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
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
IQ CONTENT BOARD INTRODUCTIONS
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EDUCATION, CERTIFICATION AND PUBLICATION
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NETWORK NEWS
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AVA FOUNDATION SCHOLARSHIP WINNERS
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MEET THE PEDINEOSIG EXECUTIVE TEAM
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IQ EXPO CORNER - NEW!
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AVA EDUCATION UPDATE
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2024 IQ THEMES
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INTRODUCING BACSIG
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CLINICAL PRACTICE GUIDELINES
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FROM THE BOARD PAUL BLACKBURN, BSN, MNA, RN, VA-BCTM TREASURER I am grateful for the opportunity of working with the AVA Board in 2024. I stepped away from AVA for a short period of time and only really followed it peripherally as I pursued other opportunities in my life. I did not realize how much I missed this organization. I was privileged to attend the 2024 Board Retreat held the weekend of January 19-21. I enjoyed the opportunity of reconnecting with former colleagues and meeting new colleagues. One of the things that drives me in my professional life is my passion regarding patients, their experiences in hospitals and my desire to improve that experience and alleviate some of the pain hospitalized patients’ experience. This passion started when I spent 8 weeks in a hospital as a young man. It was difficult for me, but also gave me some insight into the work that nurses and other professionals are called upon to do daily, day in and day out. Often, this work goes unrecognized. As I met with the AVA Board, I felt the same passion I have for improved patient care in each of these individuals--and unlike me, most of them have not taken time off. They continue to pursue this goal with a strength and vigor that I admire. It was so nice to get to know the board and the goals it has for AVA and the future of vascular access. I am so grateful that I can play a small part in helping these lofty, but worthy goals come to pass. In my role as treasurer, I will work closely with the management team and the AVA Board to see that the Association is well funded now and well into the future. By the way, we met at the 2024 national meeting venue. It is awesome!! I can tell you, not only are you in for a great opportunity to expand your educational platform, you are going to love the venue!!
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LORI KACZMAREK, MSN, RN, VA-BCTM SECRETARY Hi everyone, my name is Lori Kaczmarek, and I am your secretary for 2024. I am pleased to have this opportunity to serve on the AVA Board of Directors again this year. I will rely on my prior experience as Director-atLarge, Secretary, and Past-President to continue to drive AVAs mission and vision forward. Our face-to-face board meeting in January was a great opportunity to review AVAs strategic plan and consider opportunities to achieve our goals. This year, I will serve as the board liaison for the Policy and Bylaws committee and the Awards Task force. As a liaison, I work closely with the volunteers to ensure the goals and objectives are met. Liaisons serve as a vital communication link between the national board and the committees or task force. AVA has made much progress advancing education opportunities for clinicians. This has made a significant impact on our membership growth. The diversity of programs and platforms cater to the needs of adult learners. This year we expect to see AVAs education portfolio expanded. Check out the Learning Academy to appreciate the scope and breadth of topics already available to you. Don’t see something? Send a message to AVA education. It is important to continue to expand our relationships with other organizations and this is a key priority for 2024. This year, the board will also have the opportunity to revisit our strategic plan and consider new goals for the future. I can’t wait to see everyone in September at the Gaylord Rockies in Denver. You will love this venue for our next Scientific Meeting! Plan to bring your family: the kids will love the pools and lazy river while you take in the best vascular access education and meeting experience.
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LYNN DEUTSCH, MSN,RN, CRNI, VA-BCTM DIRECTOR-AT-LARGE The AVA Board Retreat at the Gaylord Rockies was exceptional. I am excited to work with the 2024 board. We were all energized to commit to spreading education about vascular access in schools of nursing, improving the patient experience of living with a VAD, and making sure AVA is financially stable and sustainable in today’s economy. The hotel rooms were wonderful along with the views of the Rockies. It will be a special scientific meeting in the Fall. I am excited to serve my second year on the AVA Board as a Director-atLarge. My goals for this year are to try to get the PIV curriculum in nursing schools, facilitate Bac-Sig collaboration with other nursing organizations to improve the patient experience living with a VAD, and facilitate the Awards Task Force as board liaison. I will also try to bring PIV education into the Magnet Nurse Residency program in my hospital system and into the community college where I am an adjunct. I plan to write more articles for the IQ Quarterly during the year on the topics requested by our wonderful editor Mickey Hawes. Education is the key to improving our practice as clinicians and working with our Industry Partners to improve vascular access. Those of us who are clinicians need to help create a culture of safety for our patients in our workplace by mentoring our younger colleagues and promoting evidence-based practices for vascular access. Serving on the AVA Board has been so rewarding giving back to an organization I have belonged to for many years. I want to encourage members to think about applying for a board or committee. You get to meet so many wonderful people and collaborate with experts around the world.
KRISTEN JACOBS, DNP, MBA, RN, CRNI, VA-BCTM, NEA-BC DIRECTOR-AT-LARGE I am honored to be a Director-at-Large for the 2024-2025 Board of Directors. I believe the Association for Vascular Access is an organization that is positioned to make meaningful vascular access advancements for the future. The Board gathered at the Gaylord convention center in Denver, Colorado in January. We did some brainstorming and had discussions about collaborating with other organizations, finding ways to diversify our membership, and moving our strategic plan forward in 2024 and 2025. I am thrilled to be the liaison for the Network Task Force in 2024. I hope to provide networks with the tools they need to have successful meetings and robust networks. The Gaylord Rockies venue is simply amazing- it is a beautiful property, and everything is easily accessible. There were several restaurants and shops on site. I can’t wait to see everyone there!
