Intravascular
QUARTERLY
Global Disclaimer: The views and opinions expressed in the Intervascular Quarterly Newsletter are those of the authors and do not necessarily reflect the official policies or positions of the Association for Vascular Access (AVA) or any of its leaders, volunteers, employees, committees, networks or other groups associated with AVA. For information on this publication, please email
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IQ CONTENT NETWORK NEWS.......................................................................................... 4 HOW A SPECIALLY TRAINED AND RESPONSIVE TEAM “STAR” IS CHANGING THE INPATIENT AND IV INSERTION ARENA............................................................................................................... 8 LIFE ON THE FRONTLINES.................................................................... 12 STUDENT PERSPECTIVES: OBSERVATIONS IN CLINICAL PRACTICE....................................................................................................... 14 AVASM 24...................................................................................................... 18 THE USE OF SECUREPORTIV (CYANOACRYLATE CATHETER SECUREMENT ADHESIVE) FOR PICC AND MIDLINE CATHETERS: REDUCING CLABSI, DRESSING CHANGE FREQUENCY AND COMPLEXITY........................................................ 20
NETWORK NEWS NEW AVA NETWORK SERVING CENTRAL PENNSYLVANIA!
John Hall, President Kristin Seamans, Vice President Joanna Pisani, Secretary/Treasurer Kristin Jacobs, Advisor
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CEPAVAN - Central Pennsylvania Vascular Access Network- is a new network of AVA serving the central region of Pennsylvania. CEPAVAN brings AVA’s mission to the local level with a focus on patient safety and outcomes, advancement of the vascular access specialty, sharing of best practices, and the dissemination of vascular access research. Our inaugural meeting was November 9th with a presentation from Kay Coulter, RN, CRNI, VA-BC titled Legal Aspects of Infusion Therapy. Kay is a nationally known speaker and Owner of Infusion Knowledge (infusionknowledge.com). Our meeting had a total of 22 registrants and we are grateful for the opportunity to hear Kay’s insightful presentation. If you are interested in joining CEPAVAN, please use the QR code. Annual dues are $30 and meetings will be held a virtually on a quarterly basis. Join us!
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NETWORK NEWS President Meagan Capen, APRN, CPNP-AC, MSN, VA-BC ™ President Elect David Markle RN, VA-BC ™ Treasurer Amanda Pierce BSN, RN, VA-BC ™ Secretary Austin Green BSN, RN, VA-BC ™ FLAVAN members sprung into action over the fall semester with multiple meetings and a presence at the 2023 AVA Scientific Meeting. FLAVAN President Elect David Markel was able to attend the AVA scientific meaning along with FLAVAN sending two of our members Debbie Cooke and Tina Fahey to the meeting. Debbie and Tina will be presenting their findings from the conference in an upcoming meeting.
In September we held a dinner meeting in Orlando, FL sponsored by Access Vascular. Our Speaker Eddie Korycka MSN, RN spoke on the topic of “Optimizing the Use of Midlines”. Members were able to network and learn as they had a delicious meal at Seasons 52.
Later, in October BD sponsored a dinner meeting that discussed “Vascular Access in the ICU Setting”. Kathy Kokotis MBA, BS, RN was our speaker and presented a very educational program to help understand the role of PICCs in the critical care settings. It was great getting to network and visit our FLAVAN members in Jacksonville FL. 5
FLAVAN also met online with its members and had our first virtual meeting since COVID thanks to our sponsor CIVCO. Matt Gibson RN, CRNI, VA-BC ™ Discussed hospital onset Bacteremia (HOB) in his presentation “Is Peripheral Intravenous Catheter Insertion A Source of HOB?”It was a thought provoking and very relevant topic. We are excited for our next upcoming event in December in Orlando and more to come next year. For more information about meetings, memberships and events please visit our website flavan.wildapricot.org or find us on Facebook.
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NETWORK NEWS GulfVAN had a successful meeting in September titled Stop Sticking it to Them: Improving First Stick Success and Reducing Hospital-Onset Bacteremia and MRSA Lab ID Events Using Data Analytics. Nexus Medical sponsored the event and the presenters were Chellie DeVries, Lee Steere, and Andy Rellihan. This was another meeting that demonstrated the power of improving patient outcomes through the use of data! Additionally, GulfVAN received their 5th Proclamation for Vascular Access Specialty Day for Tampa on September 28th, 2023. Congratulations to all of the vascular access specialists throughout the Tampa Bay area! And a special thank you to Suzanne Herbst for her lifelong dedication to our specialty. Our next meeting is December 12, 2023 with Lee Steere presenting Clinically Indicated- Are you Protecting your VADs from IV Related Complications? This is a joint meeting with the Gulfcoast INS chapter and will be held at Maggianos Little Italy near Westshore. Looking forward to collaborating with INS! 6
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AVA CURRENTLY HAS 43 ACTIVE NETWORKS
www.avainfo.org/networks 7
VACC-0423-398
Safer care. Knowledgeable clinicians. Improved outcomes. Vascular Access Board Certification December 2023 recertification by CE open now through 12/1/23. December 2023 exam applications open 9/1 through 10/15/23. info@vacert.org
414-231-8222
vacert.org
DECEMBER 2023 | VOLUME XI | ISSUE 4
HOW A SPECIALLY TRAINED AND RESPONSIVE TEAM “STAR” IS CHANGING THE INPATIENT AND IV INSERTION ARENA WENDY NAPOLITANO, MSN, RN WENDY.NAPOLITANO@HHCHEALTH.ORG THE HOSPITAL OF CENTRAL CONNECTICUT, NEW BRITAIN, CONNECTICUT
Even as the Covid-19 pandemic began to show a downward trend in the late Spring of 2020, hospitals continued to see high acuity patients in the inpatient arena. During this time, and in an effort to assist inpatient staff with the increased census and acuity, a unique opportunity presented itself. It was clear that putting a nurse from the Intensive Care Unit (ICU) in the inpatient areas to assist with decompensating patients, to hold ICU patients in place while awaiting a bed in the ICU, and to stabilize inpatients to avoid an ICU admission could be very helpful to inpatient staff. Overall this team could help inpatient staff with any patient requiring increased care. The opportunity continued to grow and now a Specially Trained And Responsive (STAR) Team is positively impacting both the inpatient and intravenous (IV) insertion arenas. This team is able to provide mobile ICU care in the inpatient setting along with providing IV access alternatives to central lines. By placing peripheral and midline ultrasound guided IV access (USGIV), intraosseous (IO) access, maintaining line dressings, and assisting inpatient staff this team has the ability to adapt to any situation wherever they are needed.
