In March 2017, the Association for Vascular Access (AVA) Board of Directors asked me to lead both its Association and the Foundation toward a new, exciting, and uncharted realm. Have you heard of this place? It's where vascular access proficiency and patient expectations unify around the irreducible minimum of complications and discomfort.

It's a sensible goal and exactly where we want the specialty to be. Putting needles through skin and placing tubes into veins should be as safe and painless as possible.

Vascular access is not just the most common invasive procedure in health care, it's the clinical gateway to

Abstract

This study was undertaken to determine the influence of using a sedation decision aid when selecting a sedation option for totally implantable vascular access device placement on patient choice, workup, and recovery time. An institutional review board-approved, Health Insurance Portability and Accountability Act-compliant, retrospective study of 76 patients (aged 23–89 years, 58% female) presenting to a vascular interventional radiology department between January 2, 2017, and May 5, 2017. Patients were given a decision aid that inquired about personal values and goals, and provided information about expectations; benefits; and risks of the options, including undergoing the procedure with no sedation (local anesthetic), minimal sedation (anxiolysis with a benzodiazepine), or moderate sedation (benzodiazepine and opiate). No sedation was selected by 15 out of 76 patients (19.7%), minimal sedation was selected by 26 out of 76 patients (34.2%), and moderate sedation was selected by 34 out of 76 patients (44.7%). Postprocedure recovery time differences were significant (P < .001) with a mean of 17.4 minutes for no sedation, 49.3 minutes for minimal sedation, and 70.8 minutes for moderate sedation. The use of a decision aid did not slow down the process because workup times were not significantly different: 15.9 minutes for no sedation, 22.1 minutes for minimal sedation, and 18.4 minutes for moderate sedation. Patient sedation preference for totally implantable vascular access device is variable, signifying there is a role for utilizing a decision aid because it empowers a patient to select the option most aligned with his or her goals. Influence on departmental flow is notable because this does not slow down the workup and a majority of patients choose no or minimal sedation, resulting in a decreased postprocedure recovery time burden.

Abstract

Peripherally inserted central catheter use has increased dramatically over the past decade, parallel to health care costs. Traditional bedside peripherally inserted central catheter placement requires anthropometric measurements of estimated catheter length and confirmation of appropriate tip positioning via chest radiograph. Newer bedside technology, using magnet and electrocardiogram capabilities, seeks to replace the traditional method with equal efficacy but less overall cost. The need for follow-up chest radiograph can been removed, a significant cost savings in direct patient care. In this retrospective case control study, we examine costs related to these 2 tip confirmation methods while assessing overall cost savings to the health care industry.

Abstract

Aim: This review aims to present a case series on pressure injury (PI) formation secondary to limb-splinting for preservation of peripheral intravascular catheter (PIVC) access in neonatal and pediatric patients. A literature review was undertaken to analyze the existing knowledge base on this phenomenon.

Background: Medical devices and attachments are considered a risk factor for PI development in neonates, infants, and children. Three cases of PI formation caused by contact with limb boards used to preserve PIVC access were identified in an Australian tertiary pediatric facility during 2016.

Methods: A literature search was conducted during December 2017 using the Cumulative Index of Nursing and Allied Health, Excerpta Medica database, MEDLINE, PubMed, and the Cochrane Library. Keywords used were pressure injury(ies), pressure ulcer, pressure ulcers, decubitus ulcer, and decubitus ulcers. Articles were excluded if published before 2006, patients were adolescents or adults, and if injuries were not caused by PIVC-associated limb-splinting. Patients included in the case series were identified through screening of admissions in one ward of a tertiary paediatric hospital.

Results: Five low-quality studies were included in the literature review. Three children were included in the case series. Each child acquired a PI subsequent to limb-splinting and taping adjacent to a PIVC. Hydration, nutritional state, and oxygenation did not appear to contribute to PI development in these cases.

Conclusions: There is a gap in the evidence base pertaining to PIVC splinting and its involvement with PI formation in neonates, infants, and children. The existing literature provides low-quality evidence this problem exists; thus, further research is recommended.

Substance Use Risk Assessment: Assessing the Risk of Vascular Access Device Tampering in Patients With a History of Drug Use

Toni EastridgeMHA, BSN, RN, MEDSURG-BC,

Brandy NordBSN, RN,

Ann SteffeMSN, RN, PCCN, and

Kathleen Willegal-RussDNP, MSNEd, RN, NPD-BC, a-IPC

The Worst-Kept Secret in Healthcare

What's Holding You Back?

Utilizing a Sedation Decision Aid in Ambulatory Venous Access Device Placement: Effects on Patient Choice, Workup, and Recovery Time

Abstract

Reducing Infusion Pump Alarms Through Structured Interventions

Background

Bedside Peripherally Inserted Central Catheter Tip Confirmation: A Direct Savings Analysis

Abstract

A Case Series of Patients Developing Thrombophlebitis after Administration of Flucloxacillin via a Peripheral Intravenous Catheter

Introduction

Neonatal and Pediatric Pressure Injuries Secondary to Limb Splinting for Intravascular Access: Case Series and Literature Review

Abstract

Substance Use Risk Assessment: Assessing the Risk of Vascular Access Device Tampering in Patients With a History of Drug Use

President’s Message

Don’t Get on My Nerves: A Deeper Dive

2024 Association for Vascular Access Scientific Meeting: People’s Choice Poster Winners: Poster Abstracts

Opportunities for Quality Improvement Through a Simulation-Based Mastery Learning Curriculum for Interprofessional Central Venous Care: Foundational Support