➊ The VAD selected has the lowest risk for insertion location , device size not to exceed 33 percent of vein diameter , length , and number of lumen , and is the most appropriate to deliver the treatment . The aim for the patient is greater comfort with reduction of the risk of complications .
➋ Standard-ANTT or Surgical-ANTT is used for insertion , device management , dressing care , and medication administration with hub disinfection .
➌ The VAD is individualized to patient-specific condition and medical history and placed in a suitable anatomical position to optimize dressing adherence and securement to minimize movement and reduce risk of premature failure .
➍ The number of IV attempts is limited and will be performed by well-trained , qualified inserters supervised for competency .
➎ The VAD is assessed for complications , dressing adherence , and flushed with normal saline to evaluate device function at least daily in acute care and removed when device is no longer needed , and treatment is complete .
➏ The VAD is monitored and maintained by trained , competency-assessed clinical staff who receive consistent education on best practices for management of intravenous devices . Evaluation and education are provided on a timely and consistent basis to all clinical staff in connection with routine care and with any negative outcomes ( assumes monitoring and reporting of all outcomes ).
➐ Concentrate medical product usage on those with scientifically studied and published evidence of positive patient outcomes .
Moureau ( 2019 ) emphasizes that , “ Through the delivery of these seven trust points , patients maintain confidence in the healthcare system , avoid unnecessary costs and interventions , and achieve greater satisfaction with their healthcare centers all consistent with VHP precepts .”
And as Moureau ( 2019 ) observes , “ Comprehensive assessment and selection of the best vein and insertion location , performed by a highly skilled inserter using the most appropriate device , managed in a precise way , and removed at the right time is a process that requires commitment to education , policy development , and specialized clinicians . For facilities fortunate enough to have specialists or speciality teams performing insertion and assessment , the VHP process becomes intuitive . When bedside nurses , physicians , and others are responsible for single steps in the process ,
fragmentation results and the patient suffers . The evidence suggests that reduction of fragmentation , by establishing a pathway and teaching a structured process to all stakeholders reduces complications with IV therapy , improves efficiency and diminishes cost .”
Acute-care ’ s quick pace and competing priorities have created an environment where proper technique has not always been possible , confirms Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC , the CEO of PICC Excellence , Inc .
“ Hospitals and clinicians work from a crisis and convenience point of view for device insertion ,” she says . “ It is a task to be done as quickly as possible and move on . Find the easiest vein and stick a catheter into it . Get the job done with little thought to patient , safety , or optimal methods that make it last longer . Also , clinicians tend to cover up the total number of attempts . We know from hospital supply audits an average of six to 10 peripheral catheters per patient admission , more catheters than a normal patient would have successfully inserted and used .”
Moureau continues , “ By using the VHP approach and the demonstrated performance shown in the PIV5Rights ( Steere 2019 ) research for deliberate assessment and selection by trained vascular access specialists , the patient receives one or two catheters max for the average length of treatment . There is a huge financial impact and potential patient safety involved . Initial insertion is only one part of the story , as maintenance covers a longer period .”
Education and training around proper vascular access principles and practices goes to the heart of creating a better experience for the patient and the clinician .
As Alexandrou , et al . ( 2019 ) remind us , “ Insertion of IV devices is a highly technical , high-risk procedure with greater risk to patients when CVADs are inserted and used . The successful insertion of vascular devices relies on clinician expertise which is determined by training , credentialing and procedural volume .” They add further , “ Insufficient understanding of evidence-based assessment , selection , insertion and management of peripheral and central venous access devices leaves the patient at risk for more serious complications and the added trauma associated with frequent replacement of catheters .”
Clinicians know that inadequate training and education on vascular access theory and techniques can expose patients to unnecessary complications . As Alexandrou , et al . ( 2019 ) observe , “ The insertion of central venous access devices ( CVADs ) by operators with minimal experience or supervision can pose significant risk to patient safety . Serious adverse outcomes have been reported from procedural complications related to CVAD insertion that have contributed to patient morbidity and mortality . These
Comprehensive assessment and selection of the best vein and insertion location , performed by a highly skilled inserter using the most appropriate device , managed in a precise way , and removed at the right time is a process that requires commitment to education , policy development , and specialized clinicians .”
— Nancy Moureau , RN , PhD , CRNI , CPUI , VA-BC , the CEO of PICC Excellence , Inc .
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