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The demands of Covid-19 exacerbated an already over-stretched nursing workforce. The need to provide support to inpatient staff was abundantly evident. When I recognized the burden Covid-19 was placing on nursing staff in the inpatient arena I wanted to assist them in whatever way was possible; and I had the staff to do it. The idea of placing ICU staff out in the medical surgical areas was a way to assist with the increased acuity brought on by the pandemic. Originally called the SWAT nurse the name was changed later to align with a similar department in our system. The idea was introduced to leadership and within days I began placing an ICU nurse on the inpatient units to round and be available to help with anything they could. There was a great deal of adjusting and a need to be flexible. The ICU nurses needed to adapt to needs as they arose. The newly implemented team addressed challenges such as respiratory distress requiring increased oxygen demands and newly accepted inpatients requiring ICU care while awaiting an open bed. Over the next year the team grew to include one nurse per shift and their role grew as well. They responded to cardiac codes, rapid responses (when patients decompensate and team of providers is called to the bedside to immediately assess and rapidly treat the patient), and stroke alerts. At times they were called to the bedside by the inpatient nurses to provide early intervention to avoid further patient status decompensation. The goal of the ICU nurses was to optimize patient status by improving care delivery and to assist with high acuity inpatients to decrease the burden of inpatient staff. At the same time, they supported inpatient staff by providing coaching and mentoring to grow their skill set. Some examples include but are not limited to, coaching on tracheostomy care, caring for higher acuity patients, managing chest tubes, and performing bedside procedures staff nurses might be unfamiliar with such as, chest tube insertions or blood patches. As their roles expanded so did the number of IV insertions. It was apparent that the team needed to acquire the skills to insert peripheral ultrasound guided intravenous catheters (USGIV). We looked to our system hospitals who offered similar teams. They were structured to support a specialty float pool and an IV team. The size of our facility did not warrant 2 separate teams. We opted to have one team that could provide mobile higher-level care while encompassing the skill set to insert IV access under ultrasound guidance. Combining the teams into one would fit the needs of our facility. From here a STAR was born!
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Ultrasound can be used on a variety of patient-care settings where nurses competent to perform the technique can easily visualize vasculature to insert IV catheters, Stone et al reported1. Successful peripheral insertions established the nurse’s skill set and lead to proficiency in ultrasound use and laid the foundation for a midline program. We partnered with an affiliated already established IV team to learn how to insert catheters utilizing ultrasound. We developed a “train the trainer” approach, as discussed by Graup et al2, to ensure we could train new STAR staff as needed. We also noted improved patient satisfaction due to the use of a smaller 22G catheter and improved staff satisfaction as the burden of IV placement was now removed from the inpatient nurse’s task list in most instances. The STAR nurses also maintained the dressings on these lines and improved dressing adherence was noted. Once we collected data showing high percentage of first stick success utilizing ultrasound guidance and an increase in lines lasting the length of the hospitalization. We also measured the high volume of lines that were being inserted by this team. Just under 200 per week and exceeding 200 in times of high patient census. We now had the foundation to add a midline insertion program to the STAR nurse role. Through collaboration with the Senior Director of Infection Prevention the idea of a midline program was encouraged. He was aware of the previous work being done in the ICU to decrease central line associated blood stream infections (CLABSIs) and was strongly encouraging the establishment of this type of program. Offering more options for IV access options would contribute to decreasing central line use by offering safer choices for IV access. As Haddadin et al have reported,3 The Centers for Disease Control and Prevention (CDC) estimates the cost of a CLABSI to be approximately $46,000 per infection. The National Institutes of Health state a 12-15% increased risk in mortality rate associated with CLABSI. Having a team that could offer alternatives to a central line would decrease the risk of CLABSIs for our patients.
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Midline catheters are 8-25 cm in length and inserted in the upper arm. The catheter tip rests just below the axilla and is most commonly inserted under ultrasound guidance. The STAR team was trained to insert midlines at the bedside by a radiology advanced practice provider. He was able to train staff one by one until our team of 12 was competent and safe to insert. STAR team members are experts in meticulous line care, USGIV catheter insertions, and midline placement. Evidence has shown that vascular access teams have had a significant positive affect on reducing CLABSI as written by Savage et al4. As we put the pieces of this important and complex change together, we found increasing administrative support for our work. We were able to grow our team further, and expanded from one STAR rounding throughout our facility to 3 STAR nurses on day shift and 2 for night shift. Our facility has 414 licensed beds, with a max inpatient census of 231 and a 24 bed ICU, this excludes behavioral health and neonatal intensive care unit (NICU). The team’s scope continued to expand. Currently the STAR Team responds to cardiac codes, rapid responses, and stroke alerts. When these post code or rapid response patients require ICU level of care on the inpatient unit STAR nurses will hold in place if an ICU bed is unavailable. The STAR nurses also respond to in house stroke alerts and are ready to transport patients to magnetic resonance imaging (MRI) and administer tissue plasminogen activator (tPA) working to ensure vital treatment is provided timely and safely. The team inserts peripheral USGIV and midline catheters. In emergent situations where, venous access is the essential between life and death for a patient the STAR nurses will insert an intraosseous (IO) access. They also have many tools to their toolbelt. Each STAR nurse has their own US machine with probe, a doppler, portable monitor, and an IO insertion kit. They also carry varying midline catheters as well as peripheral IV catheters and dressings. As they provide these services, they also adhere to our hospital acquired pressure injury protocol and provide early intervention for the prevention of skin breakdown. DECEMBER 2023 | VOLUME XI | ISSUE 4
