Factors causing thrombophlebitis in horses: methods of prevention 2

An intravenous catheter care bundle is defined as a collection of processes needed to effectively and safely care for patients (Boyd et al, 2011) and significant improvement in intravenous catheter management was reported by Boyd et al (2011) after the implementation of a catheter care bundle in humans. Care bundles provide evidence-based guidance for the maintenance and assessment of intravenous catheter sites (Higginson, 2011). Although an intravenous catheter care bundle check-list does exist for small animal patients, no such care bundle is available for equine patients. The creation and implementation of an evidence-based intravenous catheter care bundle could assist registered equine veterinary nurses (REVNs) to significantly improve patient care and therefore contribute to the development of equine clinical practice.

In human research, a new self-disinfecting catheter hub (Figure 1) has been used; the Curos^® Port Protector (Ivera Medical) is a simple, innovative, disposable infection prevention product intended for use on swabbable luer access valves as a disinfecting cleaner prior to catheter access and to act as a physical barrier to contamination between catheter accesses. Curos^® will disinfect the valve 3 minutes after application and act as a physical barrier to contamination for up to 7 days if not removed. Inside the Curos^® Port Protector is a 70% isopropyl alcohol saturated sponge-like foam. Once secured, the Curos^® Port Protector automatically provides effective, consistent and reliable passive disinfection of the port. It has been shown to reduce sepsis by 90% (Sitges-Serra et al, 1997). This alone is a dramatic reduction in the number of cases of sepsis, and such a reduction would be extremely valuable in high risk equine patients (Sitges-Serra et al, 1997). In veterinary medical research, 70% of all intravenous catheter-related infections occurred through the catheter hub itself (Tan et al, 2003). In human and veterinary research it has been suggested that environmental factors and poor management can influence catheter-related sepsis (Leonidou and Gogos, 2010). Improving catheter management during insertion and post catheterisation will help reduce thrombophlebitis in high risk patients (Sitges-Serra et al, 1997). Conducting regular catheter hub cultures, reducing the number of lumens a catheter may have and providing a high level of aseptic handling of catheter hubs could also help to minimise sepsis (Sitges-Serra et al, 1997). Routine catheter hub cultures should be performed, and if any of these cultures are positive for Staphylococcus, Streptococcus and Micrococcus species (Geraghty et al, 2009a), then the catheter should be removed before the vein is affected.