Volume 29: Issue 3

Gregory E. Gilbert

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Carl Zipperlen

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Lance Cho

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An educational column by

In this Foundational Support column, we provide a parallel description of the phases of clinical trials, and device trials so vascular access specialists and other healthcare practitioners gain a better overall understanding of the process for drug and device development. Although many similarities exist between

Highlights

The United States purchases an estimated 350 million PIVCs annually.
PIVC insertion is the most frequently performed invasive procedure in healthcare.
There is multidisciplinary and multi-organizational collaboration.
PIVC insertion and maintenance is underappreciated in U.S. healthcare.
There is a fundamental lack of awareness regarding associated risks.
Patients knowingly and unknowingly accept substandard care.

Abstract

Background:

The insertion of a peripheral intravenous catheter (PIVC) is the most commonly performed invasive procedure in healthcare. Despite its frequency in placement in hospitalized patients, PIVCs are generally perceived as being safe; however, the prevalence of failure ranges from 35%-50%. Additionally, complications are common and often deemed “acceptable” by clinicians. Healthcare provider and clinician foundational knowledge and competency is lacking nationally. Considering the mere volume of PIVCs placed, the failure and complication rates, the human impact is significant.

Methods:

The Association for Vascular Access (AVA) has led a collaborative effort with representatives from the Infusion Nurses Society (INS), the American Association of Critical Care Nurses (AACN), ECRI, and content experts representing nursing vascular access, infusion therapy, infection prevention, critical care, pediatrics, healthcare leadership, a physician, and a patient representative. Our aim is to provide concise guidance that will enhance and standardize practices related to peripheral intravenous catheters (PIVC). By consolidating current standards of practice into a comprehensive document, our framework seeks to advance the quality of care and improve patient safety.

Results:

This document has undergone meticulous scrutiny to ensure its quality; including incorporation of current standards, methodology for consensus from the expert panel, and input received from public comments.

Conclusions:

We anticipate that this work will have a significant impact on healthcare professionals, policymakers, and, most importantly, patients’ experiences by the promotion of consistent, high-quality treatment, safety, and comfort for patients receiving a PIVC.

Highlights

Biplane ultrasound imaging reduces need for probe manipulation during procedure.
Providers note clinical benefit of biplane ultrasound imaging for vascular access.
Biplane disadvantages include probe size, imaging quality, size of the screen.
Thorough didactic and practical education is essential for biplane success.

Abstract

Background:

Use of ultrasound guidance for vascular access procedures is commonplace in inpatient and outpatient care settings. Standard ultrasound probes offer the operator a single-plane view, necessitating rotation of probe to attain dual complimentary views. This mechanical probe rotation increases technical difficulty of ultrasound use. The purpose of this study is to evaluate the rate of cannulation success and efficiency of a synchronous biplane ultrasound mode in ultrasound-guided arterial line placement as compared with a standard single-view ultrasound mode in the operating room setting.

Methods:

Patients scheduled for elective surgery in which a radial arterial catheter would be used for hemodynamic monitoring were approached for consent to this study. Patients were randomized to either undergo placement with single-plane view versus synchronous biplane view; outcomes were recorded. Providers were provided preprocedural ultrasound education as well as the option of a short hands-on experience; their level of experience was noted.

Results:

Placement time of a peripheral arterial catheter was longer and required more attempts to be successful using synchronous biplane imaging as compared with single-plane imaging across providers of all skill/experience levels. Subjectively, providers noted the benefit of synchronous biplane imaging in vascular access; however, disadvantages including probe size, quality of imaging, and size of the screen were noted.

Discussion:

Thorough education regarding the use and functionality of biplane synchronous imaging in vascular access is essential. Additional guided-practice time with experienced operators could also be helpful to overcome the challenges observed in this study.

Highlights

Superior vena cava (SVC) syndrome with central thoracic vein occlusion associated with the use of intravascular devices, such as a catheter for dialysis, is increasing and involves younger patients.
In dialytic patients it is imperative to preserve venous access, particularly for whom who will rely on dialysis for an extended duration; endovascular venous reconstruction is the recommended treatment but there are not standardized guidelines about the type of stent and technique.
In our complex case, for the central vein occlusion, a mixed double barrel and Y approach technique was adopted using bare-metal stent (16 × 80 mm Sinus XL-Flex, Seda) and covered stent (VBX, Gore), to achieve a good clinical result.

Abstract

Superior vena cava (SVC) syndrome with central thoracic vein occlusion associated with the use of intravascular devices is increasing and involves younger patients.

Hemodialysis patients are at higher risk for central vein occlusion and symptomatic SVC syndrome. It is imperative to preserve venous access, particularly for younger patients who will rely on dialysis for an extended duration. Endovascular venous reconstruction is the recommended treatment but there are not standardized guidelines about the type of stent and technique.

In the present case report the primary objective was to resolve the central vein occlusion and maintain vein patency through double barrel and Y technique together, employing bare metal and covered stents.

Does Size Really Matter? A Systematic Review and Meta-Analysis Says It Does!!

Kimberly G. Alsbrooks, BSN, RN, RT(R), VA-BC

kim.alsbrooks@bd.com

Purpose: Peripherally inserted central catheters (PICCs) are increasingly being used in vascular access for the delivery of medication, anesthesia, chemotherapy, and/or parenteral nutrition. Nonetheless, PICC-associated complications do exist, such as thrombosis, and may result in adverse patient outcomes and treatment delays. Despite these complications, PICCs are ideal for gaining central access when compared with other catheters, as they may be more cost effective and can be conveniently placed by a dedicated vascular access specialty team.

Background: Deep vein

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