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KAREN LAFORET, RN, MCISC-AHCP, CCHN©, CVAA©, VA-BCTM DIRECTOR-AT-LARGE Early in my nursing career my most cherished mentor, Clare, encouraged me to be a life-long learner and to be actively involved in professional associations. She believed that these activities helped a person to grow personally and professionally and resulted in better patient outcomes. Well, after she volun-told me for my first critical care association meeting, I was hooked! Ever since, I have been an active member of a number of professional organizations that in large part have helped me to be the nurse I am today as a member of the 2024 AVA Board of Directors. For this year I’ll continue to be part of the Clinical Practice Guideline team and meeting our deadlines for publication; continue to work with the network task force to support and strengthen our networks; and, be a part of the Scientific Meeting D-Team. The D-Team’s mission is to make this year’s meeting the best ever! Stay tuned for more updates! I will also work with the management team in preparation for moving into the President’s role for 2025. I am honored and proud to be part of AVA. In the next few years, we are on the cusp of tremendous opportunity for AVA to improve patient outcomes. It is my hope many of you will join us in this work and that I will see many of you in Denver!
EMILY LEVY, BA DIRECTOR-AT-LARGE 6
Bridging the Gap: A Vision for Vascular Access from A Place of Lived Experience In the dynamic realm of healthcare, the patient’s perspective often remains a pivotal yet overlooked component in the tapestry of innovation. As a social impact entrepreneur, advocate for patients, and global speaker, my decade-long journey living with vascular access has led me to champion this cause. Possessing a unique viewpoint shaped by three PICCs, an implanted chest port, and numerous PIVCs, I serve as a bridge between the patient community and the Vascular Access industry. My vision for the AVA centers on embedding patient inclusion across all organizational tiers. As I assume the role of Director-At-Large, my aim is to enhance patient participation in education, procedures, and innovations, thereby elevating outcomes and satisfaction with VADs. Granting patients a seat at the decision-making table is paramount. Having navigated the challenges of maintaining my PICC during college, AVA became my lifeline in 2015 and beyond. The symbiosis between patients and the Vascular Access industry harbors untapped potential. I aspire to witness collaborative endeavors among patients, clinicians, and industry stakeholders revolutionizing overall patient care. My tenure with AVA exemplifies the profound impact of how innovative ideas can make a big impact. Eager to contribute to AVA’s mission, I aim to further narrow the divide between patients and industry, envisioning a future where patients actively shape the journey of vascular access. Together, we can amplify the patient voice, cultivate empathy, and instigate transformative changes in the Vascular Access industry.
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WARREN MCGLAUFLIN, RN, BS, VA-BCTM DIRECTOR-AT-LARGE I am going to be the board liaison to the AVA foundation. This is my first interaction with the foundation as a board member and very much am looking forward to this. As the liaison I am there to help in any task they assign me as well as bring back any issues the foundation sees that the board may need to be aware of. Being on the Board is a great opportunity for all of us to help define and direct where AVA is headed in the future. We have so much great information and current research coming out we need to channel that into the right areas. As a Board member it also allows me to serve vascular access in my own areas to bring patients the best evidence in collaboration with other professions. We need to be seen as the authority in vascular access and can only do this by research and networking with other groups (such as INS, ENA, APIC etc.) I can’t wait to see everyone in Denver as this is a great venue with some really nice options for relaxation as well as learning. Networking is where it’s at, along with the sharing of our knowledge to move us forward in vascular access. I am so humbled and thankful to be sharing a small part in the development of the future of our organization to move us forward in the specialty of vascular access. Thank you all.
CHRISTINE VANDENHOUTEN, PHD, RN, APHN-BD, CPH DIRECTOR-AT-LARGE
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I am excited for the opportunity to serve on the AVA Board in 2024. As an experienced educator, I am keenly aware of the importance of organizations like AVA to the education of our healthcare workforce. My AVA journey began in 2017 when Mark Hunter, AVA member and former student of mine, asked if I would assist in the development of a survey to determine the state of PIV curriculum in north American nursing programs. What seemed like a simple goal resulted in so much more than a survey. I am proud to share that our team (Mark Hunter, Andrea Owns, Andrea Raynak, Judy Thompson, and I) published 2 articles, one the status of PIV education (JAVA) and the other a Call to Action (Journal of Nursing Education [JONE]). We didn’t stop there though as under the leadership of Judy Thompson, our team was instrumental in the development of the AVA PIV curriculum that is currently available free of charge to nursing programs across the U.S. It was very apparent that AVA was on a mission to improve patient outcomes through improved PIV education. I was hooked....the passion of everyone I met affiliated with AVA was palpable. I wanted to be a part of this organization so when Mark once again reached out to me to ask if I would apply to serve on the Board of Directors, I didn’t hesitate to submit my application. What a privileged to attend the 2024 Board Retreat in Denver and meet the great leaders of this organization. I look forward to serving this great organization.
