February IQ 2025 by Association for Vascular Access

September 19-21

Pre-Meeting Sept. 18 Kissimmee, FL

Registration Opens Soon!

NETWORK NEWS

PRESIDENT DAVID MARKLE, RN, VA-BC™

TREASURER AMANDA PIERCE BSN, RN, VA-BC™

PRESIDENTIAL ADVISOR MEAGAN CAPEN, APRN, CPNP-AC, MSN, VA-BC™

FLAVAN’s Jacksonville Dinner meeting August covered “Infusion Nurses Society Infusion Therapy Standards of Practice Overview of 9th Edition, 2024” presented by Barb Nickel, APRN-CNS, CCRN, CRNI, Chair, 2024 INS Standards of Practice Committee and sponsored by BD/Sean Tuetken. We had a lovely dinner at Maggiano’s and had a great time communing with our North Florida providers!

FLAVAN’s Orlando Dinner meeting in October “Developing, growing and enhancing Vascular Access Teams” presented by Max Holder MSN, RN, CRNI, NEBC, VA-BCTM and sponsored by BD/Eric Smith. This was an excellent presentation and with great discussion for our attendees while they enjoyed dinner at North Italia!

The AVA Annual National Scientific Meeting in Denver, Colorado this year provided a plethora of information, exchange of ideas, and invigoration for your FLAVAN board to move into 2025 with a renewed sense of ability to lead FLAVAN and excitement for new opportunities to improve care delivery through our members and their expertise! Next year’s conference will be in Orlando and we hope to have a large cohort from FLAVAN attend!

For more FLAVAN news and upcoming events please visit our website by clicking the link FLAVAN and don’t forget to like and follow us on Facebook!

The Florida Gulf Coast Vascular Access Network (GulfVAN) had two successful workshops last weekend. One for Peripheral IV Insertion and one for Ultrasound Guided Peripheral IV Insertion. A big THANK YOU goes out to the wonderful preceptors that came to support our specialty and advance clinical practice. I would also like to give a shout out to PICC Excellence, Inc. and Infusion Knowledge Inc for supporting our network by leading the education. I would also like to thank B. Braun Medical Inc. (US) , ICU Medical , Parker Laboratories Inc., Medline Industries, LP, and BD for assisting with the supplies needed for the workshops. And thank you BayCare Health System for always allowing GulfVAN to use the rooms in the Medical Arts Building for meetings. Continuing education for clinicians is vital for better patient outcomes. You all are the best!

REFLECTION ON 2024 AND UPCOMING OPPORTUNITIES

ANTONIA (TONI) SOCHOR, BSN, RN, VA-BCTM

CLINICAL EDUCATION SPECIALIST ASSOCIATION FOR VASCULAR ACCESS

5 months ago, AVASM24 came and went in a whirlwind of education, networking, and relationship building. I hope everyone who could attend in person enjoyed the event as much as I did. As I reflect on my first year working with this amazing organization behind the scenes of the conference, I am in awe of the amount of time, hard work, and dedication that goes into making this an incredible experience for all. It truly feels reminiscent of The Wizard of Oz and the revealing of the man behind the curtain. For those of you who couldn’t attend, general session presentations will open for on-demand review in the AVA academy in early March.

In 2024, the vascular access community witnessed remarkable achievements from a diverse group of authors across multiple organizations who came together to advance vascular access practices. The collaboration resulted in significant contributions, including the Standards of Care for Peripheral Intravenous Catheters: Evidence Based Expert Consensus, the INS vesicant management resources, the Hospital Onset Bacteremia (HOB) Playbook, and the NAVIGATE project from WoCoVA—all aimed at standardizing and enhancing practices throughout the continuum of vascular access.

These resources are vital for driving best practices, and I am immensely grateful for the dedication and expertise of all involved in this critical work. Collectively, these initiatives promote improved patient outcomes and foster a culture of excellence within the vascular access community. I look forward to seeing the positive impact of these efforts on healthcare practices worldwide.

This year the AVA board of directors has updated AVA’s mission. The new mission is to build interprofessional leaders in vascular access to advance knowledge, practice, advocacy and collaboration to improve healthcare outcomes. We remain committed to provide education for everyone who touches vascular access. One of our many goals this year is to continue establishing a standardized PIVC curriculum in nursing schools across the US, Canada, and beyond. Additionally, we are working with an incredible group of volunteers to bring you the first set of Clinical Practice Guidelines in 2026.

As I look toward the future, I am thrilled about the AVASM25 in Florida the September. I eagerly anticipate reconnecting with familiar faces and meeting new attendees. AVA remains committed to offering a variety of educational opportunities throughout 2025, and I am excited for the education department to unveil even more innovative learning experiences. Your continued engagement is vital to the mission of AVA, and I can’t wait to continue this journey with all of you.

I am grateful for the participation and enthusiasm of all who contribute to the AVA community, and I look forward to the collaborative journey ahead!

CLINICAL PRACTICE GUIDELINES (CPG)

MICHELLE L. HAWES, DNP, CRNI, VA-BCTM , ACRP-CP CPG EDITOR-IN-CHIEF & DEVELOPMENT LEAD

1ST DRAFTS IN PROGRESS

Since the last CPG update in August, the section members have been working hard to write their first drafts of their recommendations. After the drafts are written and formatted, they move to the Guideline Governance Group (G3). The G3 uses a rubric to assess the draft, and then the information is combined to give the authors feedback on their draft. All the first drafts will be completed by March 15th.

AVA is now going to publish the complete guidelines in the first quarter of 2026 in a supplemental issue of JAVA. This has been a lengthy project, and we look forward to the feedback we will get when the revised drafts go out to the public for review during the spring and summer of 2025.

