Volume 26: Issue 4

Outgoing President’s Message 2021

As we close out another unprecedented year of a global pandemic and say goodbye to 2021, I am tremendously grateful and humbled for the support of my peers, friends, and family. Although 2021 was another year of restrictions and some turmoil personally, professionally, and politically, there is still so much to be grateful for.

I am grateful for my colleagues in various health care settings and disciplines around the globe. All deserve to be recognized for sacrifices and hard work in their communities. I am amazed at what we have achieved as vascular access specialists and

Highlights

Collaboration with industry is an effective model for large scale performance improvement.
PIVC changes resulted in better first-stick success and PIVC dwell time.
Staff training is a critical for sustaining performance improvement success.
PIVC catheters with integrated extension tubing can reduce staff blood exposure.

Abstract

Background: Insertion of peripheral vascular access devices (PIVC) is fundamental to patient care and may affect patient outcomes. Baseline data of PIVC insertions at a large medical center revealed that catheters required multiple insertion attempts, catheter hubs were manipulated to place extension sets, increasing the risk of complications, dwell times did not meet current standards, nurses experienced blood-exposure risk, and overall compliance with the hospital documentation policy was suboptimal. A 3-phase quality improvement project was conducted to address these concerns.

Methods: In Phase 1, an assessment of the current state of PIVC insertions and care was conducted using a mixed-methods approach consisting of an observational audit of insertion and maintenance practices, and retrospective chart reviews. In Phase 2, PIVC policies and practices were updated to reflect current standards. A new advanced design PIVC device was adopted, and education was provided to all staff. In Phase 3, the impact of these changes on key PIVC measures was assessed 1 year later.

Results: The analysis of the data found several improvements following implementation of an integrated IV catheter system: first-stick success rate increased from 73% to 84%, staff blood exposure was reduced from 46.67% to 0% (P = .01), improper securement of PIVC catheters was reduced from 11% to 0% (P = .002), and documentation compliance rate increased from 68% to 80%. The median PIVC dwell time doubled (from 2 days to 4 days).

Conclusion: Changes to policy, practices, and products plus education can improve the PIVC first-stick success, dwell time, documentation, and staff safety.

Highlights

Central venous catheter care may be complicated by complex patient considerations.
Central-line associated bloodstream infection risk factors are multifaceted.
Case report to highlight patient complexity that challenges bundled practices.

Abstract

Central venous catheters are necessary in treatment and care of pediatric patients with short gut syndrome. Despite necessity, central venous catheters come with the risk of developing central line associated blood stream infections (CLABSI). This manuscript describes a complex, pediatric gastroenterology patient with multiple risk factors who developed a CLABSI. Short gut syndrome patients can develop skin conditions and complications that may challenge nursing practice to mitigate CLABSI. Further research is needed on preventing CLABSIs in complex pediatric patients to provide the best practice implications for nursing.

Highlights

In a neonatal population peripheral infusion therapy related complication rates up to 75%.
Peripheral IV infiltration and extravasation (PIVIE) is implicated up to 65% of IV related complications.
PIVIE injury has the potential to cause serious harm.
Prompt recognition and timely appropriate intervention can mitigate many of these risks.
Adhering to the 5Rs for Vascular Access optimizes infusion therapy and potentially reduces complications.

Abstract

Introduction: Intravenous therapy-related injury, its prevention, and treatment are ubiquitous topics of interest among neonatal clinicians and practitioners. This is due to the economic costs, reputational censure, and patents’ wellbeing concerns coupled with the possibility of potentially avoidable serious and life-long harm occurring in this vulnerable patient population.

Case description: A term infant receiving a hypertonic dextrose infusion for the management of hypoglycemia developed a fulminating extravasation shortly after commencement of the infusion. This complication developed without notification of infusion pump pressure changes pertaining to a change in blood vessel compliance or early warning of infiltration by the optical sensor site monitoring technology (ivWatch®) in use. The injury was extensive and treated with a hyaluronidase/saline mix subcutaneously injected into the extravasation site using established techniques. Over a period of 2 weeks, the initially deep wound healed successfully without further incident, and the infant was discharged home without evident cosmetic scarring or functional effects.

Conclusion: This article reports on a case of a term baby who postroutine insertion of a peripherally intravenous catheter showed an extreme reaction to extravasation of the administered intravenous fluids. We discuss the condition, our successful management with hyaluronidase, and the need to remain observationally vigilant of intravenous infusions despite the advances in infusion monitoring technology.

Full Issue PDF

President’s Message

Outgoing President’s Message 2021

PIVC Best Practices: A Path to Performance Improvement

Highlights

Abstract

Managing Central Venous Catheter Dressings: A Short Gut Syndrome Case Study

Highlights

Abstract

Treatment of a Neonatal Peripheral Intravenous Infiltration/Extravasation (PIVIE) Injury With Hyaluronidase: A Case Report

Highlights

Abstract

Establishing a Contingency Plan to Improve Patient Comfort During Peripherally Inserted Central Catheter Insertions: A Quality Improvement Effort ^CE

Highlights

Abstract

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

Step Into Leadership: Make a Difference on the AVA Board

Insertion and Maintenance of PICC for a Pediatric Patient with Epidermolysis Bullosa

A Quality Improvement PDSA to Evaluate the Effectiveness of Blood Diversion Using a Three-Way Connector During Blood Culture Collection

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

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President's Message

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