June 2023 IQ

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

IQ PRESIDENT’S MESSAGE BY TONYA HEIM

The Mission of the Association for Vascular Access is to advance the global practice of Vascular Access through awareness, advocacy, and education to improve outcomes.

I have previously shared with you that the AVA Board of Directors reviewed, discussed, and revised our Mission Statement at our January Board retreat. I thought I would take this opportunity to talk about what it means and what your Board of Directors is doing to carry out this new mission,

“…advance the global practice of Vascular Access…”

Our Association has members from several countries, and we felt that it was important to place that global reach front and center in our Mission statement. I know that many of our members speak internationally to help advance the global practice of Vascular Access. AVA was represented at the joint CVAA/WaCOVA Conference by Chellie DeVries and Mickey Hawes. AVA will be represented at the VI Argentine Congress of Infusion Therapy and Patient Safety by Board Member Karen Laforet. In 2022, President Tonja Stephens was our representative at this congress. Karen will be speaking about the challenges of vascular access in burn patients, which is certainly a universal challenge. This international outreach is an important part of what we do at AVA.

“…through awareness,…”

AVA uses several channels of communication to spread the word about who we are and what we do. At the last board meeting, Tonya Hutchison, COO, shared engagement information with us that our Facebook, Instagram, and LinkedIn numbers have all increased significantly. Thank you to Blake Hotchkiss for his great work in driving those increases. Our Facebook video minutes watched increased from 966 to over 1800, and reactions to AVA posts increased by 550%. Instagram saw a 300% increase in reactions to AVA posts, and LinkedIn unique visitors and page views doubled.

AVA continues to work hard to keep our website up to date and communicate through email blasts as well as those social media channels. We certainly hope that each of you will help us spread the word by sharing those posts, emails, etc., with your colleagues and contacts. You never know when the knowledge you shared was just the thing that your colleague needed. You play a significant role in helping us carry out this part of our mission, and I want to thank you for doing so.

“…advocacy…”

What does advocacy mean to you? According to Webster’s Dictionary, advocacy is the act or process of supporting a cause or proposal. Though it seems to be a contemporary concept, this word was first used in the 14th century. Advocacy can take many forms. Speaking up for the dignity of an IV drug user who requires vascular access to treat their endocarditis. Supporting best practices for vessel conservation through input into policies and procedures, training co-workers, and obtaining your certification. For the AVA Board, advocacy efforts have included submitting comments to federal agencies for regulatory changes, and developing and publicizing position statements. Another action currently underway is the study we are participating in regarding Equity. Surveys are being sent to patients and clinicians on this important issue. Please participate if asked.

“…and education…”

AVA has certainly seen increased participation in our educational offerings. Year over year, from 2022 to 2023, CE certificates issued went from 844 to 1426. Attendance at our educational offerings increased from 1208 to 2489, and Academy Course orders increased from 143 to 389. We have recently kicked off the new IV League learning sessions every other Wednesday evening at 7:30 pm ET. These short sessions give attendees the opportunity to chat with the speaker about questions and challenges. They are designed to be accessible and appropriate for students as well, so please encourage any students you work with to register for this great series.

The AVA Scientific Meeting will be held October 14-17 in Portland, Oregon. The Scientific Meeting has been identified as one of the greatest strengths of our organization. If you haven’t registered yet, it is not too late. The Pacific Northwest is a beautiful area of the US, and the conference is lining up to be another great one. See you there!

“…to improve outcomes.”

This is the bottom line, for sure. Improving outcomes was my personal focus for the entire 51 years of my career, and I am sure that is your focus as well.

Our Vision statement is A World of Safe Vascular Access. I know that there is much work to be done to achieve this vision. Each of you knows of situations where vascular access was not safe, and I know it gets you fired up. There is so much work to be done. Use that fire you feel to increase awareness, advocate for patients, and educate those you work with. You are all ROCKSTARS, and I feel so privileged to work with this incredible organization.

Thank you for all you do.

