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Becton, Dickinson and — MACOVA 2020
45 slides from Becton, Dickinson and's conference 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: Managing the patient with peripheral IV access
Managing the patient with peripheral IV access Andrew Barton NIVAS UK Chair Advanced Nurse Practitioner Vascular Access & IV Therapy Lead Frimley Health NHS Foundation Trust MACOVA 2020
Slide 3: Peripheral IV Access
Peripheral IV Access • Peripheral IV Cannula • Longer Length PIVC • Short Midline • Standard Midline
Slide 4: Vessel Health Preservation
Vessel Health Preservation IPS & NIVAS
Slide 5: Slide 5
Slide 6: Frimley Health IZ [VAS,
Frimley Health IZ [VAS, NHS Foundation Trust
Slide 7: Frimley Health MAS,
Frimley Health MAS, NHS Foundation Trust
Slide 8: Frimley Health MAS.
sf © Frimley Health MAS. NHS Foundation Trust
Slide 9: Frimley Health [FG (VAS,
Frimley Health [FG (VAS, NHS Foundation Trust
Slide 10: 11 attempts
Frimley Health EAS, NHS Foundation Trust ye
Slide 11: Cannulation site choice
Cannulation site choice • Choose the appropriate site • Priority is vessel health • Smallest cannula possible • As far down the arm/hand • Joints and points of flexion a last resort
Slide 12: Cannulation site choice
AYGuide to) Choosing the Correct Cannulator your Pavient Approximate Flow Rates (I/hr) Colour Common Applications Gauge Crystalloid Plasma Blood Orange Used in theatres of emergency for rapid 146 16.2 44.2 12.9 S transfusion of blood or viscous fluids j j j Grey Used in theatres or emergency for rap
Slide 13: Peripheral Cannulation
Peripheral Cannulation Difficult Vascular Access Guidance 2 Failed attempts 2nd practitioner 2 Failed attempts Vein Vein Attempt Visible Palpable ennniaden 5th attempt Refer Refer to IVAS Ext 2668 Bleep 651, 879, 894 Out of Hours NNP Bleep 454 Consider : On-Call Anaesthetist Veins Vein location via
Slide 14: Vein Preparation and Location Technology
• Vein Preparation Technology Heat Electricity Hydration • Vein Location Technology Ultrasound Infrared Illumination Lights
Slide 15: 4 Step Approach
4 Step Approach Local Anesthetic Strategies for Pam Successful Patient Vascular Distraction Technology Access Positioning vas Gehan Frimley Health [iy EVAS.
Slide 16: Vein Location Technology
Vein Location Technology Frimley Health IGG {VAS, NHS Foundation Trust
Slide 17: Ultrasound
Ultrasound • First attempt success rates over 95% • Can reduce waste • Confidence that cannula is sited in the vessel. • Less painful and traumatic for the patient. • Preserves vessels. • Less complications caused through catheter malposition
Slide 18: Device selection decision tool
Device selection decision tool Andrew Barton © 2109
Slide 19: Longer PIVCs
Longer PIVCs • 18 gauge available in 1.25” and 1.75” • 20 gauge available in 1”, 1.25”, and 1.75” • 22 gauge available in 1” and 1.75”
Slide 20: Midline Catheters
Midline Catheters • Peripheral catheters • Long or short • Tip terminates before the axillary crease • For IV therapy with pH between 5-9 • Indwell time 4-6 weeks
Slide 21: Midline features
Midline features • Power Injectable • Silicone Groshong valve • Single and double lumen • 4-6 weeks indwell • Integrated all in one PowerGlide
Slide 22: 18g Peripheral Catheter Lengths
18g Peripheral Catheter Lengths 3.2cm 4.5cm 8cm 10cm 25cm . . . . . . . . . . . . . . . . . . . . . . . . . 25cm . . . . . . . . . . . . . . . . . . . . . . . . . 5cm 10cm 15cm 20cm 25cm
Slide 23: Integrated PIVC
Integrated PIVC • Long cannula length • Integrated guide wire • Curl tip guide wire
Slide 24: Device Features
Device Features • Power Injectable • Up to 29 days of access with a single catheter • An integrated all-in-one placement • High flow rates • Long PIV / short midline – 8cm to 10cm • More reliable for blood sampling
Slide 25: Integrated Guidewire
Integrated Guidewire Guidewire .018" x 1.3" nitinol (18G) .014" x 1.3" nitinol (20G) TIP: Guide the catheter into the centre of the vesseland lower the device before deploying the guide wire