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EDUCATION, CERTIFICATION, AND PUBLICATION DIANA NEGRON-SANTIAGO, BSN, RN, CDN, CAP, RN2 FRESENIUS KIDNEY CARE APOPKA, FLORIDA It was such a great honor to get published for the third time in the nursing journal Revista Impulso of the Puerto Rico Nurses Association. The goal of writing an article for this nursing journal was to educate nurses about the importance of vascular access in the hemodialysis treatment and to encourage nurses to specialize in nephrology by getting certified. Certification promotes patient safety and improves the quality of care provided to nephrology patients. Continuing nursing education supports the professional practice of nursing and the delivery of safe, evidence-based, high-quality care for patients. I enjoyed writing so much because I involved three of my former patients in it. All the photos that I used in this article were of them. I have been in the dialysis field since 2010 and since then, it became my responsibility to contribute to the nursing practice and writing for a nursing journal was a great way to advance my nursing career, get my voice heard, and share my nursing perspective on topics important to me. I have been told that to publish is considered learned because in doing so you are sharing knowledge, experience, or expertise. As we all know, nursing needs journal contributions from nurses in a wide array of practice settings to communicate and disseminate information, research findings and new initiatives that can be used to update and improve patient care. I have really enjoyed learning more about the nursing profession and sharing my thoughts and ideas with my fellow nurses. Getting published in an established, authoritative, peer-reviewed nursing journal is a great way to get involved. Translated article from Revista Impulso
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Importance of the Vascular Access in HD patients-Protecting their Lifeline Goals and Objectives • Promote safety associated with vascular access. • Decrease infections associated with vascular access. • Provide basic academic competency in vascular access. Introduction According to The Kidney Council of Puerto Rico (CRPR) and the National Institute of Diabetes and Digestive and Kidney Diseases (2014), the kidneys are two bean-shaped organs. They are about the size of a fist. In addition, they are anatomically located on the back of the abdomen, on both sides of the spine. On the other hand, its main function is to act as a filter, to remove excess water and waste products from the blood. When the kidneys lose the ability to filter and clean blood, water and waste products can accumulate and be toxic to the body. This is known as renal failure. When the kidneys are no longer able to clear the blood, dialysis may be needed. Chronic renal disease, in its terminal state, requires hemodialysis, among other techniques of renal clearance. The most common type of dialysis is called hemodialysis. Puerto Rico represents 33 percent in the prevalence rate of dialysis patients between 2006 and 2012 compared to 18.6 percent in the United States. According to the Renal Council of Puerto Rico (CRPR), recent statistics for the year 2014 reflect those 1,449 patients with end-stage renal disease started dialysis treatment in Puerto Rico. Lorenzo Tapia (2011) defines hemodialysis as “a process that consists of filtering the patient’s blood through the dialysis machine through a cleaning filter and returning it to the patient.” It also makes reference in relation that “the nurses who work in this area must be specialized in the accomplishment of these treatments”. This treatment requires vascular access, in order to ensure that
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
the patient’s blood reaches the dialysis monitor easily. It is important to consider that vascular access represents the most important link of the renal patient with life and that this depends on the possibility of effecting dialysis effectively. Since 1997, the National Kidney Foundation (NKF) has developed evidence- based guidelines and clinical practice guidelines for all stages of chronic kidney disease (CKD) and its complications through the National Kidney Foundation: Kidney Disease Outcomes Quality Initiative (NKF/KDOQI). Consequently, the program is recognized worldwide for improving the diagnosis and treatment of kidney disease, changing the practices of numerous specialties and disciplines. The above has contributed to the improvement of the lives of thousands of kidney patients. (NKF/KDOQI 2006) Know the Vascular Access A vascular access consists of a device that allows direct connection with the patient’s blood circulation continuously, for a period of weeks, months or years, according to the patient’s need, and the type of vascular access. Therefore, ideal vascular access must meet at least three requirements: First, to allow safe and continuous entry into the vascular system; second, provide adequate blood flows to administer the scheduled hemodialysis dose. And third, it lacks complications. (Lorenzo Tapia, 2011). However, guidelines for vascular access are an effort to improve patient survival and quality of life, reduce morbidity, reduce possible complications, and increase the effectiveness of care. The patency of vascular access and a suitable hemodialysis treatment are essential for these purposes. (NKF/KDOQI, 2006). Vascular Access Types A. Permanent Vascular Access 1. Arteriovenous Fistula This consists of the subcutaneous anastomosis of an artery to an underlying vein. According to Lorenzo Tapia (2011), the objective of this is to obtain high-flow venous access. Permanent vascular access is considered safer and of longer duration and first choice. At months, the arteriovenous fistula vein dilates and thickens its wall, allowing it to be punctured repeatedly. They have a maturation period of approximately for its eventual use of 3-4 months. More than 40 percent of arteriovenous fistulas fail to mature. 2. Synthetic Graft (Grafts) The synthetic graft commonly known as “Graft” is an artificial connection between an artery and a vein, usually made with a synthetic material known as PTFE (polytetrafluoroethylene or Teflon-Trademark). This graft should not be considered the first option for permanent access. These grafts are technically easy to cannulate and can be used promptly after their insertion in approximately one month and even before according to the need of the patient and with the proper medical authorization. B. Temporary Vascular Access 3. Central Venous Catheter (CVC) The central venous catheter consists of a tube inserted into a jugular or subclavian vein, or into the femoral artery. Usually, these are only used for short-term use or in emergency hemodialysis when there is no available vascular access. Venous catheters are not ideal for long-term hemodialysis therapy. With a venous catheter, a patient may develop embolisms, a life-threatening infection (sepsis) or a vein with scar tissue, causing stenosis in the blood vessel. In addition, there is a risk of damage to the central blood vessels and the heart.