Thank you to all the CPG Leaders and Volunteers who have given their passion for the patient, time, and expertise to this important project.

As always, please email Mickey with any questions. javaeditor@avainfo.org

WHAT HAS YOUR PediNeoSIG BEEN WORKING ON?

PEDINEOSIG PAGE ON THE AVA WEBSITE IS UNDER CONSTRUCTION.

Check back in a few months for our newly updated PediNeoSIG page to include:

• Links to Pediatric and Neonatal educational resources

• Exciting pediatric and neonatal conference updates

• Pediatric Neonatal Reception at AVA Scientific Meeting 2025 in Florida

• More networking opportunities with pediatric and neonatal colleagues

PATIENT/FAMILY EDUCATION SHEETS

PediNeoSIG has created education sheets as a tool to help pediatric clinicians educate patients and families on the frequently requested topics of central venous line (CVC) and port vascular access devices. The education sheets describe the device and include basic care and maintenance education to supplement your institutional educational plans. Watch your email and social media for their March release and find a link on the PediNeoSIG page on the AVA Website.

PEDIATRIC AND NEONATAL BEST PRACTICE GUIDELINES FOR CENTRAL VENOUS ACCESS DEVICES

In the process of completing final edits on Pediatric and Neonatal Best Practice Guidelines so look for them to be released this summer!!!

PEDIATRIC AND NEONATAL PRECONFERENCE WORKSHOP – SEPTEMBER 18, 2025

We reviewed all your input from the 2024 AVA Pediatric and Neonatal Pre-Conference Workshops and are in the process of creating a new and exciting content, interactive education, hands-on stations, and networking experiences with your pediatric and neonatal colleagues.

Members of PediNeoSIG Executive Leadership Council. Luis Cipriano, BSN, RN, VA-BCTM, Angela Alderman, BSN, RNC-NIC, VA-BCTM, Melissa Stebel, MSN, CNS, VA-BCTM, CPEN, Katie Frate, BSN, RN, VA-BCTM, Kacey Wiseman, MSN, RN, CPN, VA-BCTM, NE-BC

PEDIATRIC AND NEONATAL NETWORKING

PediNeoSIG is actively working on expanding our pediatric and neonatal clinician networking opportunities. We encourage you to attend the AVA Annual Scientific Meeting September 19-21 (pre-conference workshops held on September 18) in Florida where two Pediatric and Neonatal networking opportunities are already scheduled:

• September 18, 2025, 5:30pm – 7:30pm: The Pediatric Neonatal Reception

• September 21, 2025, 7:30am – 8:45am: Pediatric Neonatal Coffee Talk session

And more to come!

PEDINEOSIG ELC SPOTLIGHT

The PediNeoSIG Executive Leadership Council (ELC) is so excited to welcome our newest member Rebecca Boyer, Director at Large to the ELC group this year.

• I spent the first 27 years of my life in the Northeast before transplanting to Memphis, TN. To this day I refuse to eat a bagel anywhere further south than Baltimore.

• I’m mom to three boys, ages 4, 6, and 19. I’m not sure who is messier - college students or preschoolers!

• Before finding my calling as a nurse, I studied classical voice with the intentions of become an opera singer.

Rebecca Boyer, MSN, RN, CNL, CPHON, VA-BCTM

AVA MEMBERS!

The Canadian Vascular Access Association (CVAA) for their 50th Annual national conference (April 30 - May 2, 2025) in beautiful Charlottetown, Prince Edward Island on the east coast of Canada.

CVAA is offering a 10% discount for AVA members to attend. Simply use this code on the registration form here: AVA2025

Why Should You Attend?

• Celebrate the 50th year of CVAA as an association!

• Get the latest in best practices as we officially launch the NEW CVAA Guidelines

• Learn from national and international experts

• Network with healthcare leaders in the vascular access/infusion therapy field; make new connections and renew former connections

• Learn about and test new products and services that can improve practice for better patient outcomes

• Participate in hands-on Skills Labs designed to teach you new skills and further develop existing ones

• Prince Edward Island is one of the most beautiful regions of Canada and lobster season launches during the conference days!

• Conference registration is open to both CVAA members and non-members - there are also student and group rates available.

You can see all the details here.

Please feel free to share these details with your colleagues. Thank you and see you on the Island!

PROMOTING SCHOLARSHIP, RESEARCH AND DISSEMINATION WITH AN UNIQUE NURSING RESEARCH FELLOWSHIP PROGRAM

GUADALUPE ORDAZ NIELSEN BSN, VA-BCTM

MARY HEITSCHMIDT, PHD, APRN, CCRN, FAHA

KICKER: INNOVATIVE WAY TO COMPLETE RESEARCH

A Health Systems’ innovative path to foster research, through nursing research fellowships provided infrastructure and processes for an AVA member nurse to receive paid time off and mentorship to develop, implement, evaluate, and disseminate her research study.

Have you ever had a nursing question that could not be answered with the current literature? Have you ever felt inspired to conduct nursing research to answer your question but were unsure of where to start? Or perhaps you may have had concerns about the time commitment and support required to complete such an endeavor?

You are not alone. Despite nursing research being an expectation for Magnet recognized hospitals1, nursing research can seem daunting and intimidating. Barriers and silos such as leadership support, competing priorities between patient care and research activities coupled with uncertainty of the research process can be discouraging for many.

