Professional Documents
Culture Documents
Rachel Romo
Abstract
decrease in patient care, understanding the level of protocol necessary to eliminate all potential
contaminants may find difficult to achieve to the general private practice. Other research has
been completed to find that the removal of hair around the IVC site, using a sterile prep and
cleanser prior to the insertion of the intravenous catheter greatly decreases the percentage of
microorganism growth in the site of insertion and also general phlebitis and dermatitis.
This study provides a larger number of patient data results giving a larger percentage of
intravenous catheter positive cultures, which may give the most accurate percentage to this day.
Many studies prior had a smaller number of patients within the study that may not reflect the
majority of the public. The results of this study also provide that the more the intravenous
catheter is manipulated, maintenanced close to the site and or contaminated resulted in the most
Table of Contents
Introduction..4
Statement of Problem...6
Purpose of Study..6
Hypothesis6
Research Questions..7
Definitions7
Assumptions.....7
Limitations...8
Delimitations....8
Literature Review.9
Methodology..10
Data Analysis.13
Findings.....13
Implications of Findings14
Recommendations..15
References..16
Appendix17
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 4
Introduction
The resistance from veterinary technicians for additional infection prevention measures
enforced during peripheral intravenous catheter placements increases every year from the latest
studies pointing in a generalized direction towards any culprit. The truth is, without spending lots
of money and time, it doesnt seem worth more than the study of postoperative infections of
patients since these are much more detrimental. All the while, this is a small fight in a much
The highest quality of patient care is seen in patients that have veterinary technicians
consistently at their sharpest in prolonged care, i.e. the intensive care unit. One of the most
common, most popular issues seen in patients is with peripheral intravenous catheters. Could you
imagine how much time, money and discomfort would be saved if this skill was mastered? This
There are some serious variables to consider with this goal including the fact that the
highest incidence of inflammation at the catheter site in a study of dogs and cats was found in
increased risks to inflammation and bacterial infection. In human studies, it has been found that
Other important variables that are important to consider are the standard skin preparation
protocols and how it truly affects the infection rate. A study in 1998 found that just a one-minute
decreased bacterial growth and dermatitis than without (Coolman, 1998). The issue with this
information is that the young millennials of our times, are reluctant to trust studies that date too
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 5
far from their present day. Hence the desperate need for a current, applicable and thorough study
By utilizing the variety of studies referenced in this study, many opportunities for
potential error are eliminated making this study as accurate as possible to defeat any room for
rebuttal. The idea for eliminated as many possible reasons for error are to find as many
controlled elements as possible when the action of placing a peripheral intravenous catheter
(IVC). The place of practice will be at Texas A&M University Veterinary Medical Teaching
Hospital Small Animal Emergency Receiving by no more than 5 veterinary technicians that have
from 2 to 6 years of experience in this area with only one as a studied registered veterinary
technician. By limiting the number of people, tracking the patients included in the study and
independent variables will be better monitored. Keeping the study within one service will
provide a control of training backgrounds. The trained practice at this location includes the
following; Always remove the hair least 1 inch above and below the area intended for catheter
introduction. Use a 2% chlorhexidine gluconate solution with at least a 30 second contact time
allowance as per manufacture recommendations. Always wear clean nitrile gloves for IVC
placement. Never touch the catheter or stylet (any portion that will remain inside the patient).
Each person in allowed only 2 attempts at IVC placement. Use clean, hair/debris-free 1/2-inch
cloth tape (2 to 3 pieces). Using proper sterile technique, collect blood with a syringe and place a
flushed T-port. If necessary, use an alcohol soaked pad to siphon any remaining blood from the
T-port and IVC junction. Place clean and debris-free bandaging material that may include: roll
The plan further from these steps are to monitor otherwise healthy dogs and cats (non-
patient holding, technician skill and experience on each case, animal behavior (fractious, docile,
etc.), IVC placement difficulty and number of attempts, how IVC materials are handled and
Problem Statement
The main issue is peripheral intravenous catheter infection and coinciding issues that
could include dermatitis, phlebitis, digital edema and discomfort at any level. There are many
opinions and beliefs for the potential reasons for causing IVC infections and complications.