Admitted ICU patients boarding in the emergency department are transferred off stretchers and placed on hospital beds, have protective sacral dressings applied, perform a 4 eyes skin assessment (this assessment is when two nurses, “4 eyes” perform a head to toe assessment of the skin to identify any abnormalities), and are scanned using thermography to detect present-on-admission pressure injuries. This is all done before patients even get to ICU. The STAR team has the ability to support almost every area of our hospital. Among the most important things STAR nurses do is to monitor central line dressings on inpatient units, assess all USGIV and midline insertions for dressing integrity, and change dressings in accordance to our policies. Through auditing our infection prevention partners have reported improved dressing integrity since the inception of the team. Central line use has also decreased. The STAR Team has the ability to insert the correct line for the patient’s specific needs for any situation. Adding to their important contributions to patient safety and well-being, STAR nurses’ coach and mentor inpatient nurses to grow their practice. We have a high population of new nurses in the inpatient arena and the Covid-19 pandemic saw many of the seasoned staff leave. These new nurses need guidance and support to promote their growth. From chest tube care to trach care to managing an acuity ill patient the STAR nurses can provide insight when needed. They have become a vital support on our inpatient units due to the many ways in which they support staff and patients. The STAR nurses have become a self-governed, highly engaged, and excited team. They have enhanced ICU recruitment of inpatient nurses to ICU as those nurses see a sampling of what ICU work looks like. They have also helped with retention of ICU staff as they have supported nurses in developing strong skill sets and a desire to continue to grow in their practice. The STAR Team has also organized an IV Committee that they conduct monthly and run 10 independently to discuss areas of opportunity, ways to improve practice, and monthly data. Most recently they have partnered with the Stroke Team to look for ways to improve inpatient stroke responses and make administration of tPA more efficient. The impact of the STAR team now extends beyond our facility. STAR Team members are engaged systemwide and staff in two system facilities have been trained on peripheral USGIV catheter insertion by this team. The impact of our successful program is clear for patients too. CLABSI rates have decreased along with the need for central line placement—thanks to STAR Team intervention. These nurses have been a proven asset to the inpatient arena and are adaptable to a hospital of any size. Our STAR Team has shown a sustainable reduction in CLABSIs, improved patient satisfaction, provide coaching and mentoring to inpatient nursing staff, provide ICU level of care outside the ICU, and overall strengthened the quality of patient care. References 1. Stone, P., Meyer, B., Aucoin, J., Raynor, R., Smith, N., Nelles, S. White, A., & Grissom, J. Ultrasound-guided peripheral I.V. access: Guidelines for practice. My American Nurse. Published 2013 Aug 11. Accessed 25 Sept. 2023. https://www.myamericannurse.com/ultrasound-guided-peripheral-i-v-access-guidlines-for-practice/. 2. Graupp, P. Train-the-Trainer: Model, Methodology & Insights. Training Within Industry Institute. Published 2023. Accessed 25 Sept. 2023. https://www.twi-institute.com/train-the-trainer-model/. 3. Haddadin Y, Annamaraju P, Regunath H. “Central Line–Associated Blood Stream Infections.” National Library of Medicine, National Center for Biotechnology Information. Updated 2022 Nov 26. Accessed 25 Sept. 2023. https://www. ncbi.nlm.nih.gov/books/NBK430891/ 4. Savage, T., Lynch, A., & Oddera, S. “Implementation of a Vascular Access Team to Reduce Central Line Usage and Prevent Central Line-Associated Bloodstream Infections.” Journal of Infusion Nursing. Published Aug 2019. Accessed 25 Sept. 2023. https://journals.lww.com/journalofinfusionnursing/abstract/2019/07000/implementation_of_a_vascular_access_ team_to_reduce.6.aspx
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Learn More! AVA was founded on the premise that everyone should come together to address the complexities of VADs and their insertion, use, care, and maintenance. The first meeting of AVA (as a committee in 1985) was attended by those of diverse backgrounds from hospitals, home care, industry, pharmacy, etc. Today, AVA continues as a multidisciplinary organization of healthcare professionals that care about best outcomes for patients. This is why AVA partners with device manufacturers who provide access to the best technology, resources, and education in the specialty of vascular access.
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AVA has made it easy for YOU to have access to Devices, Products, and Solutions year-round! Check out this new resource and connect to AVA Industry Partners that want to help you provide the best outcomes for your patients.
LEARN MORE
DECEMBER 2023 | VOLUME XI | ISSUE 4
LIFE ON THE FRONTLINES
THE INCREASED IMPORTANCE OF MAINTAINING ACCESSIBILITY OF HICKMAN/BROVIAC CATHETER REPAIR KITS TO PATIENTS ON TOTAL PARENTERAL NUTRITION My name is Kristy Poindexter and I have been dependent on total parenteral nutrition (TPN) for 35 years. My story is long and complex, but the main reason for needing TPN is because I’m unable to eat or swallow due to achalasia of my esophagus. I had two major surgeries on my esophagus when I was a child. By the time I was nineteen, we learned that I also have gastrointestinal dysmotility, due to the vagus nerve being cut during my esophageal surgeries. Since 1998, I’ve had over 10 small bowel resections and haven’t been able to swallow due to esophageal stricture. Infusing TPN requires placement of a central line. I would like to share additional information about my own experience with central lines and then discuss a current issue related to the accessibility of catheter repair kits to patients on TPN. My current line is a single lumen white silicone Hickman that has been in place since June 3, 2003. I just reached my 20th “Catheterversary” on June 3, 2023, which is a milestone to celebrate. I strongly believe that a properly cared for catheter can last a long time. This means fewer complications such as central line infections and the risk of losing central venous access sites. Before my current Hickman, I had a Port for two years and it was an absolute nightmare. From my own experience, I don’t suggest ports be placed in people who require TPN daily – the infection and complication rate can be increased in some cases and changing the port needle is painful. Personally, I’ve had a much better quality of life and outcomes with tunneled central lines. 12
In the past 20 years, my Hickman catheter has only needed two repairs. When my first catheter complication occurred in 2008, I wasn’t aware that catheter repair kits were an option for Hickmans. The local Emergency Department (ED) didn’t have a repair kit in stock. The ED had to order a repair kit and have it shipped to the hospital. The next day, I went to the local outpatient infusion center and the catheter repair was done by an infusion nurse. The infusion nurse wasn’t familiar with the procedure but managed to successfully repair my central line. I had never seen a catheter repair procedure done. The benefit to repairing a catheter malfunction is avoiding having to replace the whole central line. Other patients commonly have the line repair done in the Interventional Radiology setting. My second Hickman line repair was in March 2021. I was in the ED at Stanford, where I’ve received care since childhood. The Covid-19 pandemic was ongoing and my parents (who are my caregivers) were not allowed to stay with me. While I was asleep, my ED nurse connected me to IV fluids for hydration. When I awoke, I noticed the catheter had ballooned out near the hub. I quickly realized that my Hickman catheter was kinked and the pressure from the IV fluids caused the weakened area of the catheter hub to balloon out, which indicates an internal break. Unfortunately, Stanford didn’t have any repair kits in stock. The good news is that Nutrishare, my home infusion pharmacy, provides its consumers with a catheter repair kit to keep at home. I didn’t have the kit on hand with me during this ED visit and I live two hours away. My medical team admitted me to the hospital. The following morning, my parents brought the repair kit to the hospital. A professional and experienced vascular access nurse, Nadine Nakazawa, was consulted to perform the catheter repair. Thankfully, I haven’t had any issues since my Hickman was repaired that day. Shortages of catheter repair kits has become a prominent issue during the Covid pandemic and has drawn my attention as a patient advocate. One of my advocacy roles is within the Facebook group that I established in 2011 to support, educate, and advocate for TPN patients and caregivers. Within the past year, I’ve heard more and more stories in the TPN group, as well as a few other Facebook