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COMPLICATIONS AND DISADVANTAGES OF VASCULAR ACCESSES Vascular Access Arteriovenous Fistula
Complications
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Arteriovenous Graft
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Disadvantages
Hemorrhage Infection Thrombosis Venous stenosis Aneurysms Steal syndrome Venous hypertension Recirculation Infiltration Hematoma due to inadequate cannulation techniques
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Hemorrhage Infection Thrombosis Pseudo aneurysms Infiltration and hematomas due to inadequate cannulation techniques
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Insufficient development with inadequate blood flows Slow or poor maturation Inability to cannulate Increased aneurysm formation Cosmetic damage due to dilated veins
Increased number of thrombosis complications Extensive surgeries Life expectation of 3-5 years Difficult removal Skin and tissue erosion
According to Lorenzo Tapia (2011), et al., the central venous catheter is the vascular access with higher incidence to cause problems of infection and coagulation. If these problems develop, antibiotics and thrombolytic agents such as “Activase” also known as “Cathflo” are the prescribed treatments. If these treatments fail, a nephrologist or an interventional radiologist will have to replace the catheter. Management and nursing interventions in the care of vascular accesses The nurse has the responsibility to provide quality care in the vascular access to prolong its patency. According to Lorenzo Tapia (2011) care begins even before the creation of access, being more exhaustive once the patient initiates hemodialysis treatment. Aspects such as where and how to puncture fistula, care during the session, patient education about their vascular access, and others are some of the points that nurses should consider. Observation, assessment and good care planning are steps necessary to minimize risks and to detect complications preventively. (Lorenzo Tapia, 2011). Nursing assessment techniques, where we observe the presence of “thrill” vibration and “bruit” murmur with palpation and auscultation to corroborate its patency, to monitor vital signs in order to avoid hypotension which in turn may trigger early vascular access thrombosis, observation for signs of pain or hardening of the blood vessel, monitor for signs and symptoms of infection in addition to avoiding venipunctures and blood pressure in the extremity carrying the vascular access are some examples of management and nursing interventions in vascular access. The nursing professional in the area of hemodialysis has within its functions the provision of information and education to the patient in a clear and effective way of the care that must be done and the precautions that must be taken in the care of their vascular access since in this way We involve the patient in his care and in turn ensure and prolong the lifetime of his “lifeline”. Conclusion Vascular access remains the key element in the treatment of hemodialysis in patients with renal disease in the chronic and terminal stage. It is imperative that nursing professionals who are specialists in nephrology demonstrate competence and efficacy in the skills to preserve this lifeline in conjunction with the care provided by the same patient as educated for that purpose.
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On the other hand, this competence and effectiveness of the nursing professional in the care of vascular access are achieved when training and updating through courses or certifications related to care and management of vascular access, phlebotomy, and nephrology to mention a few. The American Association of Nephrology Nurses (ANNA) in its standards for practice emphasizes that all nephrology nurses are legal, ethically and morally responsible for practicing, in accordance with recognized standards of professional nursing practice, Professional performance, recognized professional ethics code, and specialty certification. ANNA as an organism that regulates the practice of nephrology nursing at the national level, emphasizes the importance of certification in this area of specialty. Therefore, a well-trained and experienced staff is synonymous with success in treatment, minimizing the risks and complications in which the patient is compromised and eventually loses his vascular access temporarily or permanently; in the worst case. The specialist in nephrology/hemodialysis has the primary responsibility for ensuring successful cannulation, free of complications and effective hemodialysis treatment. Nursing management in patients on hemodialysis therapy emphasizes the importance of infection control at all times, the observation of possible complications, before, during and after the end of treatment, and mainly in the preservation of vascular access making an assessment to identify possible infections on the skin, palpation and auscultation to verify proper patenting and cannulation techniques. Therefore, early intervention by the nursing professional is essential to detect and correct in time complications that may have arisen with vascular access. Education is the key to success. Each professional must have the initiative to maintain their competence in their area of expertise since it depends on the life of each patient under our care, and it is our ethicalmoral duty to provide them with superior care and risk-free quality. There are a number of ways in which this competence can be achieved, if you are already working in the area there are exams that can be challenged according to the specialty. It would be very useful in addition that each dialysis institution in the country provides its nursing staff with incentives with accredited certification programs and accessible training since specializing in this area in addition to giving prestige to the company ensures excellence in practice. References • • • •