However, because there are only studies that focus on one variable, enforcing better practices can
be difficult for people to adopt. This being that because there are other opportunities to cause
error and maybe that they do not get the opportunity to see IVC infection themselves, adoption
Purpose of Study
To find contributing factors that affect the risk rate of infection over the period within
seventy-eight hours, found at the site of a peripheral intravenous catheter site initially, placed
upon emergency triage in the emergency room and by an emergency receiving veterinary
technician.
Hypothesis
Proper site preparation of, personal protection equipment use with, proper sterile
technique execution, securing of, proper placement of clean managing for the protection of and
adequate site monitoring of peripheral intravenous catheter placements congruently result in less
Research Questions
1. Does wearing gloves, shaving hair with a cleaned (not necessarily new) clipper blade
(#40), and using sterile technique with site cleansing with three 2% chlorhexidine gluconate
swabs prior to the introduction of an intravenous catheter weigh heavily on the IVC site infection
2. Does enforcing the two attempts per person rule, have an effect on infection rate and
3. Are patients more prone to contracting IVC infections in the Emergency Room kennels
4. Does placing the IVC the first attempt reduce the predicted results?
5. Does storing the bandaging material in a sealed container reduce infection rates?
Definitions
Assumptions
The need for a detailed scrutinizing of intravenous catheter placements and bacterial
growth over a three days period. That the tape used to secure the intravenous catheter (IVC) is
free of debris and bacteria upon placement. The condition of the equipment and the sterility of
the items used. Although the survey was anonymous and secured from tampering, the sincerity
and honesty of the survey answers are in question since these individuals may not feel safe
giving their truth in fear of reprimanding. These individuals are those responsible for
maintenance of the equipment and inventory handling of the materials used. All potential IVC
issues must be considered and assuming that each is recognized in a timely manner for
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 8
troubleshooting the IVC before the problem progresses into a more severe situation, therefore
Limitations
Although the same veterinary technician will be placing, troubleshooting and keeping up
with the maintenance of each IVC, it is up to the ICU technician to monitor the IVC for the time
in between these sessions. Depending on the time of day, there is a different technician and
requesting the same technician(s) for each case is quite impossible to achieve consistently to
remove all room for error. However, the number of technicians will be kept to a minimum,
schedule permitting. Within the department of the hospital used to facilitate this study there is a
severe shortage of veterinary technicians which decreases the accuracy and quality of patient
care. To assist with this, the same technician that will be placing each IVC will be on call for the
ICU technician to utilize if the IVC needs maintenance and troubleshooting to keep the quality of
care as consistent as possible. The same nitrile gloves were used to prepare for and place the
IVC.
Delimitations
Breed was not restricted due to the lack of case flow for a timely study. Because of the
increase of risk in immunity compromise, age of the animal was restricted to 1 year through 8
years; making note that some breeds may be considered seniors at this age. Feline patients were
welcomed in the study, although they tend to be more difficult when placing, maintaining and
troubleshooting the IVC. This is because felines have loose skin, are unpredictable with
behavior, and can easily conceal IVC manipulation; disqualifying their IVC from the study.
Using the same clipper blade through as many IVC placements as possible, beginning with a new
one and having the veterinary technician placing the IVCs keep up with the maintenance
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 9
themselves. The sharpness of the blade must be considered as the blade is used more often; this
can cause unwanted irritations on the skin by cutting the skin, plucking the hair instead of cutting
it and catching and pinching the skin. All of which must be included in the results in order to
Literature Review
The most recent and relevant literature on this subject was published in 2011 that focused
on the bacterial and fungal growth colonization of peripheral intravenous catheters in dogs and
cats. Limitations for this study that were influential included: only using the cephalic or
saphenous veins, using the same insertion protocol for all placements, the same clinician
performed all IVCs, hair was clipped (details not given about dimensions), skin prepped with
gauze soaked chlorhexidine (percentage of solution not mentioned) and rinsed with alcohol
(dryness of the skin before IVC placement not mentioned). Also, the clinician washed hands for
one minute (soap type not included), no gloves worn, and no drapes used. A 2-cm wide stripe of
Adheroplaste, BSN Medical, France tape was used to secure the IVC in place; the length was not
noted. An injection cap or fluid lines were attached, but sterility of the item or sterile technique
used/completed were not recorded. IVCs and body temperature (location not noted) were
checked twice a day. Replacement or removal of IVCs occurred when the IVC became
phlebitis, swelling).
