Special Edition on Vascular Access October 2020 | Page 21

As the COVID-19 pandemic continues , it has highlighted the need to transform clinical practices around vascular access device choice , use and care , and to focus on infection control practices .” serious procedural process , not simply a task . Demographic factors , patient disease states , previous device history ( and failures ), vasculature assessment , knowledge of medication and infusate characteristics , and duration of therapy , are several key knowledge areas where these professionals provide higher levels of expertise . Should the requirement of a more appropriate device be beyond the scope of the clinician , the specialist will advocate for the patient and collaborate with interdisciplinary teams to ensure the correct device is placed in a timely fashion . This requires other clinicians to acknowledge that vascular access is a specialty area , not simply a performed task .
The recent COVID-19 pandemic has shaken the healthcare community . It has also further determined the need for vascular access specialists in healthcare facilities . The opportunity to correct any substandard practices , inappropriate placements , decreased device failure and improve patient experiences and outcomes is nigh .
New decisions for vascular access requirements under current COVID-19 conditions have forced significant challenges for all . Scoppettuolo , et al . ( 2020 ) recently outlined providing maximal safety around vascular device choices when dealing with COVID-19 patients . These ranged from peripheral to central devices and the appropriateness of insertion techniques utilized . Social media accounts have been flooded with images of pumps with intravenous tubing extended out the door , one-time masks placed in paper bags and hanging to be used for the shift or the week , highlighting major infection prevention strategies that required attention . While this may not be appropriate in many U . S . facilities , there has been much learned regarding infection control practices from these experiences . COVID-19 patients may have varying degrees in severity of illness , and the critically ill COVID-19 patient often requires centrally inserted central catheters ( CICCs ) and arterial catheters or may receive a peripherally inserted central catheter ( PICC ), often placed by vascular access specialists .
It is imperative to reduce unwarranted exposure to other patients , staff , and clinical areas , therefore not moving these patients throughout the facility is paramount . Vascular access clinicians often place various vascular access devices under demanding conditions , which may include patients in prone positions , including alternate exit sites and mid-thigh femoral PICCs ( Ostroff and Chopra , 2019 ; Girgenti and Pieroni , 2019 : Ostroff and Pittiruti , 2020 ). This level of expertise and skill is often only experienced with dedicated vascular access clinicians , as many physicians have not placed a PICC , let alone a mid-thigh PICC .
Humeniuk , et al . ( 2020 ) described the use of Remdesivir for seven to 14 days in COVID-19 patients not requiring critical care , and reported irritation , extravasation and site dermatitis among reported complications of the study . This could have been avoided with appropriate device selection and placement by a vascular access or infusion therapy specialist – highlighting that an extended dwell catheter or a midline catheter may have been more suitable for the treatment regimen , based upon vasculature assessment of the patient . Hospitals without a vascular access specialist team may have a number of clinicians attempting peripheral access without the use of ultrasound , increasing their risk of placement failure and not facilitating thorough patient assessment . This approach may increase the risk of exposure to COVID-19 , misuses resources , and ultimately delays therapy , care and decreases patient satisfaction .
As the COVID-19 pandemic continues , it has highlighted the need to transform clinical practices around vascular access device choice , use and care , and to focus on infection control practices . With this in mind , it is expected that facilities will be required to develop updated local policies for vascular access device placement in these patients . In the immediate pandemic timeframe , it is imperative to assist facilities to reduce the unnecessary waste of resources and provide impactful patient care and outcomes with vascular access specialists who are passionate , skilled experts in providing quality vascular access .
Constance Girgenti , BSN , RN , VA-BC , has been a nurse for more than 25 years , specializing in neonatal nursing and vascular access . She is currently the national clinical educator for Vygon USA and a vascular access specialist at Amita Saint Joseph Medical Center .
Timothy R . Spencer , RN , APRN , BHSc , Dip . App . Sc ., Int . Care Cert ., VA-BC™ , is a critical care and vascular access specialist of 30-plus years and is currently the director of Global Vascular Access , LLC .
References :
Helm RE , Klausner JD , Klemperer JD , Flint LM , Huang E . Accepted but unacceptable : peripheral IV catheter failure . Journal of Infusion Nursing . 2015 May 1 ; 38 ( 3 ): 189-203 . https :// doi . org / 10.1097 / NAN . 0000000000000100
Helm RE . Accepted but Unacceptable : Peripheral IV Catheter Failure : 2019 Follow-up . Journal of Infusion Nursing . 2019 May 1 ; 42 ( 3 ): 149-50 . https :// doi . org / 10.1097 / NAN . 0000000000000324
Rickard CM , Webster J , Wallis MC , Marsh N , McGrail MR , French V , Foster L , Gallagher P , Gowardman JR , Zhang L , McClymont A . Routine versus clinically indicated replacement of peripheral intravenous catheters : a randomised controlled equivalence trial . The Lancet . 2012 Sep 22 ; 380 ( 9847 ): 1066-74 . https :// doi . org / 10.1016 / S0140-6736 ( 12 ) 61082-4
Marsh N , Webster J , Larsen E , Genzel J , Cooke M , Mihala G , Cadigan S , Rickard CM . Expert versus generalist inserters for peripheral intravenous catheter insertion : a pilot randomised controlled trial . Trials . 2018 Dec 1 ; 19 ( 1 ): 564 . https :// doi . org / 10.1186 / s13063-018-2946-3
Humeniuk R , Mathias A , Cao H , Osinusi A , Shen G , Chng E , Ling J , Vu A , German P . Safety , Tolerability , and Pharmacokinetics of Remdesivir , an Antiviral for Treatment of COVID‐19 , in Healthy Subjects . Clinical and translational science . 2020 Jun 26 . https :// doi . org / 10.1111 / cts . 12840
Moureau NL , Carr PJ . Vessel Health and Preservation : a model and clinical pathway for using vascular access devices . British Journal of Nursing . 2018 Apr 26 ; 27 ( 8 ): S28-35 . https :// doi . org / 10.12968 / bjon . 2018.27.8 . S28
Carr PJ , Higgins NS , Cooke ML , Mihala G , Rickard CM . Vascular access specialist teams for device insertion and prevention of failure . Cochrane Database of Systematic Reviews . 2018 ( 3 ). https :// doi . org / 10.1002 / 14651858 . CD011429 . pub2
Scoppettuolo G , Biasucci DG , Pittiruti M . Vascular access in COVID-19 patients : smart decisions for maximal safety . Journal of Vascular Access , First Published May 5 , 2020 https :// doi . org / 10.1177 / 1129729820923935
Ostroff MD , Chopra V . thinking outside the box the mid thigh femoral vein central venous catheter . Journal of Anesthesia and Surgical Reports . 2019 Nov 27 . https :// doi . org / 10.29011 / JASR-116.100016
Ostroff MD , Pittiruti M . Alternative exit sites for central venous access : Back tunneling to the scapular region and distal tunneling to the patellar region . The Journal of Vascular Access . 2020 Jul 9:1129729820940178 . https :// doi . org / 10.1177 % 2F1129729820940178
Girgenti C , Pieroni S . Complex vascular access : mid-thigh femoral peripherally inserted central catheter placement . The Journal of Vascular Access . Dec . 1 , 2018 . https :// doi . org10.1016 / j . java . 2018.07.005
Vascular Access Imperatives • oct 2020 • www . healthcarehygienemagazine . com
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