AVA BOARD & STAFF

BOARD OF DIRECTORS

2023 PRESIDENT

Tonya Heim, MHA, MSN, RN, NEA-BC

2023 PRESIDENT-ELECT

Michelle DeVries, MPH, CIC, VA-BC™

2023 PRESIDENTIAL ADVISOR

Tonja Stevens, AGACNP, RN, BSN, VA-BC™

2023 TREASURER

Mark Rowe, MNSc, RNP, VA-BC™

2023 SECRETARY

Staci Harrison, DNP, RN

2023-24 DIRECTOR-AT-LARGE

Nael Mhaissen, MD

2023-24 DIRECTOR-AT-LARGE

Warren McGlauflin, RN, BS, VA-BC™

2023-24 DIRECTOR-AT-LARGE

Lynn Deutsch, MSN, RN, CRNI, VA-BC™

2022-23 DIRECTOR-AT-LARGE

Karen Laforet, RN, MCISc-AHCP, CCHN, CVAA, VA-BC™

2022-23 DIRECTOR-AT-LARGE

Nieltje Gedney, BA

2022-23 DIRECTOR-AT-LARGE

Chaitenya Razdan, MBA

STAFF

EXECUTIVE DIRECTOR

Brent Schwartz bschwartz@talley.com

CHIEF OPERATIONS OFFICER

Tonya Hutchison, CAE, thutchison@avainfo.org

DIRECTOR OF CLINICAL EDUCATION

Judy Thompson, MSNED, RN, VA-BC™ jthompson@avainfo.org

CLINICAL EDUCATION SPECIALIST

Blake Hotchkiss, BSN, RN, CCRN, CRNI, VA-BC™ bhotchkiss@avainfo.org

PROGRAM MANAGER

Lisa Colangelo lcolangelo@avainfo.org

JAVA EDITOR-IN-CHIEF

Michelle L. Hawes, DNP, CRNI, VA-BC™, ACRP-CP javaeditor@avainfo.org

ADVERTISING AND INTEGRATED PROGRAMS

Melissa Murphy advertising@avainfo.org

JOIN US IN OREGON AT AVA SCIENTIFIC MEETING 2023 PRECONFERENCE AS WE TRAILBLAZE THROUGH PEDIATRIC AND NEONATAL PICC INSERTION.

YOU TALKED...WE LISTENED!

Based on AVASM22 attendee feedback, we restructured the workshop to include a beginner and an advanced session. Stations were streamlined for hands-on learning utilizing pediatric and neonatal-sized needles, sheaths, and simulation pads. Session capacity was increased, a question-and-answer time was added to the end of each session, and each participant will be verified upon completing the program objectives.

The beginner session will be held in the morning and is designed for participants new to PICC insertion. The stations will include ultrasound guidance, direct puncture (sheath over needle), dressing and securement devices, Surgical ANTT (aseptic non-touch technique), PICC measurement, and patient bundling for procedural success. The session will conclude with a demonstration of a full PICC insertion.

The advanced session will be in the afternoon and designed for participants with approximately 3 years (~1000hrs/yr) of vascular access practice. The session will focus on the neonatal population and more challenging pediatric cases. The stations will include ultrasound guidance and the nuisances for neonates, neonatal Modified Seldinger Technique (MST), troubleshooting and challenging pediatric/neonatal cases, and ECG tip location technology. The session will conclude with a demonstration of a Mid-thigh Femoral PICC insertion.

Both sessions will also include a Child Life Specialist (CLS) presentation on how to best support and help the child cope during a PICC insertion through procedural medical play, preparation, education, and self-expression.

After a long day on the Oregon PICC Trail, please join us as we all put up our feet, eat, drink, and network around the campfire at the Pediatric Neonatal Reception. We look forward to seeing everyone in October for the AVA Scientific Meeting 2023.

CALL FOR PRESENTATIONS FOR GRAND ROUNDS AT AVASM23

Vascular access professionals often encounter unique challenges with their patients. We invite you to submit your case for consideration for the 8th Annual PediNeoSIG Neonatal and Pediatric International Grand Rounds or for the Inaugural AVA Foundation International Grand Rounds. Your submission may describe:

• A unique presentation of a vascular accessrelated complication

• An unusual vascular access challenge or outcome

• An unusual vascular access complication

An ethical challenge or controversy related to vascular access, a patient safety-related concern, or case

You will be asked to choose which patient population your presentation will address; Pediatric/Neonatal will be patients up through age 18 and Adult patient population will be from 19 years of age and older.

Abstracts will be blinded for review with selection based on value to learning of the vascular access community, integration of evidence-based strategies, implications for practice, and quality of the written submission. No patient-identifying information should be included.

Please be certain your submission is camera ready with appropriate spelling, punctuation, and clarity and utilizes the following headings (400 words or less total):

• Case information, including patient age and timing of event

• Differential diagnosis, challenge, or dilemma

• Diagnostics, treatment, and management

• Reflection on alternate management: What could have been done differently?

