RE: "breaking the system"

[Chris Cavanaugh]

Title: Re: "breaking the system"

Procedures differ at every hospital, and the best answer perhaps is just to go to your CT and MRI departments and ask them what they do.   From what I have seen at various facilities: 1) not every injection of contrast is given via a power injector.  Many are given by hand.  It depends on what type of study they are doing.  2) Although I see NS used before and after contrast injections, both with a power injector and by hand, I have never seen heparin used after.  Why not? Not really sure—perhaps the techs are unaware of the need for heparin, and need to be educated, and have heparin supplied to their department for this purpose.  This applies to PIVs and central lines.  NS, contrast, NS.  I have never seen heparin used.  Not to say that applies to all facilities, of course.  3) I have also never seen a tech remove an injection cap from a line, again, no matter what type of line is used, just to inject the contrast.  4) Some facilities do not have the techs inject the contrast if the pt has a central line or PICC, they have nurses available to do this.   Again, depends on the state regs and the facility policies. 5) I have never seen injection caps stocked in a CT or MRI area.  This means that if they do remove them, they cannot replace them.    What is best practice here?  A dialogue with your radiology department—who takes care of lines in the department?  What is their procedures?  Do those procedures match and follow what happens in the rest of the facility?  This conversation can go far to improve patient outcomes.   Chris Cavanaugh, CRNI From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Marilyn Patterson Sent: Monday, May 15, 2006 2:30 PM To: Lynn Hadaway; Janousek, Patricia; [EMAIL PROTECTED] Subject: RE: "breaking the system"   More questions along the same line: The manufacturer’s (Bard) recommendation for using a power injector with Power PICCs includes instructions to remove the injection cap prior to use. I know the CT techs infuse through the injection caps on peripheral IVs, why the difference? Does anyone have experience with CT techs doing this? Doesn’t that open yet another door for introducing infections? Do the CT techs heparinized them after use, or do the floor nurses do this? As always, thanks in advance for sharing all your expertise and experience. Marilyn Patterson Olympic Medical Center Port Angeles, WA [EMAIL PROTECTED]   From: [EMAIL PROTECTED] [mailto:[EMAIL PROTECTED]] On Behalf Of Lynn Hadaway Sent: Monday, May 15, 2006 7:31 AM To: Janousek, Patricia; [EMAIL PROTECTED] Subject: Re: "breaking the system"   The literature on catheter-related bloodstream infection is filled with information about hub manipulation being a major source of the organisms that lead to infection. Opening the system and anything done to the catheter hub should be kept to a minimum by: 1. extending the tubing from 72 to 96 hours - both CDC and INS state "no more frequently than 72 hours" 2. changing fluid container and tubing at the same time 3. limiting the number of times the line is opened for any reason. I would not consider opening the line for the patient to shower to be a valid reason. Neither is it acceptable to disconnect the tubing to change gowns. The fluid container and all tubing should be run through the sleeve just like the arm.   Lynn   At 12:07 PM -0500 5/12/06, Janousek, Patricia wrote: Hi, Does anyone know of any supporting literature for NOT disconnecting IV fluids from an IV site for the "convenience" of the patient so that they can shower, and/or go to Xray? We recently had a BSI related to a PIV on a long-term patient (high-risk OB), that Epidemiology was able to track it back to the management of the line being broken many times for the patient to shower without being connected to the IV fluids. We would like to change the practice. Thanks, Patty   Patty Janousek, BSN, CRNI Team Leader, IV  Team Methodist Hospital 8303 Dodge Street Omaha, NE 68114 (402)354-8760 FAX: (402)354-5266 PAGER: (402)577-9527 EMAIL: [EMAIL PROTECTED]   This message and any included attachments are from Nebraska Methodist Health System and its affiliates and are intended only for the addressee. The message may contain privileged, confidential and/or proprietary information intended only for the person(s) named. Unauthorized forwarding, printing, copying, distribution, or use of such information is strictly prohibited and may be unlawful. If you are not the addressee, please promptly delete this message and notify the sender of the delivery error by e-mail or you may call Nebraska Methodist Health System and its affiliates in Omaha, Nebraska, U.S.A at (402)354-2280.     -- Lynn Hadaway, M.Ed., RNC, CRNI Lynn Hadaway Associates, Inc. 126 Main Street, PO Box 10 Milner, GA 30257 http://www.hadawayassociates.com office 770-358-7861