According to the American Association of Colleges of Nursing, “nursing research provides the scientific basis for the practice of the profession”.2 However, nursing research at the bedside is lacking3,6 despite nursing programs at the baccalaureate level and higher prepare nurses to use scientific knowledge and contribute to new knowledge.1,7

BACKGROUND & RESEARCH EXPERIENCES

I graduated from an associates degree program in 1998 then pursued a bachelor’s degree in nursing (BSN) part time while working full time as a nurse. Nursing research was covered in the BSN program, and I gained a basic understanding of the research process.

As my nursing skills evolved and expanded into specializing in vascular access, I attended both local and national vascular access conferences. The multidisciplinary vascular access experts often encouraged conference attendees to read research articles especially nursing research which can positively impact practice and improve patient outcomes.

I further developed a deeper admiration and respect for researchers and the research process while being a part of a physician led research team. I envisioned I would eventually conduct my own quality improvement projects and research.

VASCULAR ACCESS EXPERIENCE AND R-VAT TASKFORCE

In 2018 I was part of the multidisciplinary task force at a 5-time Magnet recognized academic medical center to re- implement a vascular access team (VAT). We created a new VAT practice workflow that was evidence based and collected data to help guide practice and identify areas for improvement4. I joined the VAT as team lead.

The Rush Center for Clinical Research and Scholarship5 (CCRS) offers a wide variety of educational opportunities, support and project assistance for nursing staff such as evidence-based practice, research and quality improvement (QI) modules and how to seminars. I took advantage of these educational opportunities because they were free of charge and offered continuing education credit, with most being self-paced that could be completed remotely. Building on my existing knowledge base helped decrease the “guesswork” and frustration from being uncertain with the quality improvement and research process. Furthermore, the additional knowledge and individual support from CCRS faculty facilitated with the creation of VAT metric presentations and executing additional team projects which were disseminate both internally and externally.

The VAT partnered with the Rush College of Nursing Master’s and Doctor of Nursing Practice students to provide collaborative learning opportunities in quality improvement which allowed additional support on other projects as well. For example, the VAT’s first QI project was conducted in partnership with a VAT member to fulfill their Bachelor of Science in Nursing degree requirement. Rush nursing leaders were wonderful mentors who reviewed and critiqued projects and presentations.

RNRF BASICS

The purpose of the CCRS Rush Nurse Research Fellowship (RNRF) Program is to foster nursing research activities through mentorship, education and practical experience5. A one-page flyer describing the annual peer reviewed application program was distributed via e-mail to all clinical nursing staff and posted on bulletin boards on patient care units at all system hospitals.

Prior to submitting the application, I had to give very thoughtful consideration of what the RNRF workflow would entail, plus factor in the fellowship time commitment, ensure family support plus secure department leadership sponsorship as well. After confirming that I met the eligibility criteria, I submitted the RNRF application in the fall of 2022. However, I was not chosen for the 2023 cohort. I continued to work on VAT QI and evidence based practice projects and presentations which help to guide my journey of improving patient outcomes. I submitted another application for the 2024 RNRF cohort and was awarded the fellowship in 2024.

The perfect topic I had in mind to submit for the RNRF project was promoting the use of infusion ports when patients are hospitalized. Whether a port is accessed or not for non-chemotherapy infusion therapy has been a hot topic in the vascular access community for many years.

The purpose of my RNRF research is twofold. First to describe the outcomes such as, hospital discharges, infection rates and thrombosis rates associated with the insertion of additional vascular access devices. Secondarily, I created an anonymous research survey that was sent to members of the Association for Vascular Access (AVA) to determine their experiences with additional vascular access devices when a patient has an infusion port. The study is still ongoing.

The RNRF provides ongoing research project support beginning with well drafted instructions and a timeline for project completion. The Rush Nurse fellow is paired with a PhD nurse mentor and includes at least weekly study meetings. However, the support and mentoring extended to other endeavors such as guidance on poster submissions and presentations. The RNRF program provides the nurse research fellow with books for additional education reinforcement and facilitates collaboration with the Rush University library staff to provide guidance on formal literature searches.

Each week for one year, the nurse research fellow is allotted eight hours of dedicated paid time to work on a research project. Although the RNRF is rigorous with clear timelines for meeting project milestones, there is flexibility such as taking time off.

Halfway through the RNRF, the VAT team lead positions were restructured. However, I was supported to continue with the RNRF program and my research as I transitioned to a full-time bedside nursing role.

Currently, I am in the final phases of the RNRF program and working on two manuscripts to submit for publication in 2025! Without the support and guidance from the RNRF program, I am uncertain if I would have successfully completed the research project independently.

I encourage nurses and nurse leaders who are interested in promoting, conducting and disseminating research from within their institution to develop a similar program to showcase the wonderful and exciting research being conducted done by frontline nurses.

REFERENCES

1. American Nurses Credentialing Center. Learn About the ANCC Magnet Recognition Program. Accessed December 16th, 2024. https://www.nursingworld.org/organizational-programs/ magnet/magnet-manual-updates-and-faqs/2023-magnet-manual-updates-and-faqs/

2. American Association of Colleges of Nursing. (2006, March 13). AACN Position Statement on Nursing Research. American Association of Colleges of Nursing. Accessed November 17th, 2024. https://www.aacnnursing.org/news-data/position-statements-white-papers/nursingresearch

3. Powers J. Increasing capacity for nursing research in magnet-designated organizations to promote nursing research. Applied nursing research. 2020;55:151286-151286. doi:10.1016/j. apnr.2020.151286

4. Shonda Morrow, JD, MS, RN, CENP et al. (2022, June 7). Enhancing Patient Experience Through Adult and Pediatric VAT Implementation. Healthcare Value Analysis and Utilization Management Magazine. 9-17. Accessed December 16th, 2024. https://valueanalysismag.com/ enhancing-patient-experience-through-adult-and-pediatric-vat-implementation/

5. Rush Center for Clinical Research and Scholarship. (n.d). Center for Clinical Research and Scholarship. Accessed December 18th, 2024. https://insdierush.rush.edu/clinical/CCRS/ Pages/default.aspx

6. Reilly K, Heitschmidt M, Reed M. Engaging Nursing Students in Clinical Research Through a Unique Academic-Clinical Partnership. J Nurs Educ. 2024 Oct 28:1-5. doi: 10.3928/0148483420240611-01. Epub ahead of print. PMID: 39466290.