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groups, regarding the shortage of catheter repair kits. Recent stories have brought me to tears because it’s imperative to have access to supplies needed to maintain our “lifelines” and receive life-sustaining infusion therapies. Without timely access to repair kits, children and adults are subject to removal of central lines and replacement with a new line, which arguably comes with more complications than the short time it takes to repair a catheter that’s already in place. These supply shortages significantly impact the livelihood of the TPN community, as does limited access to healthcare professionals that are qualified to safely perform the repair procedure. If a new line replacement is the only option available, arrangements have to be made with Interventional Radiology and anesthesia and that can take a few days to get scheduled. In the meantime, the patient’s infusion therapies (TPN, IV fluids, IV medications, etc.) are disrupted and it may require a hospital admission. Having to replace a central line also impacts quality of life, including recovering from pain, anxiety, fatigue, and the consequences from disrupted infusion therapies. There’s also a greater risk of infection the longer a cracked or damaged central line is left in place while waiting for access to supplies and required resources. Additionally, it’s concerning to see patients and families “jumping through hoops,” trying alternative means to obtain catheter repair kits online, including on social media platforms. Recently, a family I know had their son’s central line crack, which compromised his safety. They brought their son to the ED, which did not have a repair kit available. The 5-year-old old boy had to be prepped for a new line placement procedure. Another family that I know tried multiple means to obtain a catheter repair kit when their daughter’s line broke. Their local hospital didn’t have a repair kit in stock, but after posting on Facebook, the hospital ED team made calls and they finally found a repair kit at a children’s hospital 6 hours away. These are two stories that occurred in 2023, but it represents a much larger issue going on for at least the past two years. From my perspective, I think more home infusion pharmacies need to provide their patients with a repair kit at home, to have on hand for emergencies. Furthermore, this helps protect patient safety when traveling and navigating unfamiliar healthcare systems when emergencies happen.
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There are more innovative solutions that could arise, if we work collaboratively between patients, families, clinicians, and product manufacturers. When dealing with vulnerable chronic health issues and dependency on life-sustaining infusion therapies like TPN. It’s important we do everything we can to continue educating, advocating, and collaborating. Written by Kristy Poindexter, Patient Advocate Edited by Rebekah Urbonya, BSN, RN and Patient Advocate November 18, 2023
DECEMBER 2023 | VOLUME XI | ISSUE 4
STUDENT PERSPECTIVES: OBSERVATIONS IN CLINICAL PRACTICE AUTHOR: LYNN DEUTSCH, MSN, RN, CRNI, VA-BCTM All vascular access devices (VAD) need proper needleless connector disinfection and should be a priority for healthcare workers who are accessing these devices to give medications or draw blood. The Infusion Standards of Practice recommend needleless connector disinfection using 70% alcohol, alcohol-based chlorhexidine gluconate wipes, and/or passive disinfection caps to decrease catheter-associated bloodstream infections (CABSI1). In addition, scrub and dry times depend on the instructions for use from the manufacturer. There is one product that states its alcohol-based chlorhexidine gluconate wipes provide effective hub disinfection with a five-second scrub and five-second dry time. These wipes should be readily available for use. All health professionals are busy and those who provide infusion therapy or access VADs should have ready-to-use products easy to find. Smith et al2 published a paper investigating factors that influence nurses’ intent to disinfect needless connectors related to autonomy and self-efficacy. The findings suggested that recent graduates were more likely to do proper hub disinfection than more experienced nurses. There was also a belief that patients on antibiotics were less likely to develop a bloodstream infection. Pre-licensure nursing students are taught infection prevention strategies including hub disinfection for all vascular access devices in their curriculum and clinical areas. Nursing students learn alongside registered nurses when providing care. They look for opportunities and watch nurses giving medications and starting VADs. 14
A survey question was emailed to a Spring 23 cohort of seven students to write a paragraph on what they have been taught in theory and what practices they have observed in the clinical setting that concern them about vascular access and infusion procedures. There were common themes in the written responses: Student 1: As nursing students, we are taught to do things by the book, and throughout my time at the hospital, I have seen a couple of things happen that raise a little red flag. A lot has to do with IVs. Some things I have seen are not scrubbing the hub with alcohol, in between flushes and meds, or even before or after, and sometimes not even at all. I witnessed a nurse try to push an IV back that was very clearly already out. I have seen nurses attach the IV to the tubing instead of capping it. I have seen tubing that is not labeled. I also watched a nurse use the same flush at the beginning and the end and not use alcohol in between. Those are a few of the things that I have seen during my semester.” Student 2: Some bad practices I've witnessed have been some nurses using one flush when administering an IV medication instead of using a pre-flush and a separate post-flush. Also, I've witnessed not scrubbing the IV hub for 15 seconds before administering medication or connecting a line. Every time I walk into a room for my 60-second assessment, my patient's IV tubing has never been labeled with a date to change it Lastly, antecubital IVs should not be left in longer than 24 hours. Every shift I've worked I've had a patient with one that has had it for days.” As you can see, intravenous therapy has only been the main source of bad practice I've witnessed at the hospital. Student 3: Some things I have seen different than what I was taught in school are not scrubbing the hub after each use, capping the end of the line of primary line with the nearest port and not the proper
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sterile cap and when flushing after medication, it is not at the same rate as the medication rate. The first thing I noticed was the failure to label IV lines with name, date, and time of preparation. I also noticed nurses do not clean IV ports before flushing and between medication administration and flushing. Since the start of the semester, I have seen cleansing of the ports before the initial flush, however, I do not recall a single instance where the ports were cleaned again between the medication and the flush. Additionally, I’ve witnessed, on multiple occasions, IV tubing being connected to its y-port hub (with and without cleaning with alcohol). From my learning experience, I’ve been taught it is never appropriate or acceptable to do this. Another scenario I’ve noticed on multiple occasions was IV access being initiated distal to existing IV access points. Among my clinical classmates, we’ve agreed to consistently use appropriate standard practice throughout our future nursing careers and, hopefully, make a difference on the floor! Student 4: I’ve watched nurses push IV meds quickly when in a rush instead of following guidelines to push specific medications slowly. Instead of first scrubbing the hub vigorously for 15 seconds, I’ve watched nurses swipe an alcohol pad over a port quickly before injecting medications or flushing. Student 5: I’ve also watched nurses push medications through a port, drop the line on the patient’s bed and leave it there for a couple of minutes, turn their back to the port, then pick up the same port and inject medication through it without cleaning with an alcohol wipe first.” Student 6: I see the same errors that other students witness, the lack of hand hygiene before entering and exiting rooms, unlabeled IV tubing, and nurses scrubbing the hub for less than 15 seconds. Care is expensive. And by this, I mean not only monetarily, but also in terms of “expenditure”. Taking extra steps to do things right demands time, effort, practice and expertise.
