Professor André VAN ZUNDERT,
MD, PhD, FRCA, EDRA, FANZCA
Department of Anaesthesia & Perioperative Medicine, Royal Brisbane & Women’s Hospital, The University of Queensland, Brisbane, QLD
Friday 1:00 – 2:00pm (directly after welcome address)
The History of IV Cannulation
Spanning from ancient times till the late 19th Century, medical practitioners were convinced that all diseases were related to impurities of blood, stomach and bowel, caused by bad food intake. Consequently, treatments were based on the art of therapeutic bloodletting, vomiting (by the administration of emetics) and cleansing enemas (clysmata). They firmly believed that those who are weak from disease and impurities of blood can be cured by pure and very temperate blood infusions. However, there was no need for human blood to save a man as animal blood was preferred due to its purity and lack of contamination from the wide range of bad food ingested by humans. Blood donated by the youth was also considered pure.
The first recording of an attempted blood transfusion intravenously occurred in 1492 when physicians of the ailing pope infused blood from three healthy youths into the pontiff using a vein-to-vein anastomosis. This technique resulted in the death of both the pope and the young donors. The first well-documented, successful transfusion from animal-to-animal occurred in France in 1667, and was performed by Jean-Baptiste Denis in 1667. Denis tested this method on a 15-year-old boy who was suffering from a stubborn fever. The boy underwent 30 therapeutic bleedings in two months with no improvement. However, he recovered following the administration of three ounces of blood from a lamb. Many fatal results were seen following this, which could be explained by blood incompatibility. It was not fully understood why one blood transfusion was successful and another was not until 1900 when Landsteiner discovered the existence of different blood types.
Blood transfusion was considered an easy method of nourishment. Food taken by the mouth was compelled to pass through many body parts before it entered into the veins. Oral treatment using drugs was less efficacious and took a long time to take effect. Injections made directly into the blood stream seemed to be more efficacious, similar to the ‘noxious efficacy’ of Indian poisons (later ‘curare’) and bites from vipers and spiders. Therefore, scientists were fascinated by creating access to blood vessels. Sir Christopher Wren, the famous architect of the Saint Paul’s Cathedral in London, was the first to introduce intravenous medication to animals, in 1656. Wren designed the first working infusion device using a pig’s bladder and “needle” formed from a goose quill. He injected a mixture of wine, ale and opium until the animal became extremely drunk, post voiding, the animal arose in a rejuvenated state, surviving the experiment. Many trials followed and opened new vistas. They used several substances – often poisons – directly in to the bloodstream of animals.
During the cholera epidemic of 1831-1832, Dr Thomas Latta pioneered the use of IV saline infusions. Facilitating administration of IV drugs and infusions were inventions of the hollow needle in 1844 by Francis Rynd (Irish surgeon), the syringe in 1853 by Charles Pravaz (French surgeon) and the first true hypodermic syringe in 1855 by Alexander Wood (Scotland). The latter was the forerunner of modern syringes and underwent improvement by many manufacturers over the next century. This unlocked options for treatments used in anaesthesia and medicine (e.g. medication, insulin, cytostatics, opioids, IV rehydration, blood transfusion), but also provided access for interventional medicine and diagnosis (radiology, cardiology, surgery). Today, vascular access is a requirement for virtually all hospitalised patients and IV devices are essential to deliver necessary treatments. Intravenous access is the most commonly performed invasive procedure in clinical settings worldwide and is amongst the most prominent revolutions in healthcare.
Professor van Zundert is the Professor and Chair of Anaesthesia at the University of Queensland Medical School and Royal Brisbane and Women’s Hospital. In a prolific clinical and academic career he has authored 2 books and chapter in another 50, Co-authored over 300 scientific publications, been President of the European Society of Anaesthetists, maintained professorial roles in the Netherlands and Belgium before recently settling in Australia. He has a special interest in airway management.
Friday 4:40 – 5:00pm
Is there a Case for a National Standard and Auditing Program for Peripheral Intravenous Cannula?
Peripheral intravenous cannulae (PIVC) are frequently used medical devices and have been identified as a key source of healthcare associated infections especially Staphylococcus aureus bacteraemia .
Meanwhile there are no national standards relating to the insertion and maintenance of peripheral devices; most health service organisations rely on locally developed guidelines that lack consistency; and guidelines, when they do exist are often are poorly applied in practice by clinicians.
