Abstract

The Association for Vascular Access (AVA) is an organization of health care professionals founded in 1985 to support and promote the specialty of vascular access. The mission of AVA is to distinguish the vascular access specialty and define standards of vascular access through an evidence-based approach designed to enhance health care. There is little guidance for multidisciplinary procedures/practice, and this is the case for vascular access. There are also inconsistencies and conflicts in terminology. Additionally, there is no consensus of vascular access as a specialty. It is the focus of AVA to promote consistency in vascular access practice. This document embraces a common title for a clinician with knowledge and skills in the area of vascular access. This establishes a new paradigm that will strengthen the advancement of the vascular access specialty.

Abstract

Background: Chlorhexidine gluconate (CHG) has been shown to reduce the microbial load at intravascular (IV) catheter insertion sites and the risk of catheter-related infections. The Centers for Disease Control and Prevention and the UK National Institute for Health and Care Excellence subsequently recommended CHG-containing IV dressings for specific clinical indications.

Aim: To evaluate clinical staff perceptions of a standard transparent IV dressing in comparison to a transparent IV dressing incorporating a 2% (w/w) CHG gel pad when used at the insertion site of short-term central venous catheters and vascular access catheters for dialysis in adult critical care patients.

Methods: Following a 9-month trial period during which a CHG dressing was introduced to critical care patients at a university hospital, the staff perception of this dressing in comparison to a standard transparent IV dressing was evaluated by a questionnaire. The number of dressing changes required and skin condition under the dressing was also determined in a proportion of patients.

Results: The majority of the clinical staff (70 out of 81 respondents) considered the performance of the IV dressing containing a CHG gel pad better or much better than the standard dressing, and 77 out of 78 of the respondents recommended continuing its use. Both types of dressing performed well when applied to the insertion site of IV catheters in the internal jugular, subclavian, or femoral vein.

Conclusions: Staff satisfaction with the IV dressing incorporating a CHG gel pad was rated good, and the dressing performed well in a diverse group of critical care patients.

Abstract

Patients admitted to acute care frequently require intravenous access to effectively deliver medications and prescribed treatment. For patients with difficult intravenous access; those requiring multiple attempts; and those who are obese, have diabetes, or have other chronic conditions, determining the vascular access device (VAD) with the lowest risk that best meets the needs of the treatment plan can be confusing. Selection of a VAD should be based on specific indications for that device. In clinical settings, requests for central venous access devices are frequently precipitated simply by failure to establish peripheral access. Selection of the most appropriate VAD is necessary to avoid the potentially serious complications of infection and/or thrombosis. An international panel of experts convened to establish a guide for indications and appropriate use for VADs. This article summarizes the work and recommendations of the panel that created the Michigan Appropriateness Guide for Intravenous Catheters.

Abstract

Background: National guidelines advocating ultrasound guidance for internal jugular venous cannulation were introduced in the United Kingdom in 2002, followed by international guidelines a decade later. However, the benefits of ultrasound guidance do not appear to have universally translated into clinical practice. This study aimed to investigate the effect of ultrasound on the practice of internal jugular vein cannulation.

Methods: We conducted an ethnographic study incorporating observations, interviews, and focus groups in 2 hospitals in the north of England over a 4-month period.

Results: Twenty-seven clinical observations, 10 interviews, and 3 focus groups were conducted. In 25 clinical episodes, ultrasound guidance was used. Four distinct needling techniques were observed, which we classified in terms of needle angulation: the traditional landmark technique, the ultrasound-guided traditional approach, ultrasound-guided medial angulation, and the ultrasound-guided steep approach. The latter 2 techniques represent a departure from conventional practice and appear to have developed alongside ultrasound guidance. Although no serious complications were observed, there appears to be enhanced potential for complications to occur with medial angulation and the steep approach. Participants described a loss of anatomic knowledge and a false sense of security associated with the adoption of ultrasound guidance, which may account for the emergence of new, potentially riskier needling techniques.

Conclusions: The introduction of safe technologies may lead to unintended consequences, and clinicians should attempt to recognize and mitigate them when they occur. Education to increase awareness of the pitfalls of ultrasound guidance is recommended.

Abstract

Background: Insertion of extended dwell/midline peripheral intravenous (EPIVs) catheters is not common practice in pediatric hospitals. An interdisciplinary team in 1 pediatric hospital developed a venous access decision tree based on current standards that included EPIVs. The purpose of this evaluation was to assess the process and pediatric patient outcomes associated with use of EPIVs and with peripherally inserted central catheters (PICCs).

Methods: A retrospective record review over 22 months was conducted for 375 patients who received either a PICC (67.5%) or EPIV (32.5%). Data collected included patient demographic characteristics, diagnosis category, type and purpose of the line, insertion and removal dates, catheter size, placement location, and complications encountered.

Results: EPIVs were inserted with a 1.9F or 3F catheter, whereas PICCs generally used a 3F or 4F catheter. EPIVS were more commonly inserted in children younger than age 1 year, whereas children aged ≥ 11 years more often had a PICC inserted. EPIVs remained in place an average of 9 days compared with 20 days for PICC lines. Significantly more complications occurred during the placement of PICCs, whereas EPIVs had more complications during use such as leakage, dislodging, and infiltration.

Conclusions: EPIVs were a successful alternative to PICC or peripherally inserted venous catheters for children in an inpatient acute-care facility who need 30 days or fewer of nonvesicant intravenous therapy. The venous access decision tree provided useful guidance in determining the appropriate venous access device for pediatric patients and the decision tree was adhered to by the vascular access team.

Abstract

Background: The risk of venous thromboembolism (VTE) may be reduced if a vein of appropriate diameter is used for peripherally inserted central catheter (PICC) insertion. However, clinicians may have predilections to cannulate certain vein types and use particular insertion sites (eg, right or left arm) and therefore do not necessarily assess all veins available to determine the most optimal vessel to introduce a catheter. It is important that clinicians have an understanding of the diameter of veins used for PICC insertion and the effect of patient factors such as hand dominance on vein size to determine whether their clinical practice is appropriate.

Methods: A scoping review of published literature was performed to determine existing knowledge regarding the diameters of veins used for PICC insertion and the influence of patient factors such as hand dominance and laterality (left or right arm) on vein size.

Results: There was limited published research about the diameters of the basilic, brachial, and cephalic veins at the midupper arm, with only 6 studies identified. Three of the 6 selected articles focused on vein diameter measurement to inform arteriovenous fistula development. Only 1 study included participants undergoing PICC insertion. Scant research examined the effect of laterality on vein diameter and 1 study was identified that reported the influence of hand dominance or vein type on the diameter of veins used for PICC insertion.

Conclusions: This review found that there is a paucity of studies that have examined the veins used for PICC insertion. Nevertheless, it appears that the basilic vein has the largest diameter (with smaller brachial and cephalic veins), although this is not always the case. Laterality and hand dominance does not seem to influence vein diameter. Further research about the vasculature used for PICC insertion is needed to inform clinical practice.