• Unique features of this case or controversy: What specific factors made this case unique or controversial?

• Implications for practice: What can clinicians take away and immediately consider adding to their practice?

Selected participants will be notified in early July and will receive:

• A short presentation to be included in the 8th Annual PedNeoiSIG International Grand Rounds or the 1st Annual AVA Foundation Grand Rounds (depending on patient population) session during the AVA 2023 Annual Scientific Meeting.

• A One (1) Day Complimentary Registration to the AVA 2023 Annual Scientific Meeting, or 50% off additional days OR full meeting.

8TH ANNUAL PEDINEOSIG NEONATAL & PEDIATRIC INTERNATIONAL GRAND ROUNDS AND INAUGURAL AVA FOUNDATION INTERNATIONAL GRAND ROUNDS SUBMISSION DEADLINE: JUNE 30, 2023

IMPORTANT! PLEASE NOTE THE FOLLOWING:

Presentation slides will be due by no later than August 18, 2023.

The PediNeoSIG International Grand Rounds session will take place in person at the AVA 2023 Annual Scientific Meeting on Tuesday, October 17, 2023 from 11:00 AM - 12:00 PM local time.

• The AVA Foundation Grand Rounds session will take place in person at the AVA 2023 Annual Scientific Meeting on Saturday, October 14, 2023 from 3:00 PM – 4:00 PM local time.

• If selected to present during one of the Grand Rounds and you must be prepared to attend in-person on the date of the presentation, we will not be able to accommodate virtual presentations.

Click here to submit.

UPSTATE HOMECARE ANNOUNCES JANICE ELLIOTT RECEIVING

NATIONAL HOME INFUSION FOUNDATION’S 2023 LYNN GIGLIONE WOMEN IN LEADERSHIP AWARD

AVA would like to congratulate Janice Elliott, Director of Vascular Access at Upstate HomeCare, for being selected to receive the 2023 Lynn Giglione Women in Leadership Award from the National Home Infusion Foundation (NHIF).

This prestigious award recognizes women leaders who have demonstrated exceptional service to patients and their peers while promoting the mission of NHIF.

Janice has over 28 years of experience as a registered nurse and is an active member and chapter president of the Association for Vascular Access Central New York (AVA CNY). She will receive the award at NHIA’s 2023 Annual Conference.

Learn More! 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.

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 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.

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.

• 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

WHO’S READY FOR A CONFERENCE?

Welcome! I am incredibly honored and excited to be part of AVA’s 2023 Annual Scientific Meeting in Portland, Oregon. The design team (D-Team) has been diligently working to create a versatile meeting and has an exciting lineup planned. Session topic highlights include equity, diversity, and inclusion; hospital onset bacteremia; catheter materials; and navigating legality in vascular access.

Whether you are a conference veteran or a first-time attendee, the AVA scientific meeting is a great venue to spark inspiration and immerse yourself in the opportunity to engage with fellow vascular access specialists from around the globe. We will hear from influential leaders in general sessions, attend multifaceted breakout presentations on niche topics, explore the latest from our industry partners in the Exhibit Hall, and take a quiet moment to browse the electronic poster display.

To give you some insight into conference planning, let’s demystify the selection process. The selection committee, known as the “D-Team,” comprises a dynamic group of clinicians representative of numerous vascular access specialties and diverse settings. Careful consideration is given to survey responses, current hot topics, and emerging trends to ensure a well-rounded conference.

Submissions are collected from the AVA Call for Presentations, blinded, and assigned to three independent D-Team reviewers for critical appraisal. Each abstract is objectively scored based on clarity of purpose/goals and content description, anticipated attendee interest, and is assessed for potential risk of commercial bias. Speakers new to the AVA meeting are interviewed by a D-Team member to become acquainted with them and their experience as a presenter, as well as gain additional insight into the overall content. This creates an opportunity to answer questions and enhance the collective process for new speakers.

Conference managers and the selection committee come together for an all-day meeting to review the compiled scores and feedback. All respective submissions are evaluated in this collective forum, and votes are cast. Selected abstracts are then plugged into the schedule template to create an engaging four-day experience.

Hosted in Portland, Oregon, this vibrant city is home to unique culture, street food, and an expansive lush landscape. After a day full of intriguing vascular access content, you can sample renowned culinary diversity from food cart “pods” or indulge in some retail therapy at one-of-akind boutiques in the Pearl District. Stroll along the Willamette River or hop on the Portland Aerial Tram to enjoy sweeping city views. Home to one of the tallest waterfalls in the world and the largest independent bookstore, Multnomah Falls and Powell’s Books are also popular attractions in the City of Roses.

