vascular access infection prevention
Patient-Focused Care with Vascular Access Bundles
Most patients entering acute-care receive therapies via an intravenous access device . The success of therapy is , to some degree , contingent on the success of the device used to deliver the medications . Improving success and function of vascular access device is done through the application of research for key practices points by clinicians and administrators . Research can be effectively integrated into a bundle of patient care measures to establish , maintain , and insure the most positive outcomes . Best practice bundles for vascular access devices have resulted in infection reduction , minimized supply usage , improved through-put of patient care and reduced length of stay that puts the well-being of the patient first for a patient focused care approach .
A care bundle is a structured way of applying research and recommendations for improving the processes of care and patient outcomes . The care bundle is described as a small , straightforward set of evidence-based practices of generally three to five components that , when performed collectively and reliably , have been proven to improve patient outcomes according to the Institute for Healthcare Improvement ( IHI ) (
http :// www . ihi . org / Topics / Bundles / Pages / default . aspx ).
1 Most important to this issue is the concept that a bundle is a cohesive unit of steps must all be completed to succeed ; the “ all or none ” feature is the source of the bundle ’ s power .
2-4 Other bundle criteria include that only practices based on level 1 or A graded evidence should be included in a bundle .
Evidence is expanding in support of specialized vascular access assessment , selection , insertion of vascular access devices with practices and teams that reduce the number of unsuccessful insertion attempts , catheter failure , and minimize complications . A recent study “ Reaching One Peripheral Intravenous Catheter ( PIVC ) Per Patient Visit With Lean Multimodal Strategy : the PIV5Rights Bundle ” reported how a bundle of practices led to improved patient outcomes with PIVCs and significant financial savings . 5 Elements of the bundle that contributed to their success included the right proficient nurse inserter , the right insertion method , the right vein and catheter selection , the right supplies and technology , and the right assessment for care and maintenance . Each of these right practices are supported by a body of A through D graded evidence . 6 The evidence for each of the individual components of the care bundle must be considered separately , but ultimately the bundle is a combination of actions , that when all are applied , result in better outcomes for the patient and healthcare facility .
Integration of a skilled and proficient inserter to assess , select the best insertion site and method , choose the best catheter and length for the therapy and individual patient characteristics , organize the most appropriate supplies , and use ultrasound when needed , creates the best scenario for patient intravenous access . The results of the PIV5Rights study are consistent with these components and reflect a positive impact of the proficient ultrasound trained nurses for fewer number of attempts , longer dwell time for intravenous catheters , with meaningful differences in fewer complications or failed PIVCs when comparing the specialist to the generalist nurse .
Financially , this type of proficient nurse and care bundle makes sense . The impact of the use of the generalist model for peripheral catheter insertions represents lost revenue and waste in terms of high supply usage with multiple attempts and shorter dwell time . The global financial burden for premature PIVC failure is conservatively estimated to range from $ 9.8 billion to $ 17.5 billion annually by calculating the reported PIVC failure rates of 35 percent to 50 percent multiplied by the estimated 1 billion PIVCs inserted each year worldwide , and integration of the published uncomplicated PIVC procedure cost range of $ 28 to $ 35.6 . 7 , 8 Hospitals are under intense pressure to improve the quality of patient care while reducing total cost of care . One of the primary strategies to accomplish this is to use evidence-based practices such as the care bundle to minimize the unnecessary clinical variation that regularly occurs with invasive procedures .
Application of these type of bundled patient focused approaches result in the overall improvement of the patient experience . The goal in provision of healthcare is to promote health . The best practices identified in the PIV5Rights care bundle demonstrate a process for improving patient satisfaction , while reducing complications and cost . The Alliance for Vascular Access Teaching and Research ( AVATAR ), a research group based in Australia , says it best with their ‘ Making Complications History ’ campaign . 9 This group performs randomized controlled trials and research designed to guide practices to improve patient safety with vascular access devices . Care bundles and education for clinicians on the results of this type of research contribute to healthcare improvement establishing a patient focused approach that may lead to the eradication of vascular access complications .
Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC , is the chief executive officer at PICC Excellence , Inc ., a research member of the Alliance for Vascular Access Teaching and Research ( AVATAR ) Group , and an adjunct associate professor at Griffith University in Brisbane , Australia .
References :
1 . Sacks G , Diggs B , Hadjizacharia P , Green D , Salim A , Malinoski D . Reducing the Rate of Catheter-associated Bloodstream Infections in a Surgical Intensive Care Unit Using the Institute for Healthcare Improvement Central Line Bundle . American Journal of Surgery . 2014 ; 207 ( 6 ): 817-823 .
2 . Lavallée JF , Gray TA , Dumville J , Russell W , Cullum N . The effects of care bundles on patient outcomes : a systematic review and meta-analysis . Implementation Science . 2017 ; 12 ( 1 ): 142 .
3 . Sayin Y . What is A Care Bundle ? Florence Nightingale Hemşirelik Dergisi . 2017 ; 25 ( 2 ): 145-151 .
4 . Fulbrook P , Mooney S . Care bundles in critical care : a practical approach to evidence-based practice . Nursing in critical care . 2003 ; 8 ( 6 ): 249-255 .
5 . Steere L , Ficara C , Davis M , Moureau N . Reaching One Peripheral Intravenous Catheter ( PIVC ) Per Patient Visit with Lean Multimodal Strategy : the PIV5Rights™ Bundle . Journal of the Association for Vascular Access . 2019 ; 24 ( 3 ): 31-43 .
6 . Moureau N , and Steere L . Theoretical Methodology and Systematic Evidence Review of the PIV5Rights Care Bundle . Association for Vascular Access at Your Fingertips Virtual Conference 2020 . Poster Presentation .
7 . Helm RE , Klausner JD , Klemperer JD , Flint LM , Huang E . Accepted but Unacceptable : Peripheral IV Catheter Failure . Journal of Infusion Nursing . 2015 ; 38 ( 3 ): 189-203 .
8 . Alexandrou E , Ray-Barruel G , Carr PJ , et al . Use of Short Peripheral Intravenous Catheters : Characteristics , Management , and Outcomes Worldwide . Journal of hospital medicine . 2018 ; 13 ( 5 ).