Vessel Health and Preservation: The Right Approach for Vascular Access

302 Pages·2019·11.095 MB·English

by  Nancy L. Moureau

Vessel Health
and Preservation:
The Right Approach for
VVaassccuullaarr AAcccceessss
Nancy L. Moureau
Editor
Vessel Health and Preservation:
The Right Approach for Vascular Access
Nancy L. Moureau
Editor
Vessel Health and
Preservation: The Right
Approach for Vascular
Access
Editor
Nancy L. Moureau
Griffith University
Nathan, QLD
Australia
This book is an open access publication
ISBN 978-3-030-03148-0 ISBN 978-3-030-03149-7 (eBook)
https://doi.org/10.1007/978-3-030-03149-7
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Foreword
In 2007, clinicians were considering ideas to determine the use of the right
line, for the right patient, at the right time. Multiple stakeholders suggested an
algorithm would meet the requirement for guiding clinicians in the decision
for device selection; however, I believed it did not fully address the ever-
changing dynamics of patient-centred vascular access management. As it
turned out, there were other clinicians who held the same belief.
Communication commenced among industry partners and practising clini-
cians and, thus, began a new initiative for reducing healthcare and economic
risks associated with vascular access use and delivery of infusion therapies.
The proposed initiative was founded upon a philosophy in which a patient’s
vasculature and historical use of veins for infusion therapy would be consid-
ered and prioritized as a key healthcare objective. This objective required
patient-specific vascular access assessment from an emergency department
visit through admission, discharge and beyond. The vision for patient-s pecific
vessel health and preservation was clear; however, a defined and measurable
process was not. It would take a practising clinical partner who understood
not only evidence-based research around infusion therapy but also the practi-
cal use of vascular access devices, someone with a documented track record
of embracing a vision and turning it into an actionable plan. Enter Nurse
Consultant; Nancy L. Moureau. With industry support, an investment com-
mitted to the vision allowed Nancy L. Moureau and me to create a foundation
for a process which eventually became known as Vessel Health and
Preservation (VHP).
‘The Nancy’s’, as we were called, understood driving sustainable change
in clinical practice would require a ‘think tank’ of cross-functional key opin-
ion leaders, those who were in the vascular access device trenches every day.
These selected individuals saw what fragmented and convenience-based
device use could do to patients and to their healthcare systems. Thus the
‘G-9’ was formed and included Dr. Thomas Nifong, MD; Cheryl Kelly, RN;
Dr. Steve Gordon, MD; Lorelei Papke, RN; Cathy Perry, RN; Dr. Mathew
Leavitt, MD; Michael Doll, PA; Connie Biggar, RN; and Jessica Wallace,
ARNP. Our working group grew in strength when Dr. Ruth Carrico, RN; Dr.
Monte Harvill, MD; Lori Benton, ARNP, PA; and Deborah Phelan, RN,
joined in our efforts.
In 2012, the working group published a paper describing the VHP approach
to vascular access management, summated here as:
v
vi Foreword
Vascular access for the infusion of medications and solutions requires timely assess-
ment, planning, insertion, and assessment. Traditional vascular access is reactive,
painful, and ineffective, often resulting in the exhaustion of peripheral veins prior to
consideration of other access options. Evidence suggests clinical pathways improve
outcomes by reducing variations and establishing processes to assess and coordinate
care, minimizing fragmentation and cost. Implementation of a vascular access clini-
cal pathway leads to the intentional selection of the best vascular access device for
the patient specific to the individual diagnosis, treatment plan, current medical con-
dition, and the patient’s vessel health. The VHP program incorporates evidence-
based practices focused on timely, intentional proactive device selection
implemented within 24 hours of admission into any acute facility. VHP is an all-
inclusive clinical pathway, guiding clinicians from device selection through patient
discharge, inclusive of daily assessment. Initiation of the VHP program within a
facility provides a systematic pathway to improve vascular access selection and
patient care, allowing for the reduction of variations and roadblocks in care while
increasing positive patient outcomes and satisfaction. Patient safety and preserva-
tion of vessel health is the ultimate goal. (Moureau N, Trick N, Nifong T, et al. Vessel
health and preservation (Part I) approach to vascular access selection and manage-
ment. Journal Vascular Access. 2012)
Although the entire approach was not immediately adopted by US hospi-
tals, clinicians began talking about the importance of device selection based
not only on the immediate need for access but also selection seriously consid-
ering the long-term impact on device choice for the patient’s vessel health
and efficient provision of treatment. Following publication, the Infection
Prevention Society of the United Kingdom expressed interest in the philoso-
phy of VHP. Industry stakeholders again invested in multiple presentations
and posters, further promoting evidence-based practices in patient-centred
vascular access management. While the US and UK programmes were not
mirror images of one another, the philosophy carried over and supported the
flexibility to adapt to a healthcare system based on country-specific models of
care. Instrumental in this process were Dr. Robert Pratt, PhD; Dr. Heather
Loveday, PhD; Carole Hallam, RN; Dr. Tim Jackson, MD; and industry
leader Scott Baker.
Today, as I reflect on the past 11 years and consider the contents of this
book, written by vascular access subject matter experts, it is obvious we hit
on an unaddressed clinical need in 2007. An industry partner request for a
simple algorithm opened the door to higher thinking and now implementation
of many of the evidence-based practices, guidelines, recommendations and
processes you will find in this publication. Each author and the editor are to
be commended for investing their personal time to define best in class vessel
health and preservation. It is now up to you to implement these practices and
continue your commitment as a patient advocate. We challenge you to fully
understand the foundation of evidence-based and patient-centred vessel
health and preservation. Be curious, study, investigate, publish, and push for
improvements to vessel health and preservation as it is defined here. Our
patients deserve no less!
