Vascular Access Specialists : Providing Quality Care Under Pandemic Conditions
By Constance Girgenti , RN , BSN , VA-BC TM and Timothy R . Spencer , RN , APRN , BHSc , Dip . App . Sc ., Int . Care Cert ., VA-BC TM
Establishing reliable peripheral venous access is the foundation of any parenteral treatment for patients requiring intravenous medications , however , it is considered a skill that all nurses are expected to master . Published evidence indicates that this is not a reasonable expectation for all nurses to have the skill to start a PIV ( Marsh , et al ., 2018 ).
Patients now have greater chronic illnesses , with additional comorbidities and a higher risk of mortality . These rising incidences of chronic diseases , increase the number of hospitalization visits , requiring complex care plans that include multiple medication regimens . Parenteral therapies in chronic disease conditions can become complex and require thoughtful planning , and often multiple medications are initiated and frequently administered primarily with the use of a peripheral intravenous cannula ( PIVC ).
Patients with difficult vascular requirements are often given a label of difficult intravenous access ( DiVA ); the need for the most appropriate and reliable vascular access device is an essential decision that should be made early in the treatment planning process . The risks associated with inappropriate device choice often
The risks associated with inappropriate device choice often lead to patient-related complications and device failures , such as dislodgement , infiltration , extravasation , superficial thrombosis , and infection , are frequently overlooked and underestimated .
lead to patient-related complications and device failures , such as dislodgement , infiltration , extravasation , superficial thrombosis , and infection , are frequently overlooked and underestimated . This consortium of complications , as discussed by Helm ( 2015 ), described the “ accepted but unacceptable failure ” rates of peripheral intravenous devices as high as 63 percent . These device-related failures were echoed on a global scale ; Alexandrou , et al . ( 2017 ) found that many PIVCs were placed in areas of flexion , were symptomatic or idle , had suboptimal dressings , and lacked adequate documentation . This study suggested great inconsistencies between recommended management guidelines for PIVCs and current practices . There is no other procedure performed in healthcare today that has such a high failure rate as a frequently labeled “ innocent ” PIVC .
Patient care is becoming increasingly complex and time-competitive , and it ’ s often the bedside clinicians that manage many aspects of the patient ’ s care . The bedside clinician frequently performs many roles , also adding the responsibilities and challenges of establishing and maintaining peripheral and central venous access devices to maintain this continuity of patient therapies . Repeatedly complicating the situation , is the lack of much-needed education to the complexities of vascular access device placement , care and maintenance , as well as infusion therapies .
A solid comprehension of the current evidence is a key factor for all clinicians to fully understand and mitigate risks associated with vascular access . Patients have often described experiencing multiple attempts to have a peripheral device inserted , and often in inappropriate places such as a thumb , pinkie finger , or even in the foot or breast tissue ; these are all unacceptable but unfortunately , accepted . The current evidence suggests that the average number of attempts to establish access is 2.5 times , and the average dwell for a peripheral is 2.1 days . Considering that 68 percent of peripheral devices are placed for antibiotics for seven to 14 days , any patient is at risk of having between 8.75 to 17.5 attempts to complete the prescribed therapy ( Rickard , et al ., 2015 ).
The management of peripheral access in this manner may be cost-prohibitive , decrease facility-wide efficiencies and be detrimental to patient vessel health and preservation strategies ( Moureau , et al ., 2018 ). Healthcare leadership has an obligation to consider the costs associated with each failed attempt , from patient experience , equipment and materials , procedural time , infection risk , delays in treatment / medications and patient length of stay . Helm ( 2015 ) states that “ the insertion of an IV catheter is an invasive procedure that introduces multiple risks and potential morbidities , and even mortality , and should be given the respect it deserves .” This could never have been said more accurately to describe what is often considered as “ it ’ s just an IV .” Helm ( 2019 ) revisited the literature and the clinical practices within his facility four years after the initial publication and determined that while there had been significant efforts put forward by expert clinicians in the field , and by an industry , the underlying cause of PIVC failure had not changed . However , catheter failure and its sequelae are far less accepted and the need for improvement is now firmly recognized .
The value and impact of a dedicated vascular access specialist or team is now well established . Marsh , et al . ( 2018 ) describes less insertion failure and less post-insertion failure occur when catheters are placed by a vascular access or infusion therapy specialist . This was also supported with Cochrane systematic review performed by Carr et al ( 2018 ). A group of dedicated , skilled specialists in vascular access , that understand the latest evidence and can implement these best practices for device insertion , will continue to enhance patient outcomes .
A vascular access or infusion therapy specialist considers many clinical factors when assessing the patient , and consider this a