Volume 27: Issue 1

Continuing professional development—or more informally, continuing education (CE)—is an important core competency and member benefit of the Association for Vascular Access (AVA). It is why so many of our 3200 members and 7000 guests have embraced our vast array of digital education over the past 2 years of COVID-19. Never before have the healthcare professions seen such a dramatic shift from the comfortable and familiar face-to-face seminars, conferences, and local events to the dynamic delivery of impactful webinars, podcasts, and online education. While I believe it is safe to say that we all miss the personal interaction with our peers,

Highlights

The Central Line Securement Vest is a novel medical device for pediatric patients.
This study presents a cohort of patients with intestinal failure who use the vest.
We compare rates of multiple adverse events 12 months before and after vest usage.
The rate of line infections and trauma were lower after vest usage.
The remaining outcomes were comparable before and after vest usage.

Abstract

Background:

Tunneled central lines are used to deliver medications, hydration, and total parenteral nutrition. The current modality for their securement is by a transparent sterile adhesive. Mechanical line traumas, including line fissures, breaks and dislodgements, occur frequently in children. A novel device, the Central Line Securement Vest, was created to protect central lines from mechanical trauma.

Objective:

We present here our experience with the device and report its use in patients with intestinal failure treated at our institution.

Methods:

All patients who have used the Central Line Securement Vest at our institution during the last decade were identified. We reviewed the patients’ electronic records and compared the rate of line mechanical trauma, line infections, line replacements, Emergency Department (ED) visits, and hospital admissions for a period of 12 months before and after the use of the device.

Results:

Ten patients were identified. Four patients had purchased the device at the time of line insertion. Six patients had a period of time of line use before beginning use of the device. The rate of line traumas and infections decreased after using the device: 0.19 ± 0.15 vs 0.05 ± 0.04 trauma/month, pre– vs post–device use, P < 0.05. Similarly, the rate of line infections decreased post–device use: 0.18 ± 0.13 vs 0.09 ± 0.06 infections/month, pre– vs post–device use, P < 0.05. The rate of line replacements, ED visits, and hospital admissions were similar pre– and post–device use.

Conclusion:

We report here our institution’s experience with a novel central line securement device designed to protect the line from mechanical trauma.

Highlights

The first in-depth global study on underresearched facets of VAT initiatives.
VA professionals interviewed universally endorsed the benefits of specialized VATs.
Participants reported improvements in patient satisfaction and clinical efficiency.
Nonclinical personnel on VATs can alleviate barriers to data collection or analysis.
Collaborations, data tracking, and outcomes dissemination can serve as VAT metrics.

Abstract

Background:

Specialized vascular access training for medical professionals organized into vascular access teams (VATs) was shown to improve patient outcomes, clinical efficiency, and cost savings. Professional perspectives on VAT benefits, organization, challenges, and opportunities on a global scale remain inadequately explored. Using detailed perspectives, in this study, we explored the global VAT landscape, including challenges faced, clinical and clinico-economic impacts of VATs, with emphasis on underresearched facets of VAT initiation, data dissemination, and metrics or benchmarks for VAT success.

Methods:

Semistructured in-depth interviews of 14 VAT professionals from 9 countries and 5 continents were used to elicit qualitative and quantitative information.

Results:

Catheter insertions (100%) and training (86%) were the most performed VAT functions. Based on a 1–7 scale evaluating observed impacts of VATs, patient satisfaction (6.5) and institutional costs (6.2) were ranked the highest. VAT co-initiatives, advanced technology utilization (6.6), and ongoing member training (6.3) distinctly impacted VAT endeavors. Most institutions (64%) did not have routine mechanisms for recording VAT-related data; however, all participants (100%) stated the importance of sharing data to demonstrate VAT impacts. Time constraints (57%) emerged as one of the major deterrents to data collection or dissemination. The majority (64%) experienced an increased demand or workload for VAT services during the COVID-19 pandemic.

Conclusions:

Despite the global variances in VATs and gaps in VAT-related data, all participants unanimously endorsed the benefits of VAT programs. Evaluating the impact of VATs, disseminating VAT-related data, and forging specialized institutional partnerships for data sharing and training are potential strategies to tackle the hurdles surrounding VAT formation and sustenance.

Highlights

Chest x-rays are not needed after imaging-guided placement of tunneled catheters.
Catheter position should be confirmed by a validated method in the operating room.
Postoperative imaging should be reserved only upon clinical need or line malfunction.

Abstract

Background:

A postoperative chest x-ray (CXR) remains part of some hospital protocols following tunneled hemodialysis catheter placement despite the use of operative imaging-guided techniques. The aim is to assess the usefulness of this practice and its impact on clinical outcomes and resource use.

Methods:

A review of medical records and postoperative CXR was done for 78 adult patients who had tunneled hemodialysis catheters placed in the operating room under fluoroscopy guidance. Catheters were inserted by ultrasound-guided puncture (51.3%) or exchanged from an existing catheter over a guide wire (48.7%). The postoperative CXRs were also examined by an independent reviewer to assess the catheter tip position and the need for repositioning to mimic a real-life postoperative setting. Procedural, nursing, and billing records were also reviewed.

Results:

No patients had a pneumothorax or major complications. On postoperative CXRs, 29 (37.2%) patients had the catheter tips in the right atrium, 23 (29.5%) in the cavoatrial junction, 25 (23.1%) in the superior vena cava, and 1 (1.3%) in the brachiocephalic vein. The independent reviewer found the catheter tips in acceptable anatomical positions in 75 of 78 patients. Only 3 (3.9%) patients had catheter malfunctions during dialysis and exchanged their catheters (2 had high catheters in the superior vena cava and brachiocephalic vein, 1 had a kinked catheter). Postoperative CXRs also caused delays in patient discharge from postanesthesia care units and significant increases in medical expenses (around $199 per patient).

Conclusion:

Routine CXR after tunneled hemodialysis central venous catheter insertion is unnecessary and does not add to the procedure’s safety or to the patient’s outcome.