7. Kress C. Practical Tips for Facilitating Research in Clinical Nursing Practice. J Contin Educ Nurs. 2018 Jul 1;49(7):294-296. doi: 10.3928/00220124-20180613-03. PMID: 29939375.

WHERE TO GO FROM HERE?

BY TIFFANY DODD PURSUER OF AN ADVENTUROUS LIFE AND OCCASIONAL PATIENT.

As I sat in a hospital bed waiting for transport to my home hospital, I was left here by myself feeling anxious, scared, helpless, and dreading what the doctors would say. How did we get here? The other time I felt this way was when I was searching for a diagnosis more than a decade ago.

Back then, every time I went to the lab for “routine” blood work, my heart dropped. In my head, one stick was a small step closer to losing access. So many tubes of blood, drawn so often. It became harder and harder to find a vein. A one-stick draw turned into a multi-stick draw and sometimes even a multi-phlebotomist draw. I had become a phlebotomist nightmare. I remember thinking, “Where do we go from here?”

The doctors started talking to me about peripherally inserted central catheters (PICC)s and the use of temporary total parenteral nutrition (TPN) well before we had a diagnosis. I was starving to death, and the only way to survive was with TPN. It was a very scary conversation because with the conversation of PICC lines and other central lines comes a lot of complications and risks. And I also feared that once they got me gaining weight on TPN, they would stop searching for an answer, that the TPN would become permanent.

Unfortunately, my TPN became permanent, but thankfully, they did not stop. I was eventually diagnosed with gastroparesis, intestinal dysmotility, and failure to thrive, among other things. I was told that my stomach would regenerate in 3-5 years. However, I think that may have been incorrect since it has been over 11 years, and I have only gotten worse.

It did not take me long to have to battle one of the risks of having a central line. Not too long after the PICC line was placed, I noticed redness and discomfort. An ultrasound showed that the line had occluded, was no longer useable, and had to be removed. Quickly we were on to PICC line number 2, and so on, rapidly occluding all the veins of my arms.

After my first tunneled silicone catheter, I faced another complication: a central line infection. I can still remember how sick I was. I wanted to give up. After that, I lost count of how many infections and how many occluded lines I had.

On the one hand, once I got central lines placed, they could draw labs from one of the lumens, even sometimes from home. But the complications were also high.

How many access points do I have left?

Should that change how I live?

Should I go back to fearing to live, hiding from the world so I don’t get an infection, and I don’t lose that “last” access?

Should we make a bucket list and just live it?

We decided to start to live our lives again. If I run out of access, I want to leave knowing I experienced life. Our “Where do we go from here?” changed from an access question to an adventure question. We spent as much time as possible with family as our niece and nephews on the East Coast grew more and more. We enjoyed watching them play sports, try new things, and grow and prosper. My mom and I have gotten a lot closer, and we have enjoyed traveling to all the different bakeries in our area since we moved. We have found some great ones, but we do have a favorite.

My husband, Javier, and I traveled to various places. We would extend our Oley conference trip to include exploring other areas and enjoying the time we had together. We visited my husband’s island of Puerto Rico. We got passports and visited the Bahamas, a trip Javier earned. We even got to swim with the dolphins, which was high up on my bucket list. We went to California twice. Once, we went to Newport Beach for a few days in the winter. We also visited the LA area to visit with Javier’s brother’s family and to meet our new West Coast nephew. We got a chance to spoil our little guy. We got to experience all the things the LA area has to offer, including a Dodger’s game, Hollywood, and Disneyland, the first theme park since before I got sick.

Most recently, we went to Arizona for an Oley conference and then drove to Vegas. We stopped at the Hoover Dam and met up with some of Javier’s closest family in Vegas, including our little guy. What a great time we had.

And yet, as I sit here typing, I am still impatient that I have not broken the cycle. When we got home in July, I started a repeat pattern of infections. I have spent more time in the hospital than at home. I was diagnosed with COVID and a line infection.

Because of my lack of access, we must make decisions carefully. Usually, when you have a line infection, that line is removed, you receive a line holiday, and then they will replace the line when it’s safe. However, we decided to treat through the line. I spent two weeks in the hospital and went home to finish off a few days of antibiotics.

Some of the symptoms I had been experiencing before returned a few weeks later. I was diagnosed with pneumonia from COVID-19 and a line infection. This time, they changed it over a wire, the same track but a new line. Like the previous infection, 2 weeks inpatient, went home to finish off antibiotics.

The repeat cycle continued, although this last infection was a little different. I got stubborn and symptomatic, but I refused to go back to the hospital. It became urgent, and I fell while walking to the car. 911 was called, and I was taken to one of the hospitals in that area.

They wanted to pull my line in the hallway, saying I was septic with no blood cultures done. I was too complicated for them. However, I had to spend 10 days there waiting for a bed at my home hospital.

I finally got to my home hospital, where the staff knew my case. The conversations started: where do we go from here with this line? The decision was made to change it over a wire again. But soon after, I became very sick, spiking high fevers, pain, required oxygen, trouble breathing, and more.