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American Nephrology Nurses Association. Scope of Practice for Nephrology Nursing (2011) Recovered from https://www.annanurse.org/professional- development/practice/scope-ofpractice/nephrology-nursing Renal Council of Puerto Rico. Epidemiology of end-stage chronic kidney disease. Recovered from http://www.consejorenal.org/index.php?option=com_content&view=article&id=115&Itemi d=154 Lorenzo Tapia, F. (2011). Vascular accesses. Nursing care in the hemodialysis unit. (Second ed., Pp. 174-202). Málaga: Vértice Publications. National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Kidney Disease. What does it mean for me? (2014) https://www.niddk.nih.gov/health- information/healthcommunication-programs/nkdep/espanol/az/enfermedad-rules- means-for-my/Pages/ infermed-instruments-means-for-mi.apx National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Methods of Treatment for renal failure: Hemodialysis. (2007). Recovered: http://www.niddk.nih.gov/health-information/ informacion-de-la-salud/enfermedad-de-los- rinones/hemodialysis/Pages/Métodos-detratamiento-para-la-insuficiencia -renal- Hemodialysis.aspx National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) (2014). Vascular Access for Hemodialysis. Recovered: http://www.niddk.nih.gov/health- information/health-topics/kidneydisease/vascular-access-for- hemodialysis/Pages/index.aspx National Kidney Foundation. KDOQI Clinical Practice Guidelines and Clinical Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal Dialysis Adequacy, and Vascular Access. Am J Kidney Dis 48: S1-S322, 2006 (suppl 1)
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NETWORK NEWS
President David Markle BSN, RN, VA-BC™ Treasurer Amanda Pierce BSN, RN, VA-BC™ Secretary Austin Green BSN, RN, VA-BC™ Presidential Advisor Meagan Capen, APRN, CPNP-AC, MSN, VA-BC™ FLAVAN ended 2023 with a dinner meeting in Orlando at Season’s 52, December 14th on “Preventing Peripheral Intravenous CatheterRelated Bloodstream Infections: A Bundle Approach” presented by Max Holder, sponsored by HMP Global!
The FLAVAN team is diligently working on the 13th Annual FLAVAN Summit which will take place April 27th,2024 at the Courtyard Orlando Lake Buena Vista in the Marriott Village, 8623 Vineland Avenue, Orlando, Florida 32821. We are so thankful to be able to provide this Summit for our FLAVAN Members and the Florida/Georgia Vascular Access communities! Registration will open soon, please visit our website for more information click link: FLAVAN
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David Markle has stepped into the Presidential role for 2024! We are excited to continue to have a strong Board of Directors taking us into 2024! FLAVAN has collaborated with GULFVAN to offer a Virtual Webinar “Partnering with Patients: Promoting a Culture of Safety” presented by Beth Gore, PhD, on February 6th, 2024, sponsored by GULFVAN, FLAVAN, and the OLEY Foundation! Register by clicking link: FLAVAN
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Industry partners please reach out to FLAVAN to join us at the 2024 FLAVAN Annual Summit as a Sponsor, Speaker Sponsor, and/or Exhibitor. We could not host the Annual Summit without your support!
2023 SCHOLARSHIP WINNERS
13 DAGOBERTO SALINAS, MSN, ACCNS-AG, CNOR, CDR, NC, USN My company, CLINSPEC Solutions, LLC partnered with SimX last year to design and develop a virtual reality (VR) simulator for PICC and midline placement. VR has shown a lot of promising results in health professions education, and I am confident that it will also make an impact in vascular access education and training. I am hoping to pilot this initiative in 2024 and publish the findings in JAVA (most likely in 2025). Also, I plan to co-exhibit the VR product with Sim X at the next AVA conference in Denver, CO. The 2023 AVA scholarship allowed me to attend my first-ever AVA conference and network with other key stakeholders. I am sincerely grateful for AVA Foundation’s generosity and look forward to contributing to its mission.
VICKIE GRIFFIS, MSN, RN, CCRN, ACLS In 2024, I am embarking on a new journey via research. I was impressed when attending the AVA conference in OCTOBER 2023, with the research that was conducted and presented on this national level. What struck home to me is many of the studies/research was completed by nurses just like me, with noted quality issues and wonderful results. This year, I am initiating a research project regarding improvement in patient care delivery. Another great point from attending AVA was the exposure to new products. I have been able to introduce new products in my organization to enhance and improve patient outcomes. The networking aspect of AVA, not just at the conference, but post conference has encouraged my interest in research and has provided me with guidance along this journey. Without the support of the AVA foundation through the scholarship, I would not have had this opportunity to attend the AVA conference and grow in my profession.
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ONE PHOTO & THREE FACTS: MEET THE PediNeo SPECIAL INTEREST GROUP (PediNeoSIG) ELC
On behalf of the PediNeoSIG Executive Leadership Council (ELC), I am so excited to welcome all of you who have chosen to provide quality vascular access to our most vulnerable patients, from neonates to adolescents and beyond. We look forward to continuing important work throughout the year and connecting with you at our annual scientific meeting in Denver. As your PediNeoSIG chair, I am honored to work with the incredible group of clinicians who serve on the ELC.