Nancy Trick, RN, CRNI, VA-BC
Clinical Market Manager, Worldwide Infusion Disposables
Becton, Dickinson
Acknowledgments
Special thanks to 3M, Teleflex and Nancy Trick for making this open-access
Vessel Health and Preservation book possible. Without the support and gener-
ous offerings of these three we would not have been able to make this infor-
mation freely available. Many thanks to these donors and to the supporting
associations.
This open-access has been possible thanks to the generous contributions
of 3M, Teleflex and Nancy Trick. The free access provision would not have
happened without the support and generous offerings of these three and the
assistance of the Association for Vascular Access Foundation. Many thanks to
the donors and supporting associations of the Association for Vascular Access
(AVA), the Australian Vascular Access Society (AVAS), Infection Prevention
Society (IPS) and the National Infusion and Vascular Access Society (NIVAS)
and their contributions to spreading the Vessel Health and Preservation patient
safety model.
Association for Vascular Access (AVA) and the AVA Foundation
The Association for Vascular Access (AVA) is an organization of healthcare
professionals founded in 1985 to support and promote the specialty of vascu-
lar access. The mission of AVA is to represent and advance the vascular access
specialty and community and define standards of vascular access through an
evidence-based approach to enhance healthcare and patient outcomes. Today,
its multidisciplinary membership advances research, provides professional
and public education to shape practice and enhance patient outcomes and
partners with the device manufacturing community to bring about evidence-
based innovations in vascular access (www.avainfo.org).
The AVA Foundation, a nonprofit education and research organization,
was founded to support AVA’s mission: protect the patient, educate the clini-
cian and save the line. The mission of the foundation is to serve clinicians
interested in vascular access, students of healthcare professions as well as
vascular access patients and their families through innovation, research and
education (www.avainfo.org/foundation).
vii
viii Acknowledgments
Australian Vascular Access Society (AVAS)
The Australian Vascular Access Society (AVAS) is an association of health-
care professionals founded to promote the emerging vascular access specialty
through advancement of research, professional and public education to shape
practice and enhance patient outcomes and through partnership with the
device manufacturing community to bring about evidence-based innovations
in vascular access. Recognized as the Australian national authority in vascu-
lar access, AVAS is dedicated to exceeding the public’s expectations of excel-
lence by setting the standard for vascular access care (www.avas.org.au).
Infection Prevention Society (IPS)
Vascular access is the most common invasive clinical procedure for patients
admitted to acute hospitals and is a growing area in community settings.
However, these practices are often left to staff with the least experience and
knowledge to perform cannulation and make decisions for alternative devices
and the ongoing management of the device. This book provides the rationale
and evidence to support practice for all aspects of vascular access with vessel
health at the forefront of the guidance. It has been written by clinical experts
from around the globe and will provide a valuable resource for all healthcare
workers, irrespective of their position involved in vascular access (www.ips.
uk.net).
National Infusion and Vascular Access Society (NIVAS)
The National Infusion and Vascular Access Society (NIVAS) of the United
Kingdom aims to provide national guidance, representation and collaboration
with other organizations, through education and communication in all aspects
of intravenous and vascular access clinical practice (www.nivas.org.uk).
Contents
Part I V essel Health and Preservation (VHP)
1 The VHP Model . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Nancy L. Moureau
2 Right Assessment and Vein Selection . . . . . . . . . . . . . . . . . . . . . 9
Evan Alexandrou
3 Device Selection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Nancy L. Moureau and Evan Alexandrou
Part II R ight Education
4 Training and Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Evan Alexandrou, Nicholas Mifflin, and Peter J. Carr
5 Specialized Vascular Access Teams . . . . . . . . . . . . . . . . . . . . . . . 59
Peter J. Carr and Nancy L. Moureau
Part III Right Insertion
6 Insertion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Steve Hill
7 Tip Position . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
Steve Hill and Nancy L. Moureau
8 Avoiding Complications During Insertion . . . . . . . . . . . . . . . . . 107
Steve Hill
9 Right Securement, Dressing, and Management . . . . . . . . . . . . . 117
Steve Hill and Nancy L. Moureau
Part IV R ight Infection Prevention
10 Insertion Related Infection Prevention with Vascular Access
Devices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Michelle DeVries
11 Right Asepsis with ANTT® for Infection Prevention . . . . . . . . . 147
Stephen Rowley and Simon Clare
ix
x Contents
12 CLABSI: Definition and Diagnosis . . . . . . . . . . . . . . . . . . . . . . . 163
Michelle DeVries
Part V Right Pediatric Vessel Health and Preservation
13 Developmental Stages and Clinical Conditions for Vascular Access
in Pediatrics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171
Amanda Ullman and Tricia Kleidon
14 Right Device Assessment and Selection in Pediatrics . . . . . . . . 181
Tricia Kleidon and Amanda Ullman
15 Right Pediatric Site Selection and Technology . . . . . . . . . . . . . . 197
Tricia Kleidon and Amanda Ullman
16 Right Post-Insertion Management in Pediatrics . . . . . . . . . . . . 209
Amanda Ullman and Tricia Kleidon
Part VI Right Management
17 Assessment for Catheter Function, Dressing Adherence and Device
Necessity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219
Val Weston
18 Right Hub Disinfection for Compliance . . . . . . . . . . . . . . . . . . . 235
Carole Hallam
19 Right Management and Flushing . . . . . . . . . . . . . . . . . . . . . . . . 243
Caroline Cullinane
Part VII Right Evaluation
20 Evaluation of VHP Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265
Lisa A. Gorski
21 Staff Education and Evaluation for Vessel Health
and Preservation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275
Linda J. Kelly
22 Right Evaluation of Products and Compliance Measures. . . . . 285
Linda J. Kelly
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293