They decided I needed a line holiday and that this line must be removed. I was nervous because they said I had to have a minimum of 2 peripheral lines for 48 hours. They brought in all their fun toys and tricks, including ultrasound, vein finder, heat, and so on. It took a long time, but they eventually got the 2 IVs. My trans lumbar line was removed, and my line holiday began.

When it was time to place my femoral line, my doctor decided to run a test while I was already under general anesthesia. They looked at my heart to assess for any bacteria on my valves. They did find endocarditis. They also ran into complications when placing the left femoral line. They said there was a lot of scar tissue and occlusion.

The line has been in for 4 days, and already it is a very positional line that doesn’t want to give blood; the stitches came out already and had to be sewed back in, yet we are hoping we can make it last for some time.

Where do we go from here?

I will hopefully get to go home soon, leaving with a fickle femoral line, 5 antibiotics, and TPN. And while it might be hard with all these meds, I do not plan on hiding out. I plan on living, but maybe at a slightly slower pace.

Reflecting on the past few months in the hospital, we have not accomplished much. The doctors found more negative than positive medical issues. But I am still choosing to live my life. Now, we prepare for the holidays, anticipating the arrival of our West Coast family for Christmas. I find myself embracing my line, for now, knowing I do not have much access left.

If you are in a position to care for patients with long-term chronic access, please pass on this advice and encourage them.

If you feel like you are running out of access or if you have been told that you have no access left, please ask questions.

Try to have a plan of action to get real help before you are in the predicament I am in now.

Tap into the resources of the Oley Foundation or the Association for Vascular Access.

Ask early, “Where do we go from here?”

Ensure that the question includes both your vascular access and your big adventurous life.

EXPO CORNER

CENTRAL VENOUS ACCESS DEVICES: AN EVIDENCEBASED APPROACH TO CATHETER SECUREMENT

DARCY DOELLMAN, MSN, RN, VA-BCTM

BACKGROUND

Central venous access devices (CVADs) play an important role for patients requiring all types of infusion therapy and central venous pressure monitoring.1 A CVAD is a catheter inserted into a vein and threaded to the superior or inferior cavoatrial junction.1 CVADs are indicated for medications that are inappropriate for peripheral infusions (irritants, vesicants, parenteral nutrition and vasoactive medications) and for therapies 30 days or longer.1 Types of CVADs include peripherally inserted central catheters (PICC), tunneled catheters, non-tunneled catheters and implanted ports.2 Selecting the most appropriate CVAD is a collaborative decision between the healthcare team and the patient/caregiver taking into account the patient’s diagnosis, condition and planned therapy.2 CVADs are not without risk and require visual inspection from the IV solution container, administration set, patient, and insertion site with each infusion intervention.2 An integral component of care and maintenance practices with CVADs is appropriate catheter securement to ensure the catheter does not dislodge or migrate in and out of the central veins.1,3 Inadequate or lack of catheter securement can lead to complications that may require premature removal of the catheter.2

CVAD COMPLICATIONS

CVAD complications may delay treatment, damage vessels, limit options for future vascular access, add to the length of stay and increase morbidity, mortality and healthcare costs.4 Early recognition and intervention of CVAD complications is essential to minimize patient harm.2 Complications include central lineassociated bloodstream infection (CLABSI), migration of skin organisms, dislodgement and micromotion.5 CLABSI is a serious complication influenced by patient condition, comorbidities, diagnosis and catheter type.1 Micromotion of the CVAD can be a contributing factor of CLABSI due to vessel irritation and endothelial stimulation leading to a localized response.1 Clinicians can help prevent CLABSI by following evidencebased guidelines for CVAD care and maintenance.2

CLABSI PREVENTION MEASURES2

• Perform hand hygiene before and after CVAD care.

• Disinfect needleless connectors with 70% isopropyl alcohol or alcohol-based chlorhexidine gluconate. Consider the use of an alcohol protective cap.

• Maintain aseptic technique with all CVAD access and dressing changes.

• Change administration sets and add-on devices at appropriate intervals.

• Maintain a closed infusion system.

• Remove unnecessary CVADs promptly.

Catheter movement and dislodgement are the most common causes of device failure due to inadvertent catheter removal by the patient, tension on IV tubing with patient movement, patient transfers and inadequate catheter securement.3 To minimize risks, appropriately protect and secure the catheter with a dressing and securement device.1

INFUSION STANDARDS OF PRACTICE FOR CVAD SECUREMENT

The Infusion Nurses Society Standards of Practice Recommends:

• Vascular access devices (VADs) are secured to prevent complications associated with dislodgement and motion at the insertion site.2

• Methods used to secure the VAD do not interfere with the ability to routinely assess and monitor the side or impede vascular circulation or delivery of the prescribed therapy.2

• Avoid the use of sutures as they are not an effective securement method.2

• Assess the integrity of VAD securement with each dressing change, and change the securement device according to the manufacturer’s Instructions For Use.2

• Assess skin when the securement device is changed due to the potential risk of skin injury.2

TYPES OF CATHETER SECUREMENT

Types of catheter securement include adhesive securement device (ASD), integrated securement device (ISD), subcutaneous anchor securement system (SASS) or tissue adhesive (TA).2 Selecting the most appropriate catheter securement is based on the type of CVAD, patient age, skin turgor and length of therapy.2 During the application and removal of the securement device, take measures to minimize manipulation and movement of the CVAD.7

In a study by Evangelista and Valle evaluating ASD catheter stabilization properties, commercially available devices were tested for their ability to withstand multiple pull force angles, micromotion and adhesive peel strength.6 Both the Clik-FIX® Soft PICC/ Central Securement Device and ClikFIX PICC/Central Tricot Securement Device showed the highest pull strength values up to 17.84 pounds, minimal micromotion and moderate adhesive peel strength.6