A 2013-14 survey of the eight states and territory departments of health found there is no standardised approach to training, ongoing education or assessment of competence related to insertion and maintenance of peripheral devices at an organisation or jurisdictional level. Only half the jurisdictions have a policy for insertion and maintenance of PIVC; and of those that do have a policy, none measure or evaluate any aspects of compliance. None of the jurisdictions had a method for assessment of competence for insertion of PIVC.
What might be the benefits of a national standard and auditing program for peripheral intravenous cannula?
- Director of national HAI program at ACSQHC
- Professor at School of Nursing /Midwifery, Griffith University
- Oversees national programs to reduce infections and AMR – hand hygiene, AMS, CLABSI, HAI surveillance, national guidelines.
- published on AMS and HAI
- represented Australia at APEC and WHO.
- Present-elect of ACIPC
Friday 4:40 – 5:00pm
The Catheter to Vein Ratio and Rates of Symptomatic Venous Thromboembolism in Patients with a PICC
Background: Peripherally inserted central catheters (PICCs) may be complicated by adverse events such as venous thromboembolism (VTE). The size of the vein used for PICC insertion and thus the catheter to vein ratio is thought to be a controllable factor in the reduction of VTE rates in patients who have a PICC. However, an optimal catheter to vein ratio for PICC insertion has not previously been investigated to inform clinical practice.
Objectives: To determine the effect of the catheter to vein ratio (proportion of the vein measured at the insertion point taken up by the catheter) on rates of symptomatic VTE in patients with a PICC and identify the optimal ratio cut-off point to reduce rates of this adverse event.
Method: Adult patients waiting for PICC insertion at a large metropolitan teaching hospital were recruited. Vein diameter at the PICC insertion site was measured using ultrasound with in-built callipers. Participants were followed up at eight weeks to determine if they developed symptomatic VTE.
Results: Data were available for 136 patients (50% cancer; 44% infection; 6% other indication for PICC). Mean age was 57 years with 54% males. There were four cases of confirmed symptomatic VTE (two involving the deep veins, one superficial vein and one pulmonary embolism). Receiver operator characteristic (ROC) analysis determined that a 45% catheter to vein ratio was the ideal cut off point to maximise sensitivity and specificity (AUC 0.761; 95% CI 0.681–0.830). When a ratio of 46% or above was compared to one that was less than or equal to 45% using a log binomial generalised linear model it was found that participants with a catheter to vein ratio >45% were 13 times more likely to suffer VTE (relative risk 13, p = 0.022; CI 1.445–122.788).
Conclusion: A 45% catheter to vein ratio was the optimal cut off with high sensitivity and specificity to reduce the risk of VTE. However, further research is needed to confirm these results as although adequately powered; the number of cases of VTE was comparatively small, resulting in wide confidence intervals.
Dr Rebecca Sharp is a lecturer in the School of Nursing and Midwifery at the University of South Australia. Her research centres on generating evidence to guide PICC insertion. Specifically, she is interested in the role of the catheter to vein ratio in the risk of venous thromboembolism. Rebecca is the South Australian representative for AVAS and is the co-lead of the South Australian chapter of the AVATAR Group.
NHMRC Centre of Research Excellence in Nursing (NCREN)
Menzies Health Institute
Saturday 10:00 – 10:30am
Inaugural Results of the OMG PIVC Study
Approximately 1.2 billion PIVs are inserted in hospitalised patients around the world every year. Although a common device, almost half will fail before the device is required to be removed. Internationally, this equates to millions of patients having IV therapy prematurely ceased requiring the re-siting of a new PIV. The financial loss to healthcare services globally is enormous, the personal cost to patients is even greater with reports of pain and anxiety as well as delays in vital treatment. Up until this study, the management practices of PIVs across different regions of the world was relatively unknown, including important bench-marking rates such as phlebitis, dressing techniques as well as size and anatomical position of PIVs used. This presentation will provide the audience with information on global PIV rates collected from over 400 hospitals in 50 countries. Importantly we present data on over 40,000 patients that were audited which will provide some insight into what factors contribute to PIV failure globally, where such information can then be translated into clinical practice locally.
BIOGRAPHY – Evan Alexandrou
Evan Alexandrou is a Senior Lecturer with the School of Nursing and Midwifery at the University of Western Sydney. Evan is also a Clinical Nurse Consultant in the Intensive Care Unit at Liverpool Hospital where he divides his time inserting central venous catheters and undertaking clinical care of critically patients.
