Intravenous dressing issues and complications

Nursing - IV Dressing Issues

INTRAVENOUS INJECTION SITE DRESSING ISSUES

Historical Background and Contemporary Relevance of Intravenous Dressing Issues: According to many medical historians, modern medicine began with Joseph

Lister's introduction of the Germ Theory of Infection and the corresponding importance of asepsis in the middle of the 19th century (Starr, 1982). Prior to the American Civil

War, bacterial infection was the single greatest cause of mortality associated with non- fatal battlefield casualties. In the hundred years between the first implementation of antiseptic techniques and the eventual discovery of antibiotics in the middle of the 20th century, antisepsis changed virtually every aspect of medicine by profoundly reducing the incidence of secondary infection. Today, overuse of antibiotics has helped produce new strains of antibiotic- resistant bacteria that, together with failure to comply with wound care protocol have accounted for disturbing levels of hospital-acquired infections that result in thousands of patient deaths from causes wholly unrelated to the ailments that necessitated their hospitalization in the first place (Taylor, et al. 2005). One of the primary modes of all hospital-acquired infections relates to improper wound care, much of which can be traced directly back to specific techniques of sterile dressing application and change (Fitzpatrick

1997).

To the extent that hospital-acquired infections are caused by deviation from established protocol, nurses are bound, both professionally and ethically, to ensure that this problem is addressed directly and rectified.

Mechanical Issues in Intravenous Dressings: Unlike adherence to antisepsis, which is (generally) first understood in principle and then implemented through objective protocols, applying dressings with appropriate regard for potential mechanical disruption is a skill developed through practice and something that varies considerably among practitioners. It is not uncommon for individual departments, or even the personnel of regular nursing station shifts to develop ad-hoc solutions to problems to many problems that only become apparent in practice (Fitzpatrick 1997).

Typical examples of ubiquitous fixes that almost certainly originated in practice include orienting the direction of tubing protruding from dressings, choice of IV line placement, and looping of additional lengths of flexible tubing under supplemental dressings to minimize their vulnerability to accidental disruption and to both unintentional and purposeful removal by patients. Generally, improving the mechanical integrity of the dressing minimizes wound contamination from external bacteria. However, when ad-hoc methods meant to maintain the former conflict with protocols necessary to ensure the latter, the consequences can be compounded by the anaerobic environment under the dressing that promotes more rapid bacterial infection instead of protecting the wound site from external bacterial contamination (Fitzpatrick 1997).