CLIK-FIX® CATHETER SECUREMENT DEVICE

Clik-FIX PICC/Central Catheter Securement Devices are designed to secure PICCs and CVADs with wings.7 Clik-FIX Catheter Securement Devices are made with a cushioning foam base designed for patient comfort.7 The PICC/CVC family of catheter securement devices are clinically tested to secure and perform better than market leading devices.7 All types of Clik-FIX Catheter Securement Devices are skin-friendly and designed to provide a comfortable and secure hold.7

SUMMARY

The Clik-FIX PICC/Central Catheter Securement Device is designed with patient care in mind and follows the INS standards of practice.7 Clik-FIX Catheter Securement Devices are designed to be simple, easy to use and maximize patient comfort.7

REFERENCES

1. Ullman AJ, Cooke ML, Mitchell M, et al. Dressings and securement devices for central venous catheters (CVC). Cochrane Database Syst Rev. 2015 Sep 10;2015(9):CD010367. doi: 10.1002/14651858.CD010367.pub2. PMID: 26358142; PMCID: PMC6457749.

2. Nickel B, Gorski L, Kleidon T, et al. Infusion Therapy Standards of Practice, 9th Edition. Journal of Infusion Nursing 47(1S):p S1-S285, January/February 2024. | doi: 10.1097/ NAN.0000000000000532

3. Moureau NL, Carr PJ. Vessel health and preservation: a model and clinical pathway for using vascular access devices. Br J Nurs. 2018;27(8):S28-S35. doi:10.12968/bjon.2018.27.8.S28

4. Xu H, Hyun A, Mihala G, et al. The effectiveness of dressings and securement devices to prevent central venous catheter-associated complications: A systematic review and metaanalysis. Int J Nurs Stud. 2024 Jan;149:104620. doi: 10.1016/j.ijnurstu.2023.104620. Epub 2023 Oct 9. PMID: 37879273.

5. McParlan D, Edgar L, Gault M, et al. Intravascular catheter migration: A cross-sectional and health-economic comparison of adhesive and subcutaneous engineered stabilisation devices for intravascular device securement. J Vasc Access. 2020 Jan;21(1):33-38. doi: 10.1177/1129729819851059. Epub 2019 Jun 4. PMID: 31159638.

6. Evangelista P, Valle JV. When the dressing is compromised…how well does the securement device stabilize. 2021

7. B. Braun Data on file.

THE JOURNAL 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.

ADVANCING PEDIATRIC AND NEONATAL VASCULAR ACCESS TOGETHER

TODD A. HESLEP MSN, RN, PARAMEDIC, VA-BCTM

PEDINEOSIG BOARD LIAISON

DIRECTOR-AT-LARGE, BOARD OF DIRECTORS ASSOCIATION FOR VASCULAR ACCESS

At the Association for Vascular, we recognize the critical role vascular access plays in the lives of pediatric and neonatal patients. As a clinician caring for pediatric and neonatal patients for over 17 years, I am excited to have the opportunity to serve as the AVA Board of Directors liaison to the Pediatric Neonatal Special Interest Group (PediNeoSIG), and I am proud to represent AVA’s ongoing commitment to supporting clinicians who dedicate their expertise to this vulnerable population.

Recent survey data from AVASM24 revealed that 27% of attendees provide vascular access services to pediatric patients, and 18% care for neonatal patients. Additionally, pediatric and neonatal vascular access ranked as the 8th highest topic of interest in conference survey data. These numbers confirm what we’ve long known—pediatric and neonatal vascular access is a priority for many of our members, and AVA is dedicated to expanding resources, education, and networking opportunities for this community.

PediNeoSIG: Driving Innovation and Education

PediNeoSIG continues to lead the way in providing resources tailored to pediatric and neonatal vascular access. Here’s what’s coming soon:

• Patient & Family Education Sheets –

Developed as educational tools for clinicians, these sheets will help guide families and caregivers.

• Pediatric & Neonatal Best Practice Guidelines – The members of PediNeoSIG are actively completing edits, and plan for these guidelines will be available this summer.

• Pre-Conference Workshop Enhancements – PediNeoSIG holds TWO hands-on preconference workshops at the annual AVA scientific meeting. Based on AVASM24 evaluations, our upcoming Pediatric and Neonatal Pre-Conference Workshop will feature new interactive content, expanded hands-on training stations, and enhanced networking opportunities.

• Pediatric & Neonatal Networking at AVASM25 – PediNeoSIG is planning dedicated opportunities to connect with peers caring for pediatric and/or neonatal patients. Stay tuned for upcoming developments.

Get Involved: Be a Champion for Pediatric and Neonatal Vascular Access

AVA’s strength lies in its members, volunteers, and leaders who drive our mission forward. If you’re passionate about improving pediatric and neonatal vascular access, I encourage you to:

• Join a Leadership Role: Apply for AVA’s Call for Leaders here

• Volunteer with AVA: Explore opportunities to contribute here

• Review Clinical Practice Guidelines: Help shape the future of best practices by signing up as a guideline reviewer.

Your voice and expertise matter. Whether through mentorship, education, research, or advocacy, your contributions help shape the future of pediatric and neonatal vascular access. We invite you to engage, collaborate, and help continue making a meaningful impact.

Together, we are advancing excellence in vascular access—one patient, one innovation, and one connection at a time.

POSTERS: WHY READ THEM? WHY SUBMIT ONE?