KACEY WISEMAN, CHAIR • Although my dream of being an Olympic • •
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figure skater didn’t come true, I love being a pediatric/neonatal vascular access nurse. My attempts at being creative include interior design and photography. When not snowed in with over 6 feet of snow, upstate NY is my happy place.
KATIE FRATE, CHAIR ADVISOR • I Love working with neonate and pediatric • •
patients. I wouldn’t change it for the world! While I’m not working, you can catch me and my family at Walt Disney World. I love all of the parks but my favorite is Magic Kingdom! I am not at runner (actually dread everything about it!) but completed two 1/2 marathons in 2023. Next race: November 2024!
ANGELA ALDERMAN, SECRETARY • I love to vacation in the Outer Banks in North • •
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Carolina with my family I am a very proud Veteran spouse I love to cycle every chance I get.
LUIS CIPRIANO, DTEAM SENIOR LIAISON • My birthday is Cinco de Mayo. • A child meeting Mickey for the first time is •
MELISSA STEBEL, DTEAM JUNIOR LIAISON • I love living in California but miss the •
unmatched. Rather than eat reindeer, I once paid $42 for a medium Domino’s pizza.
Wisconsin Fall Colors and First Snow Fall I have so much fun beating my 20 something kids in game night Catan when they come home to visit!
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DEANNE AUGUST, DIRECTOR AT LARGE • Guilty pleasure- baking • My 3 year old and I have the best dance
DANIELLE BAKER – DIRECTOR AT LARGE • I turn 40 this year and will be celebrating
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parties I like looking at gory pics (wound and extravasations) I’m a nurse by background and did my apprenticeship in PICU UCSF.
by checking off a bucket list item! Cruising Alaska! My first in person AVA conference was last year, and I can’t wait until AVA 2024!
CHLOE RUSSIN – DIRECTOR AT LARGE • I have 4 dogs (Luna, Coco, Tequila, and • •
Summer). My favorite actor is Nicolas Cage. I love listening to podcasts!
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Don’t miss your moment
Exam applications close April 15 16
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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VACC-0124-732
Become VA-BC™ this summer and level up your career.
NEW: IQ EXPO CORNER At an AVA Scientific Meeting (AVASM) many years ago I referred to the Expo Hall as “Disney World for IV Geeks”. One of the best parts of going to an AVASM is going to the Expo Hall to see all the options available to solve clinician and patient problems. It is my hope that IQ can offer a small part of the Expo Hall with each issue. Expo Corner will make available a forum for manufacturers to tell their stories about their products. A clinician’s or patient’s experience in real life. How did your product help them? Branded pictures are acceptable. Early research results are welcome. There will be a disclaimer that AVA is not endorsing the claims. Your advertorial will be highlighted in the issue. Expo Corner is a chance for readers to experience a small corner of the Expo Hall. Submissions should be 750-1500 words, first person, de-identified pictures, references (if needed) in AMA format, no more than 5 references. QR codes are acceptable for more information. Let me know if I can help, Mickey javaeditor@avainfo.org For advertorial information and cost contact: Melissa melissalmurphy@gmail.com
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AVA EDUCATION UPDATE JUDY THOMPSON, MSNED, RN, VA-BCTM DIRECTOR OF CLINICAL EDUCATION
The AVA education department is really excited for 2024. We are so happy to have Toni Sochor join the team. She has been with us for a few weeks now and, as anticipated, she is a wonderful addition to the AVA family. The creation of the first edition of AVA’s Clinical Practice Guidelines (CPGs) has proven to be a mammoth task. Our amazing volunteers have logged countless hours towards creating AVA’s biggest accomplishment. There is still a lot of work ahead, but with the help of Dr. M. Hawes leading the effort, the amazing efforts of the team leaders and their volunteers we will publish this amazing work by the 1st quarter of 2026. IV League learning starts back on February 14th, please join us every other Wednesday at 7:30 ET for these Micro-Learning sessions. There is no cost for members and non-members (bring a friend!). Use this link to register for the series: IV League Learning - Association for Vascular Access (avainfo.org)
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AVA’s ISAVE that Webinars are one of our most popular learning events. We are kicking off the year with Matt Ostroff speaking about Equity in Vascular Access on February 21, 2024. If you haven’t registered for the event click on this link to secure your spot! Association for Vascular Access (avainfo.org) AVA has been heading up a multi-organizational team of incredible volunteers. With the help of an expert in the UCLA/Rand process, we have created the PIVC Consensus Document. Public Comment is open from Feb 8-22nd. The document and other details can be found on the AVA Website Another multi-organizational initiative, Equity in Vascular Access research is still in full swing. We created two surveys in 2023, where we collected data related to the effect of skin tone (and other factors) as it related to the vascular access experience. We are deep into data analysis and will continue to update you to our progress. More information can be found on the AVA Website We continue to add schools to our PIV Curriculum. Please help us get the word out! Contact your alma-mater and other schools in your area, invite them to participate. This program is free for colleges and universities. More information can be found at https://www.avainfo.org/page/ piveducation Do you have an idea for an AVA Position Paper? If so, please submit your idea here!
