Short reportPre-filled normal saline syringes to reduce totally implantable venous access device-associated bloodstream infection: a single institution pilot study
Introduction
Totally implantable venous access devices (TIVADs) are used extensively in adult cancer patients. Complications requiring removal can mostly be prevented by adequate insertion and management procedures.1 These may reduce catheter-related bloodstream infections (CRBSIs) that are associated with mortality, morbidity and increased hospitalization costs. Flushing and locking procedures for TIVADs at established intervals are frequently required to ensure catheter patency.2 There is a 5–8% contamination risk when using manually filled syringes, contributing to CRBSI risk.3, 4 Manufactured pre-filled saline syringes avoid the need for manual filling of disposable syringes on the wards, thereby reducing the risk of contamination. This study compares the use of pre-filled syringes with manually filled syringes for flushing and locking procedures of TIVADs in adult cancer patients with a focus on reducing CRBSIs.
Section snippets
Methods
This was a retrospective observational cohort study of 718 TIVADs implanted in adult cancer patients at the National Institute for Cancer Research, Genova, between September 2009 and August 2011. The study followed the principles of the Helsinki Declaration and was approved by the institutional review board. It compared the outcomes of TIVAD implantation in two consecutive patient groups before and after switching from 10 mL manually filled to 10 mL pre-filled syringes for flushing and locking
Results
This study included 734 consecutive implanted TIVADs. Medical records of 16 patients were missing, leaving 718 patients for statistical analysis. In all, 269 TIVADs were flushed and/or locked with manually filled syringes and 449 with pre-filled syringes. The two groups were similar with respect to baseline clinical characteristics (Table I).
Sixty-six devices (9.2%) were removed for complications, 32 (11.9%) in the manually filled syringe group and 34 (7.5%) in the pre-filled syringe group. The
Discussion
Standardized nursing care protocols for TIVAD management are crucial for minimizing CRBSI. Guidelines for skin cleaning, the use of ‘no-touch’ technique, timing for non-coring needle substitution and procedures for flushing and locking devices have been extensively reported.5, 6 Flushing and locking with pre-filled syringes to maintain catheter patency, ease nursing staff work, reduce medication errors and decrease risk of nosocomial transmission of infection has not so far been considered in
Conflict of interest statement
None declared.
Funding sources
None.
References (10)
- et al.
Bacterial colonisation and endotoxin contamination of intravenous infusion fluids
J Hosp Infect
(1997) - et al.
Reduction of catheter-related bloodstream infections through the use of a central venous line bundle: epidemiologic and economic consequences
Am J Infect Control
(2011) - et al.
Guidelines on the insertion and management of central venous access devices in adults
Int J Lab Hematol
(2007) - et al.
Efficacy of normal saline versus heparinized saline solution for locking catheters of totally implantable long-term central vascular access devices in adult cancer patients
Cancer Nurs
(2012) - et al.
Unexpected high risk of contamination with staphylococci species attributable to standard preparation of syringes for continuous intravenous drug administration in a simulation model in intensive care units
Crit Care Med
(2002)
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Nursing and midwifery practice for maintenance of vascular access device patency. A cross-sectional survey
2015, International Journal of Nursing StudiesCitation Excerpt :Additionally, the overall risk of failure was noted to be very low compared to other studies (8.7%, n = 497) and this was possibly related to the use of pre-filled flush syringes across both groups (Schreiber et al., 2015). One non-randomised study suggests pre-filled flush syringes can reduce bloodstream infections, over manually filled syringes (Bertoglio et al., 2013). Reported use of prefilled syringes by participants was minimal in this survey (Peripheral 10% and Central 11%).
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