Volume 26: Issue 3

The death of professional societies and not-for-profit associations has been greatly exaggerated, to paraphrase Mark Twain. Professional societies, like your Association for Vascular Access (AVA), have proven to be the invaluable resource to their members during this time of COVID-19 crisis. Clinicians, healthcare administrators, stakeholders, and others have turned to their trusted professional homes to seek reliable, accurate, pertinent, and distilled information. Like our members, AVA has used this horrific pandemic to learn lessons and come back stronger and nimbler. Here are some of the projects the Board of Directors, committees, special interest groups, and staff have been

Highlights

Extended intravenous catheter dwells to therapy completion.
Reducing needle sticks improve thalamus development.
Vessel preservation is a lifesaving strategy for neonates.
Pain reduction leads to better developmental outcomes.

Abstract

Background: The use and efficacy of extended dwell peripheral intravenous catheters (EPIVs) has been extensively described at scientific conferences and in recent literature. The ramifications of repeated needle sticks include damage to vessels and ultimately the need for more invasive and costly access devices, which clearly support the need for reliable forms of vascular access.

Methods: This quality improvement project spanned 4 years, 2017 through 2020, and included 128 patients who required a peripherally inserted catheter as their primary or secondary access site for a prescribed therapy. The EPIV utilized was a 4-cm, 22-gauge catheter made of thermosensitive polyurethane inserted using the Seldinger technique.

Results: Over the course of 4 years, 128 patients received an EPIV for 2 or more days, totaling 849 days of therapy. Total insertion attempts were 174 or an average of 1.4 per patient. An estimated number of short PIVs needed for 849 days would have been 404 with 1011 attempts. Resultant savings with EPIV are estimated to be $30,686.

Conclusions: Reducing the number of patient peripheral intravenous attempts while extending the dwell time results in less patient trauma, reliable longer-term access, reduced infection risk, reduced supply usage, and savings in terms of nursing time. The ultimate result for preterm newborns is more efficient delivery of care with less cost.

Highlights

Discussion of ethical and legal principles and challenges in the informed consent process.
Discussion of minimal elements that should be included in a written informed consent document.
Discussion about the challenges in ensuring adequate education for patients to provide informed consent and mitigation strategies.
Discussion about informed consent practice variability stratified by device type, procedural complexity, inherent risks, and goals of therapy.

Abstract

Background: Vascular access device insertion is one of the most performed procedures in healthcare today. With different device types available to provide infusion therapy, there are many different variables to consider, including the process of obtaining informed consent from patients. This literature review aims to discuss common themes present in current evidence-based practice and point out critical areas of variability that exist.

Methods: A literature review was conducted searching Cochrane Library, Joanna Briggs Institute for Evidence-Based Practice, Cumulative Index to Nursing and Allied Health Literature, PubMed, and Google Scholar databases for recently published articles in the English language and those written in English. Articles were screened to include those that describe informed consent within the context of vascular access or other invasive procedures. There were 35 articles and 5 systematic reviews identified that met criteria for inclusion in this literature review.

Discussion: The topics of ethics, legal responsibility, who provided consent, and how education about procedures was performed demonstrated clear insight into how to improve the consent process. Some areas in current evidence lack clear direction and create variability in the informed consent procedure. These included who should obtain consent from the patient and which vascular access devices required a written consent. Who obtains consent was found to be more related to current legal precedence and not the clinician inserting the device like that found when a nonphysician clinician performed the procedure. Vascular access device related variability in requiring written versus verbal consent was found to be rooted in the degree of complexity of the procedure, need for specialized training, and the inherent risk to the patient.

Conclusion: These two areas of variability described in current clinical practice require more research and consensus agreement to standardize the practice of obtaining informed consent in vascular access device insertion.

Highlights

The adoption of a VA-CNS has demonstrable benefits on organizational and patient outcomes.
The VA-CNS is a cost-effective option for health systems, demonstrating a positive payback of $417,525 to the organization in a 1-year period.
This methodological approach to the evaluation of the VA-CNS may be useful for other clinicians in determining the effects and/or cost effectiveness of new positions on patient and organizational outcomes.

Abstract

Purpose: The purpose of this quality improvement study was to examine the impact of a Vascular Access Clinical Nurse Specialist (VA-CNS) on patient and organizational outcomes.

Description of the Project/Program: The VA-CNS role was created and implemented at an acute care hospital in Thunder Bay, Ontario, Canada. The VA-CNS collected data on clinical activities and interventions performed from April 1 to March 29, 2019. The dataset and its associated qualitative clinical outcomes were analyzed using deductive content analysis. Furthermore, a cost analysis was performed by the hospital accountant on these clinical outcomes.

Outcome: Over a 1-year period, there were 547 patients protected from an unwarranted peripherally inserted central catheter (PICC) insertion among 302 patient consultations for the VA-CNS. A total of 322 ultrasound-guided peripheral intravenous catheters were inserted and 45 PICC insertions completed at the bedside. The cost associated with the 547 patients not receiving a PICC line result in an estimated savings of $113,301. The VA-CNS role demonstrated a positive payback of $417,525 to the organization.

Conclusion: The results of this quality improvement project have demonstrated the positive impacts of the VACNS on patient and organizational outcomes. This role may be of benefit and worth its adoption for other health systems with similar patient populations.

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

Full Issue PDF

CEO’s Message

President’s Message

Impacting Neonatal Patient Care: Reducing Needle Sticks, with an Extended Dwell Catheter ^CE

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Abstract

A Critical Appraisal of Variability in Informed Consent for Vascular Access Procedures

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The Clinical Nurse Specialist Role and its Relevance to Vascular Access: A Canadian Perspective

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Randomized, Controlled Clinical Study on the Use of Noninvasive (Near-Infrared Light) Technology Compared with the Conventional Technique for Peripheral Venous Access Puncture in Pediatrics

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Peripherally Inserted Central Catheters in Children: A Prospective Single-Center Analysis of Associated Complications

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Effectiveness of a Modified Measurement of the Peripherally Inserted Central Catheter in Newborns: A Randomized Study

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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