REGISTRATION FOR AVASM23 IS OPEN!

At the heart of this meeting is the work each and every clinician puts into advancing this specialty and bringing best practices to our patients for optimal outcomes. I want to extend a heartfelt “Thank you” to the immense team required to make this annual event possible. The dedication from the AVA organization, conference managers, industry partners, and D-Team members is remarkable. It has been my distinct privilege to be your D-Team Chair for the AVASM23. I can’t wait to see you in Portland, learn from each other, and celebrate the achievements shared by the vascular access community.

AVA offers two types of attendance options, which is best for you?

IN-PERSON ATTENDANCE

OCTOBER 14-17, 2023

Join us in Portland, October 14-17, 2023 (premeeting workshops available at additional fee and will be held on October 13th) for education, networking, and some FUN! You can earn up to 30+ CEs with this registration type. 20 CEs will be available to you during the in-person event (more CEs offered if you attend a pre-meeting workshop). Starting on October 25th you can listen to any session that you missed in Portland to earn an additional 10 CEs.

ON-DEMAND ATTENDANCE

STARTING

OCTOBER 25, 2023

Unable to join us in Portland? We will miss you but have provided an alternative way for you to still obtain CEs and get the amazing education from AVASM23! Register for AVA On-Demand and you will have access to 20 CEs. Starting on October 25th you can watch the sessions presented at the In-Person conference at your convenience. Some presentations will be video recordings and others will be audio/slides only.

ADVANCE DISCOUNT: BETWEEN MAY 20, 223 AND AUGUST 31, 2023

LATE REGISTRATION: BETWEEN SEPTEMBER 1, 2023 AND OCTOBER 17, 2023

More information about registration types and fees can be found by clicking here.

Kacey M. Wiseman, MSN, RN, CPN, VA-BCTM, Chair - D-Team, AVA Scientific Meeting 2023

NETWORK NEWS

RISING TO THE OCCASION VASCULAR ACCESS SUMMIT

MAY 20TH, 2023, TAMPA, FLORIDA

GulfVAN had an amazing Rising to the Occasion Vascular Access Summit on May 20th in Tampa- We hope all our Florida nurses filled their cups just a little bit and enjoyed a massage while they learned.

Thank you, Mike Serle, Tammy Johnson, Matt Gibson, Nancy Moureau, Wayne Teipen, and Jack LaDonne, for presenting for the Summit.

Thank you to our many vendors for spending a Saturday with us- we hope you enjoyed your time at Vendor Splendor with our attendees.

A BIG thank you to the Board of Directors from our sister network FLAVAN who helped us manage the event. Left to right: FLAVAN BOD, Dave Markle, Meagan Capen, Austin Green. GulfVAN BOD, Kristin Jacobs, Sandra Mehner (not pictured)

Another shout-out to Tampa General for supporting us during our event. You are all truly amazing! xoxoxo

That’s all the news from GulfVAN,

Kristin Jacobs #GulfVAN #MannyMatters #AVA #vascularaccess

Call for news, product evaluations, quality improvement initiatives, and patient stories.

IQ is a quarterly AVA Newsletter that serves our membership in a way that a peer-reviewed publication can’t. In this publication, our members can tell us how a product performs in the real world, let patients tell us about their side of the line, and share what our AVA Networks are up to.

IQ is a way for new authors to get started with publishing less formally. Submissions will require disclosures for product evaluations, patient permission to tell their stories, and references to support your statements. All IQ manuscripts are subject to scrutiny by the JAVA editor, and mentoring will be offered to help you be successful.

If you have questions or don’t know where to start, contact the JAVA editor @ javaeditor@avainfo.org.

SUBMISSION DATES ARE:

• August 25, 2023 for submissions for Fall IQ

• September 22, 2023 for submissions for the AVA Scientific Meeting IQ Special Edition

• November 24, 2023 for submissions for the Winter IQ

DON’T ACCEPT THE WAY IT’S ALWAYS BEEN: CHANGE THE WAY YOU MONITOR IVS FOR INFILTRATIONS BEFORE IT’S TOO LATE.