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
TONI SOCHOR, RN, BSN, VA-BCTM CLINICAL EDUCATION SPECIALIST When I started my nursing journey in 2000, I never could’ve imagine that it would have brought me to where I am today. I was introduced to the specialty of vascular access when I placed my first peripherally inserted central catheter (PICC) in 2008. I knew it was something I was going to love doing. However, in 2010 when I went to my first Association for Vascular Access (AVA) conference in San Jose I knew there was no going back. There was so much knowledge, connection, and opportunity in those few days. I had never experienced anything like that. I didn’t even make it back to work before I started bombarding my boss with all the ideas I wanted to implement. Over the next 10 years, I focused all that energy and information into creating a program for vascular access that I was so incredibly proud of. Throughout that time, I continued to attend AVA conferences annually. After putting my heart and soul into that rural hospital system I decided I needed to seek out new growth opportunities. There was so much more to learn. I was fortunate enough to be hired by a large teaching facility where I was able to expand into pediatrics, as well as the challenged daily by the complexity of the patient population. I have been very fortunate to learn and grow in various hospital settings. I have always kept the mindset that we can learn something from everyone we meet. I am eternally grateful for the opportunity to take the next step in my journey. Thank you for such a warm welcome into this community. I look forward to having a much more active role within the organization and working with so many brilliant minds. I have never seen more passion than when I am immersed in this community.
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2024 IQ THEMES & SUBMISSION OPTIONS The theme for this IQ is Vascular Access Resolutions. How will we, as AVA members, approach this new year? What goals do we have for our organization, practice, and ourselves? My hope is that more of our membership will dive into research and publication. A simple way to start is to submit your case stories or personal stories to IQ. To help you focus your writing consider which IQ you may be interested in.
Intravascular
QUARTERLY
MAY ISSUE: BEYOND ACUTE CARE (DUE 5/1/24) • • • • • • • • •
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All ages. Homecare Long-term vascular access Dressings & Securement Activities of Daily Living with a line. Training & Education for clinicians and patients Skin care Patient stories! Anything about vascular access beyond insertion.
AUGUST ISSUE: PERIPHERAL INTRAVASCULAR CATHETERS (PIVC) (DUE 8/1/24) • • • • • • • • • • • • •
Intravenous Arterial Skin Tone factors Pain control Vessel visualization options Neonatal to Geriatric All lengths 2cm – 20cm Dressings & Securement Hospital Onset Bacteremia (HOB) Assessment Patient stories! Training & Education Anything about PIVCs
NOVEMBER ISSUE: CENTRAL VENOUS ACCESS DEVICES (DUE 11/1/24) • • • • • • • • • •
Neonatal to Geriatric HOB Training & Education Scope of practice Tip termination verification Specialized Teams Interprofessional collaboration Dressings & Securement Patient stories! All things good & bad related to CVADs.
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PATIENT, CLINICIAN, OR STUDENT STORIES
Your stories could be from a personal perspective as a patient or clinician. You could interview a patient about their experience or interview student nurses to get their perspectives. (7501250 words, first person, informal.)
CASE STORIES
These are short-format patient cases without the rigor of medical case studies. Please follow this modified “SBAR” format.
ACTION
INCLUDE
EXAMPLE
Situation
What are the basics?
48 yoa Male with history of injectable drug use requires 6 weeks of intravenous antibiotics.
Background
What do we know about the situation? Objective information. Just the facts.
The patient is diagnosed with osteomyelitis post right knee replacement. The order is to discharge the patient to an ambulatory infusion center for once-a-day infusions, inserting and removing the vascular access each day. Ultrasound of patient’s peripheral vasculature reveals inadequate size and flow for repeated insertions. However, the patient’s upper arms with sufficient venous health for access.
Assessment
What is the problem? Subjective issues.
The patient has been sober for 2 years, has good family support, and mental health assistance. Punishing the patient with unrealistic and unethical repeated venipuncture will cause additional trauma and possible noncompliance.
Intervention
What did you do with the situation you were given? How did you collaborate with other healthcare professionals and the patient/caregivers?
After discussions with the patient, family, behavioral health, ambulatory care, and the physician ordering the antibiotic, a plan was developed. A PICC was placed with tamper evident technology applied. A contract delineating rights and responsibilities was signed. The patient was set up to report to ambulatory care once a day for the remainder of his infusion therapy.
Outcomes
What happened?
The patient successfully finished his antibiotics with one PICC. No evidence of tampering with the device and negative random urine drug screens.
Conclusions
What now?
Based on the success of this case my hospital is moving forward with developing a program to help other patients with a history of injectable drug use.
Your case story should be between 250-750 words. No more than 5 references if needed in AMA format. Non-branded and de-identified information. You must include your name but do not mention your specific hospital. You can say “a rural hospital in the Midwest”, “a teaching hospital in Canada”. You may leave your contact email if it is not your hospital email. For any questions or concerns please contact Mickey, javaeditor@avainfo.org
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Call for news, product evaluations, quality improvement initiatives, and patient stories.