The 100 IVCs tested were of an average of 1.75 days in length with the data collected
over ten days. Twenty-three animals (18 dogs and 5 cats) were suspected to be
immunosuppressed from either a drug received, or disease related to their reason for the hospital
visit. Local complications and hypothermia were observed in 11 dogs and 1 cat. Nineteen IVCs
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 10
from 14 animals were tested positive for microbiologic culture resulting in an overall 15.4% with
twenty different organisms isolated. Nineteen yielded one organism and one yielded two:
administration of a dextrose solution and indwelling of greater than 72 hours in both human and
veterinary medicine. No notes were made with association between IV-line changes or
administration of drugs through IV-line ports with positive microbial culture (Seguela & Pages,
2011).
Methodology
Research Design
A mix of both qualitative and quantitative approaches were carried out for this study,
however the most important being qualitative. A qualified patient arriving in the Emergency
Room was clipped, cleaned, and IVC placed by the same technician in either the cephalic,
forelimb accessory or lateral saphenous veins via the study protocol. A clean #40 clipper blade
was used to clip the hair approximately two inches above and below the anticipated insertion site
of the IVC, taking care that any remaining hair was clear of the insertion site and minimized on
the tape to secure the IVC. Nitrile gloves were worn to prepare all equipment to minimize
contamination potentials; this includes pulling tape pieces, rerolling vet wrap and opening any
sterile items all on a freshly wiped mayo-stand. After any residual hair was brushed or wiped
from the area, three chlorhexidine swab sticks 2% were used on the insertion site; two scrubbing
as a dirty prep and the last swab in a bullseye technique starting at the insertion site. Nitrile
gloves were changed if too much hair existed on them, and again after the IVC was placed if too
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 11
much blood bore threat to stick on any of the bandaging material to house bacteria. The IVC was
securely placed with two attempts or less, blood was drawn from the IVC if applicable before the
T-port attachment was secured. The IVC at the colored hub was taped to the patient using inch
cloth tape in two or three strips and a last three-inch strip just over the IVC and T-Port junction
to secure them together. A light layer of cast padding was placed, then rolled gauze lightly
wrapped, followed by vet wrap. A two-inch piece of one-inch white tape was used for the T-Port
adapter line to secure it to the top of the vet wrap with the time, date, IVC size and initials of the
technician.
Over the three-day stay, all kennels were cleaned and steamed before use, and all IVC
catheters were maintenanced by the same technician. This would include IVC troubleshooting,
Sample Population
Gathering more patients to test increases the accuracy of the result, however it is most
important that all limitations and protocols are followed in order for quality results. Since
patients for this study were admitted through the Emergency Service, widening of the patient
pool was necessary. Most patients were admitted into the hospital with presenting problems that
may have the patient in an immunity compromising situation. the age limitation was however,
Informed Consent
A form was presented to the client with detailed description of the study purpose and
and Emergency Service clinicians and supervisor, this study was fitting for maintaining the
Confidentiality
Patient confidentiality is a withstanding protocol for all Texas A&M University staff and
faculty of the Veterinary Medical Teaching Hospital. All patients are safe and secure within our
Geographic Limitations
This study data was collected all within the hospital which remains at 62 to 73 degrees
Fahrenheit and approximately 35% to 45% humidity. No other geographic limitations were set.
Data Collection
A survey was used to gather information on the perception of the study problem and
realistic IVC placement protocol outside of such high-quality limitations. For the purpose of
setting up IVC problems up for the best success rate, every action possible was taken to avoid as
many possibilities for contamination to narrow down the list of contaminants. If the IVC needed
any maintenance whatsoever, two culturette swabs were collected from the insertion site of the
IVC; aerobic and anaerobic. All notes were documented by the same technician who placed the
IVCs, maintenanced and collected samples. Clinical Microbiology department was called in at
any hour to have the sample plated within two hours of collection. The person who performed
Instrumentation
Instruments used included, #40 clipper blade, standard battery-operated clipper handle,
chlorhexidine 2% swabsticks, nitrile gloves, Monoject IVC, BD syringe 1mL - 5mL, T-Port
extension set, inch cloth tape, 1-inch waterproof white tape, cast padding, cloth gauze roll,
vetwrap.