MICHELLE L. HAWES RN, DNP, CRNI, VA-BCTM , ACRP-CP

Scientific posters are snapshots of emerging research and practice. Posters can be case studies, quality improvement, and early research. Posters blend visual and data-driven narratives in a concise format.In this IQ, I am highlighting the posters presented at the 2024 AVA Scientific Meeting, which focused on Central Venous Access Devices and Pediatrics. Our conference planning team peer-reviewed these accepted posters.Your opportunity to submit a poster for the 2025 AVASM starts when you identify an issue and consider ways to address it. The application for next year will be coming in the Spring of 2025. Please enjoy reading these posters, and I hope they spark an idea for your contribution.

Poster Title Authors

Femoral Inserted Central Catheter as an Advanced Nursing Technique in Neonates

Impact of PiccPed® on preventing adverse events in Pediatric and Neonatal Peripherally Inserted Central Catheters (PICCs): A Quasi-Experimental Study

Impact of the I-DECIDED® tool on reducing complications, substandard dressings, and idle peripheral intravenous catheters in pediatric inpatients: Interrupted time-series study

Implementation Frameworks, Strategies and Outcomes in Optimising Central Venous Access Device Practice in Neonates: A Scoping Review

Implementation Frameworks, Strategies and Outcomes in Optimising Central Venous Access Device Practice in Paediatrics: A Scoping Review

Implementing Emotional Safety Initiatives to Reduce Needle Stick Pain in Pediatric Hematology/Oncology Patients: CORE Promise

PICCTIP: A New Measurement for Peripherally Inserted Central Catheters in Neonates

PIV Extravasations in Pediatric and Neonatal Care: A Call for Enhanced Vigilance and Education

Point of Care Ultrasound Using the Retract, Advance, Position (RAP) Technique for Catheter Terminal Tip Positioning of Lower Extremity Central Venous Catheters in the Neonatal Population

Radiant Resilience: CVAD skin injury prevention practices in paediatric radiation oncology.

Retrospective observational study of antimicrobial and antithrombogenic coated peripherallyinserted central catheters in the pediatric population

Presenter: Carolina G. Salini, MSc (she/her/hers) – Hospital de Clinicas de Porto Alegre, Vascular Access Program

Poster Author: Sabrina de Souza, RN, PhD – The University of Queensland (UQ) and Universidade Federal de Santa Catarina (UFSC)

Presenter: Thiago L. Silva, MSN – Universidade Federal de Santa Catarina

Poster Author: Elouise R. Comber, B Biotech (Hons) (she/her/hers) – The University of Queensland

Presenter: Elouise R. Comber, B Biotech (Hons) (she/her/hers) – The University of Queensland

Presenter: Mary Rebecca Tafaro Boyer, MSN, RN, CNL, CPHON, VABC (she/her/hers) – St. Jude Children's Research Hospital

Presenter: Sabrina de Souza, RN, PhD – The University of Queensland (UQ) and Universidade Federal de Santa Catarina (UFSC)

Presenter: Caitlin Anders, BSN, RN, VA-BCTM –Nationwide Children's Hospital

Poster Author: Matthew D. Ostroff, MSN, AGACNP, VABC – St Joseph's University Health

Presenter: Colleen A. Pitt, RN (she/her/hers) –Queensland Children's hospital

Presenter: Thomas E. Philbeck, Jr., PhD, MBA (he/ him/his) – Teleflex Incorporated

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Poster Title

Safe Insertion Epicutaneo Cava Catheter: a novel bundle to minimize complications related to the insertion of epicutaneo cava catheter.

Safe Insertion Umbilical Venous Catheter: a novel bundle to minimize complications related to the insertion of umbilical venous catheter.

Tunneled peripheral inserted central catheters in newborns admitted to neonatal intensive care: clinical data from 147 cases

Where Is the Tip of the Umbilical Venous Catheter?

Tip Position Determined by a New Device Using Intravascular Electrocardiography (IV-ECG) Correlates With Tip Position on Ultrasound

A GAVeCeLT consensus on the management of antithrombotic treatment and bleeding disorders in patients requiring venous access devices

A Vascular Access Team's 6 year Outcomes for Central Line Insertion in an Alternative Femoral Site

Antimicrobial Catheters: Classification, Myths and Facts

Decreased Dressing Changes Post Central Line Insertion by Interventional Radiology Team

Do No Harm: Decreasing Pain During Peripheral Intravenous (IV) Insertions

ECG tip location technology for ANY patient or picc catheter - is it possible?

Enhancing the Efficacy of Vascular Access Devices via Optimized Administration of Alteplase

Evaluating 5- and 4-lumen Central Venous Catheters Using a Quantitative Benefit Risk Assessment Tool

Feasibility and appropriateness of PICCs among cancer patients with chronic kidney disease observed over a two-year period

Femoral access in 2024: new techniques, new methods, new clinical indications

Frontline Engagement to Increase Efficiency & Decrease Risk of Staff Injury in an Oncology Vascular Access Department

Good practices to care for central venous catheters in adult patients with parenteral nutrition

Good practices to maintain central venous catheter in a public university hospital

Gum Mastic Liquid Adhesive Optimizes Central Venous Catheter Dressing Care in Transplant & Surgical ICU Patients

Haemostatic discs demonstrate inhibitory effects against microbes commonly associated with vascular access device related infections.