Evan is involved in clinical education at an undergraduate and postgraduate level. He teaches in the Nursing Program at the University of Western Sydney and also as a conjoint lecturer with the Faculty of Medicine at the University of New South Wales where he tutors intensive care, anaesthetic and emergency medical trainees in vascular access. He is also a senior research fellow with the AVATAR Group at Griffith University.
BIOGRAPHY – Gillian Ray-Barruel
Gillian Ray-Barruel, RN, PhD, is a nurse researcher with the Alliance for Vascular Access Teaching and Research (AVATAR) group at Griffith University, Australia. Gillian has extensive experience in critical care nursing, patient assessment, project management, medical writing and editing, and clinical trials coordination.
Home Infusion, OPAT – Vancouver, Canada
MN, RN, OCN, CVAA(c), VA-BC
Saturday 11:00 – 11:30am
Making it Work for Patients at Home: Vascular Access, Infusion Therapy and Parenteral Nutrition
Clinicians who appreciate and specialize in vascular access and infusion therapy have the opportunity to impact patient care directly in and out of the hospital. Some patients simply do not need to be hospitalized for infusion therapy. We should strive to get these patients home with vascular access and infusion therapy safely and efficiently.
This presentation will describe a Home Infusion Program in Vancouver, BC Canada that includes Home IV Antibiotics and Home TPN. Factors such as improved safety, better outcomes, cost effectiveness, compliance and antibiotic stewardship will be discussed. Vascular access and infusion therapy will be the focus in terms of what works for patients and strategies to ensure positive outcomes.
Upon completion of this session, participants will be able to:
- Discuss the benefits of a Home Infusion Program for organizations and for patients.
- Describe challenges and barriers in getting patients home with vascular access and infusion therapy.
- Discuss strategies to ensure to patients go home (and stay home) with optimal outcomes related to vascular access and infusion therapy.
Jocelyn is a clinical nurse educator in Vancouver, BC, Canada. She has clinical expertise in peripheral IV and PICC insertion, CVC care, maintenance and complication management. Her work includes close collaboration with educators, physicians and leaders for infusion therapy and peripheral and central vascular access issues.
Jocelyn is an active member of numerous organizations and associations that relate to vascular access, infusion therapy and oncology in North America. She served as President of the Canadian Vascular Access Association (CVAA) from 2012-2014. Her priority is to ensure clinicians have access to education, resources and information that relate to vascular access and infusion therapy and ultimately to help facilitate best patient care by the clinicians she reaches.
Saturday 11:40 – 12:40pm
Casting a Critical Eye on the Vascular Access Literature
Everyone working in vascular access research should be able to critically examine scientific papers and judge the value of the evidence presented. However, many researchers do not get formal training in this process; this is especially true for professions like nursing. Even those who have taken a course on reviewing the literature still often struggle with things like the study design, epidemiological measures, power calculations and statistical analysis. One of the best ways of learning how to cast a critical eye over a paper is by attending a journal club. In my workshop, I will be running a journal club, albeit with a much larger group of attendees than usual. I will provide those attending with two seminal papers from the vascular access literature. I will then divide you into groups, and with the help of myself and one or two willing helpers, will help you critique the papers. We will then discuss the merits of the papers together.
Adrian is Professor of Biostatistics at the University of South Australia and James Cook University. His career includes seven years as a WHO staff member and 15 years as a Principal Epidemiologist with the South Australian Department of Health. He has nearly 300 publications with an h-index of 45.
Saturday 11:40 – 12:40pm
Pro-active Vascular Device Choice in the Emergency Room
Peripheral intravenous cannulation is the most performed clinical procedure in the Emergency Department (ED) that involves a medical device. However, not everyone needs to be subjected to such an invasive intervention. Furthermore, the first attempt insertion rate is variable and the post insertion complication rate unacceptable if national clinical standards are to be maintained. This presentation will highlight the importance of appropriate vascular access decision-making in the ED. Data along with clinical images and footage from the Vascular Access Decisions in the Emergency Room (VADER) study are presented.
Pete Carr is a Lecturer in Emergency Medicine at The University of Western Australia and PhD Candidate at Griffith University. His research focuses on vascular access outcomes in the Emergency Department. He is a collaborator and investigator on the One Million Global Catheter study. He is a practising clinician who is competent in ultrasound-guided peripheral intravenous cannula and peripherally inserted central catheter assessment and insertion. He is skilled in maintenance and surveillance of peripheral and central vascular access devices. As an emerging researcher in vascular access he has been invited to present his own research and on the topics related to vascular access in Australia, New Zealand, Asia, Europe and USA. His additional roles included Vice President of the Australian Vascular Access Society (AVAS) and Global Committee representative for the World Congress on Vascular Access.