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Student 7: A nurse refused to administer any more opioid medication to a patient. Because of the patient’s history of opioid addiction. In school, we are taught to believe in our patient’s pain level reports. No bias should be included in the patient’s pain level reports. The nurse thought the patient appeared to be seeking a rush from the medication rather than experiencing genuine pain. It is stunning to hear in post-conferences what they have observed nurses demonstrate needleless disinfection and infusion practices. The Fall 23 cohort all reported similar themes of nurses not administering IV push meds correctly or proper needleless connector disinfection. I have been a vascular access/infusion nurse for over 20 years. I have been a clinical professor of nursing for seven years. I am stunned at the lack of proper administration of IV medications as well as the lack of needleless disinfection among my colleagues. I see the bad practices when I am working as a vascular access nurse. As clinicians, we always need to model professionalism and encourage our colleagues to create a culture of safety and use best practices related to infusion and vascular access procedures. Keep the saline syringes and disinfection wipes in your pockets and when you see bad practice, I have a phrase I use,” Let me help you with this.” References Gorski LA, Hadaway L, Hagle ME, et al. Infusion therapy standards of practice, 8th edition. J Infus Nurs. 2021;44(1S suppl 1):S1-S224. doi:10.1097/NAN.0000000000000396 6. Smith JS, Kirksey KM, Becker H, Brown A. Autonomy and self-efficacy as influencing factors on nurses’ behavioral intention to disinfect needleless connectors intravenous systems. J Infus Nurs.2011:193-200
DECEMBER 2023 | VOLUME XI | ISSUE 4
CLINICAL PRACTICE GUIDELINES (CPG) BY: MICKEY HAWES AND CHELLIE DEVRIES
Each IQ will include a Clinical Practice Guideline (CPG) update. To answer a few questions right off. • Blake Hotchkiss will still be involved with CPG as a volunteer while he pursues his doctorate and settles into his new job. • Chellie DeVries remains the AVA board liaison as she begins her role as AVA President. • Mickey Hawes is assuming the role as CPG AVA staff (independent contractor) to assist all the dedicated volunteers. The CPG guidelines are broken down into 6 sections.
SECTION ONE: ASSESSMENT, LEADER KAREN LAFORET
Current volunteers: • Ame Allen • Joanne Dalusung • Nancy Moureau • Mary Alice Vanhoy • David Paje Subjects in this section include device planning, patient history, general assessment, DIVA, CKD, and device selection among others.
SECTION TWO: PRE-INSERTION, LEADER PETER CARR 16
Current volunteers: • Lynn Deutsch • Lori Ewalt-Hughes • Paloma Ruiz-Hernandez Subjects in this section include anesthetics for insertion, consent, allergies, infection prevention, insertion bundles, patient positioning, ultrasound, near infrared, transillumination, vessel assessment, and all other pre-insertion possibilities.
SECTION THREE: INSERTION, LEADER NADINE NAKAZAWA
• Amy Bardin-Spencer • Joseph Hommes • Vicki Mabry • Amy Rissler • Michael Stern Subjects in this section include minimal attempts, navigation, tip confirmation, antimicrobial protection, securement, dressing application, insertion complications, prevention of complications, and managing procedural issues, etc.
SECTION FOUR: COMPLICATION, LEADER MIKAELA OLSEN
• Lisa Caffery • Cheryl Campos • Chris Cavanaugh • Robert Helm • Shelly Robinson Subjects in this section include thrombus, phlebitis, occlusion, infiltration, extravasation, pneumothorax, arterial puncture, nerve injury, catheter failure and much more. THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
SECTION FIVE: DEVICE, LEADER BLINDA BORDEAUX
• Carmen Cernusca • James Joseph • Barbara McElroy • Carey Prather • Elaine Schuessler Subjects in this section include care, maintenance, caps, dressing changes, site assessment, device removal, and phlebotomy from devices among many others.
SECTION SIX: ADMINISTRATIVE, LEADER LOIS DAVIS
• Warren McGlauflin • John Pilcher Subjects in this section include competency validation, legal, ethical, business case, policy, procedure, data collection, and quality improvement along with other possible issues. The volunteers for CPG have been evaluating hundreds of full-text articles that were gleaned from thousands of possibilities to determine the level of evidence for each study. Once this phase is completed the teams will begin item writing for AVA’s first iteration of CPG. A timeline will be available in the first edition of IQ 2024. From the AVA staff, AVA Board of Directors, and AVA members around the world, a big THANK YOU to all the amazing volunteers currently working on CPG and those that have helped get us this far.
