vascular access infection prevention
Patient Safety Enhanced Through Vascular Access Specialist Care
A Cochrane systematic review defines vascular access specialists and teams ( i . e ., VAS or VAST ) as any of the following ; infusion teams , intravenous teams , individual specialists ( nurse , doctor , respiratory therapist , radiological technologist , nurse practitioner , and physician assistant ) who have knowledge and skills , formal training , and who frequently perform insertion or manage VADs . 6
Vascular access devices ( VAD ) are used daily in almost all inpatient settings with a range of healthcare professionals sharing the responsibility for insertion , management , and removal of VADs . Vascular access catheter insertions are accepted as common invasive clinical procedures that expose patients to risks such as procedural pain , bruising , bleeding , vessel depletion , nerve injury , or infection , and , in extreme cases , death . 1 , 2 , 3 There is much variation and fragmentation in practices suggestive of opportunities to reduce risk and improve patient care . 4 One action to achieve positive outcomes is by shifting vascular access ownership to specially trained clinicians for ( i ) assessment , ( ii ) insertion , ( iii ) care maintenance , and ( iv ) education as is seen with vascular access or infusion teams . We have seen in the COVID-19 crisis an increased urgency for VAD placement and innovation in maintaining infusions outside patient rooms . Ensuring the placement of a reliable intravenous device in an optimal location designed to perform without complications was a high priority during this time of crisis .
We know the Centers for Disease Control and Prevention ( CDC ) has emphasized specialized teams as a method to reduce infections , complications , and cost of infusion therapy . 5 A Cochrane systematic review defines vascular access specialists and teams ( i . e ., VAS or VAST ) as any of the following ; infusion teams , intravenous teams , individual specialists ( nurse , doctor , respiratory therapist , radiological technologist , nurse practitioner , and physician assistant ) who have knowledge and skills , formal training , and who frequently perform insertion or manage VADs . 6 Teams and individual specialist functions will vary , but commonly include the insertion and maintenance of some or all vascular access devices . Given the growing complexity in patient needs , a unique specialist discipline , namely the vascular access specialist ( VAS ), is needed to deliver efficiently and safely the prescribed intravenous treatment plan .
The No . 1 fear of patients entering a hospital is fear of pain associated with needles . The evidence to date is suggestive that the highest achieving system of initiating and delivering treatment to patients in acute care is tied to a purpose-driven group of skilled individuals and the processes that guide their practices . 7 Starting an intravenous device is
• often associated with repeated attempts following insertion failures leading to increased patient risk of complications . Evidence supports the value of specially trained individuals that have greater first-time success with fewer insertion attempts , and lower infection rate associated with intravenous or arterial device insertion . 11 Patients indicate that inadequate skill level of those performing these types of procedures is a source of great dissatisfaction , while use of technology and increased skills of the VAS promotes higher satisfaction . 8 , 9 According to da Silva in 2010 , use of a specialized team increased first attempt success achieving 84 percent with one peripheral intravenous catheter ( PIV ) attempt and lower complications . 10 Complications associated with VADs relate to the skill and knowledge of the operator for insertion 11-14 and for post-insertion complications relate to maintenance by knowledgeable clinicians and patient specific risk factors . 15-18 Specialized education has led to infection prevention practices that reduce complications . 19-21 Advanced practice nurses and those teams receiving specialized training to perform insertions of all CVADs , working in collaboration with medical providers , offer valuable contributions to patient safety by performing ultrasound guided insertions with low incidence of complications . 22-27
Standards for infusion therapy call for an increase of teams to perform CVAD insertion , ultrasound guided peripheral insertions for difficult access patients , maintenance , and removal of devices when no longer needed to promote patient safety and better outcomes . Other functions embraced by these specialists may include patient access for difficult blood draws , use of ultrasound guidance for any or all of the insertion and assessment functions , dressing changes for central catheters , careful daily assessment and monitoring of dressing and insertion site for complication identification , and daily evaluation of catheter necessity with removal of unnecessary catheters . Additionally , they provide a professional point of care for education and resource of VAD queries for device maintenance and management .
Patient-focused safety initiatives should apply evidence of improved outcomes such as those represented in establishing and maintaining effective vascular access teams . 28 The value of specialized teams for insertion and management of vascular access is