You can follow him on Twitter @pcarriv and read his research here
Saturday 1:50 – 2:10pm
Living with a Drip: CVCs are Close to my Heart … Literally!
I live with a Central Venous Catheter (CVC) to keep me alive. Twenty-five years ago I was diagnosed with Crohn’s disease. By the end of 2006, it left me with Intestinal Failure – I don’t have enough intestines to live. Hello Parenteral Nutrition and CVCs! This life-source has kept me alive for over 9 years and will continue for the rest of my life. I have been given a second chance at life, and I’m more than happy to ‘live with a drip’!
I’ve had a dream run with PN and CVCs, including no CVC infections in those 9+ years! There are CVC challenges however that I and others who ‘live with a drip’ can face.
- There is more than one way to skin a cat, but the variations in CVC care that those on Home Parenteral Nutrition (HPNers) are taught are mind-boggling!
- What could there be to fear for an HPNer needing to attend Emergency Department with a possible CVC infection?
- At similar levels of trepidation – being an in-patient and having to hand over the care of my CVC … on a weekend!
- And new CVC placements – is it any wonder I choose to remain awake through the process?
- Let’s have the conversation – what are my options if I run out of viable veins?
Professionals passionate about vascular access and CVC best practice – you are HPNers’ best friends! Let’s together highlight and promote the specialised CVC needs of those ‘living with a drip’ for life!
Karen Winterbourn was diagnosed with Crohn’s disease 25 years ago. By 2006, following multiple bowel resections, she was diagnosed with Intestinal Failure and began ‘living with a drip’, on Home Parenteral Nutrition (HPN) via a CVC. Karen volunteers as President of PNDU, a patient support group for HPNers and carers.
Parenteral Nutrition Down Under Inc. (PNDU) is a non-profit support group whose mission is to support, research and inform consumers, carers and providers of Home Parenteral Nutrition (HPN) for Intestinal Failure (IF), with our website, private discussion forums, newsletters, brochures, and social gatherings. Clinicians interested in IF/HPN are welcomed as associate members. firstname.lastname@example.org
Visit us at AVAS ASM 2016 just outside the Exhibition Hall.
Cochrane aims to gather and summarise the best evidence from research, to help clinicians and patients make informed choices about treatment. The contributors and groups are based all around the world – with majority of review work being carried out by expert volunteers (like you).
Cochrane Systematic Reviews represent the highest quality evidence available on specific content areas – including vascular access. This session will present:
- The background to the Cochrane Collaboration
- How to interpret Cochrane reviews
- The “Top 10” Cochrane Systematic Reviews in vascular access
- How to apply Cochrane evidence to your vascular access practice
- The importance of high level evidence to support vascular access practice
This session will be interactive – with opportunities to reflect on your current practice and identify elements needing improvement.
Prof Webster is the Nursing Director for Research at the Royal Brisbane and Women’s Hospital. She also holds Professorial appointments with the Schools of Nursing & Midwifery at Griffith University, QUT and UQ; and is a Visiting Professor at the University of York in England. Joan’s research interest is the generation of high quality evidence for nursing and midwifery practice. She has over 120 peer reviewed publications, including 17 active Cochrane reviews. Professionally she is an Editor for the Cochrane Wounds group a reviewer for NH&MRC project grants, and a reviewer for many other health related journals.
Amanda Ullman (RN MAppSci) is a paediatric nurse researcher, PhD candidate and a Director for the Alliance for Vascular Access Teaching and Research (AVATAR), based in Griffith University. She is also an assistant editor for the Cochrane Collaboration, Cochrane Clinical Answers. Her research focuses on the prevention of complications and the promotion of best practice in the paediatric vascular access domain. Follow her on Twitter @a_ullman.
Nicole is a PhD candidate with the NHMRC Centre for Research Excellence in Nursing at Griffith University. She is a Clinical Nurse in Haematology and Bone Marrow Transplant and acting as the Nurse Researcher in Cancer Care Services at Royal Brisbane and Women’s Hospital. She has been involved in one Cochrane Review. She is involved with the Queensland Chapter of AVATAR and is the Chair of the Vascular Access Device and Infusion Therapy Specialist Practice Network with the Cancer Nurses’ Society of Australia.