Slide 26: Ultrasound
1.1cm Ultrasound 6.5cm Aim for 80% Catheter in vessel
Slide 27: Frimley Health IES (MAS,
Frimley Health IES (MAS, MACOVA 2020 : —
Slide 28: Frimley Health VANS
Frimley Health VANS MACOVA 2020
Slide 29: Case study
Case study • 52 year old male. • Traumatic right arm amputated from the shoulder, he also sustained head and right hip trauma • Admitted to the ICU where a short non-tunnelled CVC was placed to his left IJ – right IJ not viable for CVC Patient discharged to the surgical ward after 2 month stay in th
Slide 30: Case study
Case study Patient deteriorate on the surgical ward and required vascular access for ongoing IV therapy for acute kidney injury • Patient had multiple CVC lines in ICU • Referred for new PICC • Previously had 2 PICC’s sited in the left arm over a 4 week period • Both PICC’s pulled out by mistake one
Slide 31: Case study
Case study Patient deteriorating and needed IV access • IV fluids urgently required for fluid balance • Unable to cannulate peripherally • Neck CVC attempted unsuccessfully • Femoral access high risk for infection • Patient was considered for readmitted to the ITU • Patient reviewed one final time b
Slide 32: Case study
Case study • Ultrasound assessment discovered the lower cephalic vein which appeared to be patent and appropriate for an 8cm 18g PowerGlide
Slide 33: Case study
Case study Preparing the ultrasound probe tip to be sterile
Slide 34: Case study
Case study 18g 8cm PowerGlide midline inserted into the vessel
Slide 35: Case study
Case study • Guidewire successfully deployed • Catheter aspirated and flushing well
Slide 36: Case study
Case study • PowerGlide midline prevented readmission to the ICU and stabilised the patient by providing reliable vascular access.
Slide 37: Case study
Case study • 45yr old female with learning difficulties, unable to hyper extend arm for PICC and had 15 PIV attempts • Required 2 weeks of intravenous antibiotics for aspiration pneumonia • PowerGlide placed with Ultrasound on first attempt
Slide 38: Catheter Fixation
Catheter Fixation Frimley Health VANS NHS Foundation Trust MACOVA 2020
Slide 39: Our Success with PowerGlide
Our Success with PowerGlide • No complications reported after insertion • No infections post insertion • Occlusion rate low less that 10% • So far the longest required indwell time has been 24 days • Our insertion success rate 98% on first attempt • Units will refer patients for PowerGlide as first
Slide 40: Insertion Technique
Insertion Technique MACOVA 2020
Slide 41: Considerations
Considerations • Therapies not appropriate for a Midline catheter including those therapies requiring central venous access. • Safe pH drug administration range 9-5 • Use a reliable passive displacement needle free connector • Ensure a good flushing regime • Care bundles are key
Slide 42: MIDLINE Insertion Record
MIDLINE Insertion Record Prelae r OES [VAS Intravenous Vascular Access Services Operator: Reason for MIDLINE Line: POWER IWECTABLE: Yes / No Maximum Sein/Sec Microintredveer uses: Wa/No_ Ultrasound used: exe Local Anaesthetic used ~ Lidocaine 19% 2mg: Yes /No | tite Aspirated with blood: Yes/No Sign
Slide 43: Peripheral cannula insertion record
Surname fins . Frimley Health [V/i54 9 ONE PATHWAY PER CANNULA NHS Foundation Trust 3 3 First name Male / Female * GLOVES must be worn for peripheral cannulation « Disposable tourniquets must be used Es Date of Birth esdal no * ANTT must be observed * Cannulation of the feet Is not allowed @ D ™ Y W
Slide 44: Midline Catheter Care Bundle
MIDUNE CATHETER CARE BUNDLE— GROSHONGOR POWERGLIDE Frimley Health [ere "@ GLOVES must be wornwhen handling/sccesting vascular access device and ANTT must be observed. NHS Number: (© Chiloraprep 1 Seni application must be used to clean the skinduring dressing change ‘¢ Needie free connectors mut be u
Slide 45: Thank you MACOVA
Thank you MACOVA