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For questions, concerns, or a desire to volunteer please contact Mickey Hawes at javaeditor@avainfo.org
DECEMBER 2023 | VOLUME XI | ISSUE 4
join us at the
Gaylord Rockies in Denver, Colorado September 28-October 1
CALL FOR TOPICS AND PRESENTATIONS:
www.avainfo.org/CFP2024
Submissions accepted until January 9, 2024
WHO IS AVA?
AVA ANNUAL SCIENTIFIC MEETING
AVA, The Association for Vascular Access, is a notfor-profit multidisciplinary professional organization uniquely positioned as the leader in vascular access education and research. Its mission is to improve patient safety, comfort and outcomes, define the vascular access specialty, promote a favorable public policy environment, optimize professionals’ knowledge and skills, share best practices, and promote research in vascular access.
2024 marks AVA’s 38th Annual Scientific Meeting with at least 1,300 attendees, which include 60–70 industry partners. The meeting site is in Denver, Colorado at the Gaylord Rockies. AVA demonstrates its leadership role in the art and science of vascular access. This four-day conference (September 28-October 1, 2024) provides attendees with opportunities to participate in educational sessions, hands-on training, facilitated discussion, and networking.
AVA’s membership includes clinicians from many disciplines including nursing, medicine, radiology, respiratory 18 therapy, pharmacy, as well as consumers, professionals from industry, education, research, and others with an interest or specialization in vascular access and related fields.
Meeting attendees come from many countries and include professionals from: Interventional Radiology • Oncology • Surgery • Education and Training • Critical Care • Home Care • Home Infusion • Hematology • Radiology • Pediatrics and Neonatology • Nephrology and Dialysis • Anesthesiology • Infectious Disease • Infection Prevention • Vascular Access • Research and Development • Sales and Marketing • Engineering
General Sessions focus on development of the vascular access specialty, clinical research, professional development, technological advances, and evidence-based practice. Breakout Sessions will offer small group presentations emphasizing subjects of interest for the vascular access specialist and related disciplines; abstract and poster presentations allow participants to share original research, education projects and clinical innovations. Symposia, VA Talks, and Exhibits afford participants, industry partners, and exhibitors the opportunity to learn from one another in order to design and apply new technologies, science, and techniques in the most effective ways. With separate registration fees, an additional day of Pre-Meeting Workshops (September 27, 2024) offers in-depth exploration of topics of critical importance to the vascular access community.
The Call for Topics seeks submissions from: 1) Professionals who wish to submit a Topic for Presentation 2) Recommendations for speakers and/or topics to be included in the Scientific Meeting • •
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Participation and submission of topic suggestions is NOT limited to AVA members Topics should address the general or specific interests of AVA members and meeting participants keeping in mind that AVA is an organization of clinicians, healthcare specialties, and industry/corporate professionals involved in vascular access and related fields Presentations must avoid any semblance of commercialism General Sessions are limited to 60 minutes in length Breakout Sessions may be scheduled from 30 to 60 minutes in length at the discretion of the selection committee Hands-On Workshops may be scheduled for a full day (8 hours) or for a half day (4 hours) A topic submitter may submit more than one topic, but please note that each speaker may be limited to presenting at only one invited session and one poster/oral abstract as the principal author AVA values diversity, inclusion, and professional mentoring among its membership and promotes these values in its topic and speaker selection processes AVA reserves the right to solicit additional and/or new speakers for any proposed topic
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Get prepared for your Presentation Submission. The information listed below is required to complete the submission process. Each submission is reviewed by program committee members who score the key elements based on how closely the given criteria are met.
Presentation Title:
Use key words that describe the specific topic and content of the abstract. Catch phrases can be used but need to include a reference to the topic. For example, “Making a Difference” may get attention but does not suggest what the abstract is about. By adding a specific reference to the abstract subject matter, the abstract title becomes clearer; i.e., “Making a Difference: Ace Inhibitors in Hypertensive Patients.”
Target Audience:
What population is this session designed to benefit most?
Level of experience of the target audience: Basic, Intermediate, Advanced
What type of presentation is this? General Session Breakout Session* Hands-On Workshop
*Breakout Sessions may be scheduled from 30 to 60 minutes in length at the discretion of the selection committee.
Prerequisite:
Include the minimum knowledge and/or skills required to most benefit from this session.
Purpose/Goals:
This statement should be the most important primary information you want to convey for the abstract. This should be one or two sentences. The title should not be repeated.
Has this presentation been given before? Where? Learning Objectives /Outcomes:
Minimum of three objectives are required. Provide three to five outcomes that complete the statement: “By the end of this session the participant will be able to....” DO NOT type this statement in the text box when entering each of your outcomes.
well while considering the same question. (max. 1,000 characters including spaces)
Additional Text:
Any additional text that expands the content description to be used for the review process. This narrative is your opportunity to provide a convincing overview of the value of your proposed session. If the reviewers cannot clearly understand what this session is about, your odds of having your abstract selected are greatly reduced. Expansion of the content description must be written in a brief, well-organized, and focused manner. In one paragraph the potential speaker should have written a narrative that: 1. Identifies the key topics that will be addressed 2. Describes any special learning activities, such as case study analysis, audience participation, or interactive discussion.
Speaker Contact Information, CV/Resume, Presentation Experience, and Availability Over Meeting Dates. Contracts are signed only with the primary presenter. Only the Primary Presenter may 19 be eligible for any speaker incentives. All presenters must be aware that this application is being submitted. Some applicants will be contacted by an AVA 2024 Annual Meeting Design Team Member for a phone interview between January and February of 2024 to discuss the presentation submission. Please try to return messages promptly. The interview is an integral part of the submission review process. Failure to participate, or be available for an interview may result in the elimination of the submission from the review process. The program will be selected by the end of March 2024. Applicants will receive notice by email.
