7 day service for OPAT patients • Specialist infection management • Cellulitis service • A&E, GP, Ambulatory Care referrals • Line insertions (PICC, midlines & cannula) Vascular access services: a vision for the future
Slide 18: Community pathway
Community pathway • Community nurse visits patient in their own home • Provides line care • Collects safety labs/monitoring • Administers antimicrobial therapy • Pt returns weekly to OPAT team for medical & nurse review Vascular access services: a vision for the future
Slide 19: Self-administration pathway
Self-administration pathway • Teach patient or carer to deliver IV medications • How to identify an issue with their vascular access device • Empowers patients & carers • Escalation procedure to follow • Encourages self-care • Returns weekly to OPAT for medical/ nurse review & line care • Facilitate
Slide 20: Elastomeric devices
Elastomeric devices Vascular access services: a vision for the future
Slide 21: Benefits of elastomeric devices
Benefits of elastomeric devices • Available as ‘short’ or ‘long’ infusions • 1 hour or 24 hours • Can promote antimicrobial • Can reduce community & hospital stewardship visits • Various antimicrobial therapies are • Needle-free (EU directive 2012) compatible to use via this format • ANTT compliant
Slide 22: Evidence of OPAT success
Evidence of OPAT success Data collected & input into National OPAT Database (NORS, BSAC): • OPAT OUTCOME • Success, Partial, Failed, Indeterminate • INFECTION OUTCOME • Cured, Improved, Failed Vascular access services: a vision for the future
Slide 23: OPAT VAD infections
OPAT VAD infections January 2015 – December 2019 • Continuous monitoring of all lines placed No. of device No. of VAD • 1 catheter related blood stream related infections infections --------------------------- X 1000 = per 1000 infection Total no. of catheter catheter days days • Rate reported per R
Slide 24: OPAT Line placements
OPAT Line placements • ECG guided PICC insertions • Team accuracy rate of 99.4% • Line infection rate: • 0.04 per 1000 catheter days • PICC & midlines Vascular access services: a vision for the future
Slide 25: Vascular access services: a vision for the future
Vascular access services: a vision for the future
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