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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 @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-vascularaccess/ Association For Vascular Access www.youtube.com/AssociationForVascularAccess
2024 SUBMISSION DATES ARE: •
Issue 2 (May):
5/1/2024
•
Issue 3 (August):
8/1/2024
•
Issue 4 (September): SPECIAL CONFERENCE ISSUE
•
Issue 5 (November): 11/11/2024
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
INTRODUCING BEYOND ACUTE CARE SPECIAL INTEREST GROUP (BACSIG) BY: LEE GORSCHBOTH, MHA, RN, VA-BCTM BACSIG CHAIR AVA is the leading provider of all things vascular access, starting before the vascular access device is placed until it is removed. Has anyone ever had a patient, family member, or friend sent home from the hospital with an indwelling vascular access device? They were scared and confused about what they could and could not do with it. They would ask many questions of any medical personnel or the internet and get various answers, making them even more confused. AVA has made a resource to support anyone with an indwelling vascular access device called the Beyond Acute Care Special Interest Group or BACSIG. BACSIG provides educational resources to patients, families, and clinicians to support those at home, in rehabilitation facilities, infusion centers, nursing homes, and assisted living facilities. While patients are in the hospital, they have numerous resources available to them when they have questions. But, once they have gone home, those resources are no longer available to them. That is where AVA’s BACSIG steps in. Although we have only been active for three years, we have partnered with experts and other organizations to provide some wonderful resources for clinicians and patients, such as the webinar by Dr. Jack LeDonne, Vascular Access in Alternate Environs, Mighty Well’s Ultimate Guide to PICCs, and the I SAVE THAT LINE: A Guide for Patients and Families (in partnership with the Oley Foundation. Additionally, several of our Board Members have been published in the IQ quarterly newsletter and in JAVA. BACSIG is working on a few projects to support the community it services. We are in the process of creating a patient and family task force that will help identify what information or resources are missing to help support them on their vascular access journey. Additionally, we are creating a one-stop shop location to provide education and evidence-based guidance. It will have resources in multiple different mediums to support all levels of learners. As we continue to work on these massive projects, we will continue to provide articles in JAVA and IQ Quarterly, and webinars focused on concerns relevant to our community. Most importantly, we are asking for volunteers to help with all of our projects. If you or you know of someone who would be interested in volunteering their time writing articles, doing webinars, or doing some research, please reach out to Judy Thompson jthompson@avainfo.org or Toni Sochor tsochor@avainfo.org .
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CLINICAL PRACTICE GUIDELINES (CPG) BY: MICHELLE L. HAWES, RN, DNP, CRNI, VA-BCTM, ACRP-CP CPG EDITOR-IN-CHIEF & DEVELOPMENT LEAD Some of you may have been hearing about the development of the AVA Clinical Practice Guidelines since its initiation in 2021. Others may be hearing about it for the first time. You may wonder why it takes so long to develop guidelines. Many of us are making up “guidelines” each day as we attempt to bring best practice to our unique patients. First, congratulations to the Infusion Nurses Society for their publication of the latest Infusion Therapy Standards of Practice!!! Standards are a necessary part of practice and are considered a higher level than guidelines. So why do we need to develop guidelines? Because most of us can think of all the patients that are not STANDARD. In fact, if it wasn’t for the non-standard patient, we probably wouldn’t need specialists. Guidelines give specialists the evidence-based boundaries to work within and spotlight areas in need of more research. Of course, you must also stay within the boundaries of your licensure. AVA’s CPG volunteers have been deep into Phase III of the CPG development. This phase deals with evidence collection, review, and grading. The facing page shows a simple illustration of the process in place to rigorously assess the evidence.
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Some of the CPG sections have completed, or are about to complete, grading and finding consensus with their assessment buddy. Our Complications section has over 1000 full-text articles to grade, and they only received those at the end of December 2023. With the help of volunteers from the sections who are finished and others who have completed the necessary training I hope that we will be done with this part Phase III by the end of May 2024. Then we will start the UCLA/ RAND process in June 2024.
Thank you to all the CPG Leaders and Volunteers who have given their time, expertise, and passion for the patient to this important project. As always please email me with any questions. javaeditor@avainfo.org
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The precursor to Phase III was the development of questions that would apply to each section. The CPG sections are; assessment, pre-insertion, insertion, complications, device, or administration. From these many PICO questions search terms were developed. Phase III Starts Here The research librarian developed a comprehensive search strategy through the appropriate data bases. The pile of peer-reviewed articles that she found was enormous. With each section having its own pile to assess based on their questions. Understandably the section on complications was especially large. Using a program designed for systematic reviews, each team member would assess the abstracts of each article for inclusion or exclusion. The process diminished the piles significantly.
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The last part of part of Phase III will involve a UCLA/RAND methodology which is a specific way for an expert panel to make recommendations on those PICO questions with limited or low level evidence. The panel consists of all six CPG Leaders, AVA staff liaisons, and the AVA Board liaison. FEBRUARY 2024 | VOLUME XII | ISSUE 1
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
THE E-NEWS PUBLICATION OF THE ASSOCIATION FOR VASCULAR ACCESS
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.
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
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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: $105 digital only $135 print only $165 bundle (print and digital) NON AVA MEMBER PRICE: $135 digital only $175 print only $205 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
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ACADEMY
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
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Copyright 2024 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.
FEBRUARY 2024 | VOLUME XII | ISSUE 1