Content Description:
The content description should be concise yet comprehensive. Ask yourself as you are reading the session description, “As an attendee, do I know what this abstract is about and would I want to attend?” Ask a colleague to read it as
www.avainfo.org/CFP2024 Submissions accepted until January 9, 2024
DECEMBER 2023 | VOLUME XI | ISSUE 4
THE USE OF SECUREPORTIV (CYANOACRYLATE CATHETER SECUREMENT ADHESIVE) FOR PICC AND MIDLINE CATHETERS: REDUCING CLABSI, DRESSING CHANGE FREQUENCY AND COMPLEXITY BECKIE CHURCH, MSN, APRN, ACNP-BC FAYE BAKER, MSN, APRN, CCNS, CNS-CP CLINICAL SPECIALISTS, CENTER FOR BEST PRACTICE LEXINGTON MEDICAL CENTER 2720 SUNSET BLVD WEST COLUMBIA, SOUTH CAROLINA, 29169 US In 2017 Lexington Medical Center transitioned to a 2-stage kit system for dressing changes. The first packet was for dressing removal, and the second was for the sterile application of the new dressing. House-wide dressing education and checkoffs were provided for every nurse in our facility using the new kits. After completing the initial checkoffs for current employees, all new hires undergo a check off for dressing changes of central lines and ports during orientation. Any new dialysis staff from our contracting agency are validated on dialysis line dressing changes. 20
Surprisingly most of our dressing checkoff failures were from removing and applying the adhesive securement device on the catheter. In 2022, after considering available alternatives on the market and talking with the SecurePortIV representative, the product was considered for trial. SecurePortIV® (SPIV) is a cyanoacrylate catheter securement adhesive and is one of four catheter securement technologies recommended in the Infusion Therapy Standards of Practice (Gorski et al., 2021). It also received recommendations with high-level evidence for its microbial barrier and for providing hemostasis. SPIV may be used with any vascular access catheter (venous or arterial) and has no age restriction. SecurePortIV® has an 8-log reduction of a broad spectrum of pathogens, including gram-negative, gram-positive, yeast, and fungi, within the first three minutes of contact (Adhezion Biomedical LLC). The available published evidence supports its use to mitigate multiple vascular access challenges like device securement, catheter migration, hemostasis, and dressing adherence., After speaking to the Adhezion Biomedical, LLC Account Manager, a demonstration was arranged for the SecurePortIV (Cyanoacrylate Catheter Securement Adhesive) product. After the demonstration, the decision was made that it would be feasible to use this with our lines instead of the CHG disc at the insertion site and the securement device. Infection Control was provided information about using SecurePortIV and approval for the trial was obtained. The Products’ Committee also approved the trial. The clinical education team from Adhezion Biomedical came and provided staff education. Based on the planned two-week trial and our average daily catheter and dressing change usage, one hundred vials of SecurePortIV were obtained. Our Interventional Radiology (IR) practitioners and Intensive Care Unit (ICU) Intensivists place most of our catheters.
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
Every patient where SecurePortIV was used was followed throughout their hospital course. We also partnered with our Home Health Infusion Company so their nurses would be prepared when receiving a patient who had the SecurePortIV applied. One patient visited our in-hospital Infusion Center. The Infusion Center received a supply of SecurePortIV to use with his dressing changes. That patient did not require any early dressing changes while being seen in our Infusion Center. Dressing changes routinely occur every seven days. After the completion of our trial, the results were compiled, reported to the Products’ Committee, and reviewed with the team. The SecurePortIV was overwhelmingly approved by the nursing staff and physicians that used it during the trial. The dressings stayed intact resulting in a reduction in unscheduled and early dressing changes. The Infusion Center was eager to implement SecurePortIV in their department. The Products’ Committee approved implementation beginning with all PICC and Midline catheters. Notification was sent to our kit manufacturer to customize our kits on the next run, adding the SecurePortIV and removing the CHG disc and securement device. By January 2023, the new kits were available to ship to us.
21 SecurePortIV added to the kit package
White packet is the 1st Stage for the Removal of the old dressing
Sterile Dressing Application packet with the SecurePortIV dropped onto the field.
Adhezion Biomedical sent a team of educators to our facility to educate the entire staff on the product’s use. We also notified our Home Health Infusion company that we would begin using the SecurePortIV on all PICC and midline catheters and offered them further education. Single packets of the SecurePortIV were brought in to stock all the supply rooms. Some of the Intensivists prefer to use it on insertion sites with mild oozing, and this product has been very successful for this purpose. We also use the individual SecurePortIV on any line insertion site where the patient has a documented CHG allergy. The electronic health record (EPIC) was updated to include tissue adhesive as a documentation option when SecurePortIV was used on a catheter. At the start of the trial, low Central Line-Associated Bloodstream Infection (CLABSI) rates were fortunately already attained, which we attributed to our 2-stage dressing kits and the extensive education and awareness campaigns. The goals were to achieve intact dressings for a greater length of time and decrease the complexity of the dressing change process, saving critical nursing time. We found that the time to complete a line dressing change has decreased using the SecurePortIV instead of the CHG disc and adhesive securement device. This has increased staff satisfaction with the dressing change process.
DECEMBER 2023 | VOLUME XI | ISSUE 4
At the end of March 2023, Adhezion Medical sent the education team back to the facility to reinforce education and to ensure that all was going well with the implementation. To say that we have been pleased with the implementation and maintenance education is putting it mildly. Our facility’s CLABSI rate (SIR = 0.48) for July 2022-June 2023 is below the State (SIR = 0.826) and the National (SIR = 0.844) benchmarks. CLABSI rates continue to improve. See the graph below for CLABSI data before SecurePortIV implementation at the end of January 2023/early February 2023 and after implementation. Zero CLABSIs were celebrated in March, May and June 2023.
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All CLABSI events continue to be reviewed to identify opportunities for improvement and provide feedback to staff. References Adhezion Biomedical LLC. SecurePortIV: Indication for Use (IFU). Retrieved April 14, 2021, from www.SPIVTraining.com Gorski, L. A., Hadaway, L., Hagle, M. E., Broadhurst, D., Clare, S., Kleidon, T., Meyer, B. M., Nickel, B., Rowley, S., Sharpe, E., & Alexander, M. (2021). Infusion Therapy Standards of Practice, 8th Edition. J Infus Nurs, 44(1S Suppl 1), S1-S224. https://doi.org/10.1097/NAN.0000000000000396
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
Call for news, product evaluations, quality improvement initiatives, and patient stories. IQ is a quarterly AVA Newsletter that serves our membership in a way that a peer-reviewed publication can’t. In this publication, our members can tell us how a product performs in the real world, let patients tell us about their side of the line, and share what our AVA Networks are up to. IQ is a way for new authors to get started with publishing less formally. Submissions will require disclosures for product evaluations, patient permission to tell their stories, and references to support your statements. All IQ manuscripts are subject to scrutiny by the JAVA editor, and mentoring will be offered to help you be successful. If you have questions or don’t know where to start, contact the JAVA editor @ javaeditor@avainfo.org.
