It is my honor and privilege to represent the 2020 Association for Vascular Access (AVA) Board of Directors (BoD) as President. I want to take this opportunity to introduce the 2020 BoD:

President: Lori Kaczmarek, MSN, RN, VA-BC^™, Wisconsin
President-Elect: Jocelyn Hill, MN, RN, CVAA(c), VA-BC^™, Vancouver, British Columbia, Canada
Presidential Advisor: Ken Symington, MD, VA-BC^™, Washington
Secretary: Amy Stone, BSN, RN, CRNI^®, IgCN, VA-BC^™, Arizona
Treasurer: Russ Nassof, JD, Nevada
Director-at-Large, Tonja Stevens, RN, VA-BC^™, Maryland
Director-at-Large, Michelle (Chellie) DeVries, MPH, CIC, VA-BC^™, Indiana
Director-at-Large,

Background

The Critical Importance of Aseptic Technique

Preventable healthcare-associated infection (HCAI) remains a significant problem, with the Centers for Disease Control and Prevention (CDC) estimating 1.7 million infections in US hospitals and 99,000 associated deaths per annum.1 Vascular access devices (VADs), especially, provide a direct invasive route for microorganisms to infect patients during their insertion and ongoing maintenance, and consequently they provide a relatively high risk of preventable morbidity and mortality. The CDC estimates the cost of central line–associated bloodstream infections were close to $3 billion per annum in 2007.2

Consequently, for all invasive clinical procedures and

Abstract

Background: Difficult venous access (DVA) is common in liver patients requiring blood collection using traditional peripheral approaches. This study aimed to understand the experience of DVA for liver patients and the acceptability of peripheral venepuncture versus external jugular venepuncture (EJV). A secondary aim was to explore the impact of EJV on local resource utilization.

Methods: Semistructured interviews with liver outpatients with DVA (n = 10) requiring venepuncture were firstly themed inductively. We then deductively applied the acceptability framework of Sekhon et al. as a further analytic lens. Audit data from DVA encounters (n = 24) allowed analysis of issues from multiple perspectives. The Consolidated Criteria for Reporting Qualitative Research reporting checklist guides this report.

Results: Peripheral venepuncture had poor prospective, concurrent, and retrospective acceptability, requiring significant mental and physical preparation. Fear, stigma, pain and distress, poor continuity of care, and poor effectiveness led to service disengagement. While EJV caused initial trepidation, it had high concurrent and retrospective acceptability. The significant improvement in patient experience was corroborated by audit data for both procedure duration (5 versus 15 minutes) and first attempt success (100 versus 28.5%) for EJV versus peripheral venepuncture, respectively. While EJV required a recumbent position, it required less staff.

Conclusions: EJV is highly acceptable to patients, using less time and staff resources. EJV protocols and staff training should be considered where DVA presentations are common. Individualized care plans and careful care coordination could divert DVA patients needing venepuncture to services that use EJV preferentially.

Abstract

Purpose: Preventing central line-associated bloodstream infection (CLABSI) events in the dialysis inpatient population represents significant challenges. Bacteremia associated with lines or grafts are common health-associated infections that lead to adverse patient outcomes. Dialysis patients represent a much higher infection risk due to health frequency needs, more frequent hospitalizations, multiple comorbidity issues, fistula functionality, and multiple attempts for line access leading to additional complications, costs, morbidity, and mortality.

Methods: An observational study was conducted including central line device days, CLABSI events, and possible confounding variables in admitted dialysis patients. All CLABSI data were identified according to the Centers for Disease Control and Prevention's National Healthcare Safety Network's definitions for CLABSIs. The intervention involved the removal of 70% alcohol swabs and alcohol hub disinfecting caps, then replacing with swabs containing 3.15% chlorhexidine gluconate/70% alcohol for central line hub disinfection and vascular graft access skin disinfection.

Results: The 5-year preintervention period (2008–2012) involved 7568 central line days, 11 CLABSI events, and a 1.45 per 1000 device day rate. The 6-month trial period involved 1559 central line days and no CLABSI events. The 5-year postimplementation period (2013–2017) involved 9787 central line days, 5 CLABSI events, and a 0.51 per 1000 device day rate. The postimplementation period represented a statistically significant (P value = 0.0493) reduction with 65% fewer CLABSI events compared with the preimplementation period.

Limitations: A limitation was variations in scrub time and dry time during central venous catheter hub access. While we were comparing 2 products, behavioral practices using these 2 products were possible influencers and represent a possible confounding variable.

Conclusions: This study found that using alcohol with chlorhexidine gluconate prior to accessing central line hubs and vascular grafts allows for reduction in CLABSI events and sustains statistically significant lower CLABSI rates in the inpatient dialysis population.

Abstract

Background: The difficult intravenous access (DIVA) score is validated for predicting success of the initial attempt at peripheral intravenous insertion by nurses and physicians. A score of 4 or greater is 50% to 60% likely to have a failed first attempt. The study objective was to assess the validity of this score for emergency department technicians.

Methods: This study used a prospective convenience sample of 181 children presenting to the emergency department with intravenous access attempt by one of 29 emergency department technicians. DIVA score, total number of attempts, and median time to successful intravenous cannulation were obtained.

Results: Comparing patients with a DIVA score <4 to ≥4, first-time IV placement failure rates were lower (9% [95% CI, 3–24] vs. 41% [95% CI, 33–49]) and median time to IV placement was shorter (75 [interquartile range (IQR) 42–157] vs. 254 [IQR 91–806]) seconds. In patients with scores ≥4, emergency department technicians with ≥5 years of experience were significantly more likely to be successful on the first attempt (OR 2.8; 95% CI, 1.03–7.63). For every year of technician experience, the time to catheter placement, adjusted for DIVA score, decreased by 25 minutes (P ≤ 0.05, R2 = 0.05). Comparing our receiver operating curve to the derivation study, the areas were similar (0.67 vs. 0.65).

Conclusions: This study provides preliminary evidence for the validity of the DIVA score when applied to IVs placed by emergency department technicians. For patients with high DIVA scores, ≥5 years of IV experience was associated with higher odds of successful first-time IV placement and shorter time to placement.

Introducing the 2020 Association for Vascular Access Board of Directors

Thank you, JAVA Reviewers!

Standardizing the Critical Clinical Competency of Aseptic, Sterile, and Clean Techniques with a Single International Standard: Aseptic Non Touch Technique (ANTT^®)

Background

The Critical Importance of Aseptic Technique

Ultrasound Guidance for Vascular Access Procedures by Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians

Introduction/Summary

CE Article: Acceptability of External Jugular Venepuncture for Patients with Liver Disease and Difficult Venous Access

Abstract

The Use of 3.15% Chlorhexidine Gluconate/70% Alcohol Hub Disinfection to Prevent Central Line-Associated Bloodstream Infections in Dialysis Patients

Abstract

Utility of the DIVA Score for Experienced Emergency Department Technicians

Abstract

Short- and Intermediate-Term Use of Peripherally Inserted Central Catheters in Europe: A Systematic Literature Review

Abstract

Fistula Salvage Open Thrombectomy in a Pediatric Patient

Abstract

Venous Valves: What’s the Hang-Up? A Deeper Dive

Evaluation of a Line Guard for Pediatric Central Line-Associated Bloodstream Infection Prevention: A Pre-Post Intervention Study

A Randomized Control Trial to Determine the Effect of Handball Exercise on Arteriovenous Fistula Maturation

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