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 13
Data Analysis
Out of 300 patients (263 dogs and 37 cats), 87 IVCs were tested positive for bacterial
growth. 20 organisms were identified, 8 of which were resistant to one or more antibiotic used to
treat the patient. Factors thought to have influence on the presence of the bacteria include: the
location the patient was housed and cleaning protocol, infusion of dextrose solution of any
Data from the culture growth plates were collected from a microbiologist and results
Findings
Staphylococcus was the most prominent bacteria found to be present with the total
percentage of problematic IVCs 34.4%. 423 patients began the study and 123 were disqualified
due to premature IVC replacement, patient death, patient discharged from the hospital prior to
the 72-hour limit or break of other study limitations. Other considerations that must be taken into
note for future studies; 178 IVCs were rebandaged more than once per day, 54 were completely
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 14
re-taped with minimal site cleaning. All of the causes for extra IVC maintenance were mostly
due to bandage contamination from IVC fluids, saliva, urine, drinking water or feces. Some
bandaging maintenance, 100 (57 cats), were necessary due to patient behavioral issues. IVC
bandages that remained clean from the time of IVC placement and after each bandage change,
over a three-day period has proven itself an issue even through careful protocol. Staphylococcus
was the most prominent bacteria found to be present with the total percentage of problematic
IVCs 34.4%. It would be safe to note that cleanliness in any step of IVC placement and
maintenance is beneficial to decreasing the risk of IVC issues even after the first 24 hours. Any
environmental cleaning, safer storage of materials and proper personal hygiene protocols proved
successful throughout the study. Potentially sending the technician performing the IVCs for the
next study to learn better ways of IVC placement may improve these findings.
The question that remains is what further steps need to occur to bring this percentage of
infection rate down? Or is there even a practical and affordable protocol that exists? Is reaching
less than or equal to 1% infection rate of indwelling IVCs realistically attainable? This study will
be repeated with increased limitations to provide a more accurate pool of data to find a common
denominator for the cause of IVC contamination. Allowing more time elapsed over the study
should allow for an increase of patient numbers for a larger data pool.
It is important to understand that the research was completed on a generally healthy pet
and within a age range that was most likely to have a better immune system. This brings to light
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 15
the increase of risk of peripheral IVCs if signalment were different than the limitations for this
study.
Recommendations
Further research is encouraged to find the breaking point of 30% of infection rate of IVC
placement. Protocol for wearing at least nitrile gloves during placement is recommended for all
veterinary practices for the prevention of infection. Also, proper skin cleansing is imperative to
the decrease of risk of infection as proven in the study and others in years prior (resource). All
other protocols taken should be valued, but may not be practical for smaller veterinary practices.
For instance, the storage and housing of sterile items may not be available and therefore at rise
for a decrease in the integrity of the package. If the sterile item is at risk for integrity damage,
REFERENCES
Jones, I. D., Case, A. M., Stevens, K. B., Boag, A., Rycroft, A. N. (2009). Factors
contributing to the contamination of peripheral catheters in dogs and cats. Veterinary Record,
With Intravenous Catheters in Dogs and Cats in an Intensive Care Unit. JOURNAL of the
related infection in the dog. Journal of the American Veterinary Medical Association, 180(7),
Lobetti, R. G., Joubert, K. E., Picard, J., Carstens, J., Pretorius, E. (2002). Bacterial
Maki, D. G., Weise, C. E., Sarafin, H. W. (1977) A Semiquantative Culture Methos for
296(23), 1305-1309.
Ashby, J. (2017). Peripheral intravenous catheter care in hospitalized cats and dogs.
Seguela, J., Pages, J.-P. (2011). Bacterial and fungal colonization of peripheral
intravenous catheters in dogs and cats. Journal of Small Animal Practice, 52, 531-535. doi:
10.1111/j.1748-5827.2011.01101.x
CAT AND DOG IV CATHETER CONTAMINATION FACTORS 17
Appendix