Hitting the Mark on the First Try - Peripheral Intravenous Central Catheter (PICC) Insertion Utilizing a Tip Positioning System (TPS)

How do you effectively incorporate patients into product development

Authors Link to Poster

Presenter: Giovanni Barone – AUSL della Romagna https://cdmcd.co/7bZmbr

Presenter: Giovanni Barone – AUSL della Romagna https://cdmcd.co/MK4BKK

Poster Author: Rodrigo N. Ceratti, RN (he/him/his) – Hospital de Clinicas de Porto Alegre - Vascular Access Program

Presenter: Christiane Theda, MD PhD MBA – Royal Women's Hospital Melbourne

Poster Author: Mauro Pittiruti (he/him/his) –Policlinico Universitario A.Gemelli, Roma

Poster Author: Tyger L. Homan, RRT, VA-BCTM –Banner Health

Poster Author: Nisha Gupta, MSc., PhD (she/her/ hers) – Teleflex

Presenter: Bailey Wood, VA-BCTM (she/her/hers) –Northwestern Medicine Kishwaukee Hospital

Presenter: Jennifer Bartowitz, BSN, RN, VA-BCTM –Froedtert Hospital

Poster Author: Casey Schuller, BSN, RN, VA-BCTM – Bon Secours Mercy Health System - Northwest Ohio Region

Presenter: David Markle, BSN, RN, VA-BCTM, EMT-B (he/him/his) – Adventhealth

Presenter: Lee S. Toni, PhD – Teleflex Incorporated

Poster Author: Joanne A. Dalusung, DNP, APRN, AGACNP-BC, CCRN, VA-BCTM (she/her/hers) – UT MD Anderson Cancer Center

Poster Author: Mauro Pittiruti (he/him/his) –Policlinico Universitario A.Gemelli, Roma

Poster Author: Maria Theresa Dizon Fabros, MSN, RN, NEBC, VABC (she/her/hers) – City of Hope Medical Center

Presenter: Aline C. Nunes (she/her/hers) – Hospital de Clinicas de Porto Alegre - Vascular Access Program

Presenter: Eneida R. Rabelo-Silva, Prof. Eneida Rabelo (she/her/hers) – Universidade Federal do Rio Grande do Sul

Poster Author: Zach S. Lassiter, RN – Mayo Clinic Florida

Presenter: Elise S. Pelzer, PhD (she/her/hers) –Queensland University of Technology

Primary Author: Janine C. Tayag, BSN RN (she/her/ hers) – New England Baptist Hospital

Poster Author: Chaitenya Razdan – Care+Wear

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Poster Title

ICU Nurse Reported Tube and Line Management Safety Incidents, and Techniques to Physically Handle and Manage Tubing and Cords at the Bedside

Impact of Evidence Based Practice Quality Improvements on PICC related DVT Complication Rates: One Health System’s Journey

Observational Experiment of Catheter Reflux During Huber Needle Withdrawal

Peer to Peer Audits to Increase Adherence to Central Vascular Access Device Maintenance Practices

Peripherally inserted central catheter in a patient with persistent left superior vena cava: a case report

Preventing CLABSIs, Introduction of an Evolving Central Line Care Bundle

Proctor the Doctor: VAT RN-led Internal Jugular Central Venous Catheters Training for Resident Physicians

Retrospective observational study demonstrates safety and performance of antimicrobial central venous catheters

Retrospective observational study of a new ECGguided tip positioning device for central venous catheter placement

Should ultrasound evaluation for catheter-related thrombosis be required before PICC removal?

The Choice of the Vascular Access in the Critically Ill

The FICC-port: an innovative totally implanted vascular access device

The Reduction of Central Line Associated Bloodstream Infections with the Use of Silver Impregnated Disk Dressings in Burn Injured Patients

The Use of Antimicrobial Silver-Plated Dressings for LVAD Driveline Infection Prevention: Data to Support Clinical Practice

Trading Sutures to Subcutaneous Anchoring Devices with Initial Securement for Tunneled CVCs

Tunneling as an Advanced Technique for Peripherally Inserted Central Catheter in Adults: Clinical Outcomes of a Five-Year Cohort

Ultrasound methods for intra-procedural tip location of central venous access devices: safe, accurate, fast, inexpensive!

Using the Electronic Medical Record: A Tool to Improve PICC Requests

Authors

Presenter: Lindsey R. Roddy, BSN, PhD(c) –RoddyMedical Inc.

Presenter: Kelly Ann Zazyczny, MSN, RN, NE-BC, VA-BCTM, CPN – Main Line Health System

Poster Author: Constance Girgenti, MSN, RN, VA-BCTM – VygonUS

Poster Author: Sebastian P. Arenas, MPH CIC VABC (he/him/his) – University of Miami Health System

Presenter: Tiago O. Teixeira, Sr., RN (he/him/his) – Hospital de Clinicas de Porto Alegre - Vascular Access Program

Poster Author: Courtney Ross, MSN, RN, CEN –UPMC St. Margaret

Presenter: Nate Ball, MSN, BA, RN, CCRN, VA-BCTM – Sutter Roseville Medical Center

Poster Author: Thomas E. Philbeck, Jr., PhD, MBA (he/him/his) – Teleflex Incorporated

Presenter: Fulvio Pinelli, MD (he/him/his) – Careggi University Hospital

Presenter: Michaela M. Craig, BA, BSN, RN, CCRN –Atrium Health Wake Forest Baptist

Presenter: Nancy Richards, MSN, APRN-CNS (she/ her/hers) – The University of Kansas Health System

Presenter: Jedediah Gervacio, BSN, RN, VA-BCTM, CRNI (he/him/his) – The Johns Hopkins Hospital

Presenter: Leandro A. Hansel, MSc (he/him/his) – Hospital de Clinicas de Porto Alegre - Vascular Access Program

Poster Author: Mauro Pittiruti (he/him/his) –Policlinico Universitario A.Gemelli, Roma

Presenter: Amanda Saba, RN, CRNI, Master in Science – Universidade São Paulo

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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.