Visit our website www.avainfo.org
23 @associationforvascularaccess www.facebook.com/associationforvascularaccess/
@ISaveThatLine twitter.com/ISaveThatLine
@i-save-that-line www.instagram.com/i-save-that-line/
Association For Vascular Access www.linkedin.com/company/association-for-vascular-access/
2024 SUBMISSION DATES ARE: •
Vol 1 (February):
1/19/2024
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Vol 2 (May):
4/19/2024
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Vol 3 (August):
7/19/2024
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Vol 4 (September):
9/16/2024
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Vol 5 (November):
11/11/2024
Association For Vascular Access www.youtube.com/AssociationForVascularAccess
FOR COMMENTS OR SUGGESTIONS, PLEASE SUBMIT TO AVA@AVAINFO.ORG DECEMBER 2023 | VOLUME XI | ISSUE 4
AVA Academy is always open!
ACADEMY
The Association for Vascular Access (AVA), in collaboration with The Clinician Exchange (TCX), launched a new, best-in-class learning management system tailored to aspiring and established vascular access clinicians. Providing cutting edge training, critically-acclaimed presentations from scientific meetings, journal review courses and much more, AVA Academy is a groundbreaking initiative that advances the heart of AVA’s mission – Protect the Patient | Educate the Clinician | Save the Line. Academy curriculum is now available to the public, and to active AVA members at a discount.
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Looking to further your education but struggling to find the time amidst a busy work schedule? AVA Academy is always open! It's our mission to create greater public awareness of vascular access and to empower our members with significantly more educational resources, networking opportunities, and advocacy tools in support of and dedication to the patients that we are entrusted to serve.
AVA Academy is now open to all curious minds Choose and enroll in your classes today!
View Course Catalog
Launch My Courses
• Review course content, outlines and objectives • Purchase courses • Add courses to your personal Course List • Available to Members, Non-members and all site visitors with a Guest Account • If you're not an AVA member, consider Joining AVA or you may create a Guest Account at no charge
• Sign in to your personal AVA Academy Account • Launch your courses • Take quizzes • Available to Members and Non-members with a Guest Account • You will need to sign in to the AVA website prior to clicking Launch My Courses above
Learn more at www.avainfo.org/AcademyLaunch THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
We invite you to submit original manuscripts that may improve patient outcomes and our understanding of the vascular access specialists’ role in the healthcare system. Manuscripts could include: • Clinical Practice • Patient Education • Clinician Education • Promoting & Sustaining Change • Vascular Access Research • Legal perspectives • Financial Considerations • Anything to move AVA’s mission forward. For complete instructions, go to Information for Authors at www. avajournal.com If you would like some mentoring help, email AVAFoundation@ avainfo.org. The AVA Foundation board can match you with free mentoring for AVA members on research and publication. If you have general questions or don’t know where to start, contact the JAVA editor at: javaeditor@avainfo.org.
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DECEMBER 2023 | VOLUME XI | ISSUE 4
AVAILABLE NOW
RESOURCE GUIDE FOR VASCULAR ACCESS
The 2021 AVA Resource Guide for Vascular Access: AVA's Recommended Study Guide for Vascular Access Board Certification provides an overview of basic vascular access knowledge and covers essential elements that clinicians implement on a daily basis. Throughout the Resource Guide, readers have access to high definition images, videos, illustrations and engaging animations that give them a greater understanding of the concepts. The guide may be used to prepare for the vascular access board certification examination (VA-BC™), as well as serve as a resource throughout professional practice.
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AVA MEMBER PRICE: $99 digital only $129 print only $159 bundle (print and digital) NON AVA MEMBER PRICE: $129 digital only $169 print only $199 bundle (print and digital)
Check out the Resource Guide sneak peak videos on our YouTube channel!
PURCHASE IT ONLINE TODAY! Digital Access: • Not a downloadable file. It is not printable and is for view on your device only. The digital access is not shareable with another account. You will receive a redemption key and an access link after purchase. • Corrections and incremental updates to version one will automatically populate your digital copy (no additional charge)
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
Educational Offerings from AVA
Available anywhere you get your podcasts
I Save That Podcast
• Streaming on Spotify, SoundCloud, iTunes, Stitcher, Google Play Music, iHeart Radio, Pandora, Amazon Music
Journal of the Association for Vascular Access • Published quarterly • Approximately 3,000 subscribers
ACADEMY
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Intravascular Quarterly (IQ)
• Published quarterly • E-newsletter sent to AVA members
AVA Academy
• Continuing Education courses ALL available on demand • Procedural courses, webinars, scientific meeting sessions, etc.
AVA Resource Guide for Vascular Access
• Prepare for the VA-BC™ exam, as well as serve as a resource throughout professional practice
Learn more at www.avainfo.org DECEMBER 2023 | VOLUME XI | ISSUE 4
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Copyright 2023 Association for Vascular Access. All rights reserved. Disclaimer: AVA (Association for Vascular Access) is a professional organization of vascular access professionals dedicated to improving vascular access practice and patient outcomes through education and other means. AVA publishes this periodic electronic newsletter for our membership and other interested parties for information purposes only. AVA distributes this electronic newsletter with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the IQ publication. AVA is not giving advice and does not subscribe to guarantee the accuracy or efficacy of the information provided. Privacy Policy and Unsubscribe Information -AVA maintains strict rules of confidence with regards to your email address and all other personal contact information. We will not, under any circumstances, sell, transfer, or provide your email address to any third party for any reason. Email lists are compiled on an opt-in basis by AVA for the sole purpose of distributing the IQ newsletter. AVA does not condone or participate in the distribution of unsolicited email. If you feel that you have received an email transmission from AVA in error, please contact AVA at and ask to be removed from the list. All removal requests are addressed promptly.
DECEMBER 2023 | VOLUME XI | ISSUE 4