AVASM 2023, 60 MIN BREAKOUT

TUESDAY, OCTOBER 17, 2023

9:45 – 10:45

PRESENTED BY: ROLANW

Peripheral neonatal vascular access is essential in providing medical care to neonates. Are you interested in the latest advances? Look no further than AVASM23, where Matheus (Roland) van Rens, a highly experienced neonatal nurse practitioner and researcher, will present on this important topic.

With over thirty years of clinical experience and a MA in Advanced Nursing Practice from Erasmus University in the Netherlands, van Rens is a leading authority on neonatal vascular access. He has worked as an advanced neonatal nurse practitioner, performing complex vascular access procedures and conducting clinical research in Europe and the Middle East. Additionally, he has developed and delivered multi-professional education activities and presented at numerous international conferences.

Van Rens’ research focuses on improving neonatal care, particularly vascular access. He has collaborated with researchers worldwide and published several peer-reviewed journal articles on neonatal vascular access, infusion therapy, and related technologies.

At AVASM23, van Rens will share his expertise on peripheral neonatal vascular access and discuss new technology to improve outcomes for neonates and limit the severity of complications. One such technology he will be highlighting is the ivWatch, a device that has shown promise in reducing the incidence of infiltration and extravasation.

Don’t miss this opportunity to learn from one of the leading experts in neonatal vascular access. Register for AVASM23 today and be sure to attend van Rens’ session!

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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HOW DO YOU INSERT, MANAGE AND REMOVE CVADS IN YOUR PEDIATRIC CANCER CARE PRACTICE?

As a vascular access community, we strive to promote central venous access device (CVAD) performance and prevent adverse events, such as infections and blood clots. This involves carefully selecting and inserting the appropriate type of device, effectively managing it, and monitoring for potential complications. [1]

In pediatrics, almost all children receiving treatment for cancer require a CVAD during their treatment.

By providing a safe and reliable means of access, this device will significantly contribute to the child’s well-being and improved outcomes. [2]

However, current CVAD practices may vary between individuals, settings, and countries.

CVADs move across traditional disciplines and health services, with multiple specialties (e.g., infectious disease, surgery, anaesthetics) and their primary team involved in their selection, insertion, use and removal.

In 2015 an Australian point prevalence audit in tertiary pediatrics described considerable variability in the insertion, management and removal management between departments and hospitals [3]. However, the current CVAD practices, and potential variability, in pediatric cancer care is less clear, and this is a population at high risk for adverse outcomes. [4]

We want to understand how these devices are used in pediatric cancer care in different healthcare services, internationally.

While current CVAD practices are likely to be based on guidelines, many individual recommendations do not have high-quality evidence. Regional variations in CVAD practice may also be due to tradition, opinion, and resource availability rather than best practice [5]. However, undirected diversity in clinical practice rarely leads to quality clinical outcomes. Therefore, it is important to understand the current situation and identify the variations in usual practices for future management changes.

Please help us improve patient care by sharing your experiences with CVADs in pediatric cancer care.

We aim to describe the current CVAD practice in paediatric cancer care by exploring and comparing CVAD selection, insertion, management, and complication management practices. These results will be used to target improvements and innovations in practice.

WHO CAN PARTICIPATE?

Clinicians (doctors, nurses, vascular access specialists), who are involved in CVAD practice (selection, inserting, management and removal of CVADs) in their pediatric cancer setting are eligible to respond to our survey.

Are you involved in the insertion, management, or removal of CVADs in your pediatric cancer setting? If so, your valuable participation can improve pediatric oncology CVAD practice.

AUTHORS:

DR. AREUM HYUN, MARI TAKASHIMA PROF. AMANDA ULLMAN (THE UNIVERSITY OF QUEENSLAND, AUSTRALIA)

If you do not use CVADs in your pediatric oncology practice, please share your current associated practice (e.g., use of peripheral intravenous catheters) on the first page.

HOW TO PARICIPATE

To participate, Click here CVAD survey. Or scan the QR code.

If you have any questions or would like additional information, please contact Professor Amanda Ullman at a.ullman@uq.edu.au

This study has been approved the University of Queensland Human Research Ethics Committee (#2023/HE000076). If you have concerns or complaints about this research, please contact the Chair of the HREC on +617 3365 3924 / +617 3443 1656 or email humanethics@research.uq.edu.au.

REFERENCES

1. Ullman, A.J., et al., Complications of Central Venous Access Devices: A Systematic Review. Pediatrics, 2015. 136(5): p. e1331-44.

2. Ullman, A.J., et al., Prevention of occlusion of cEnTral lInes for children with cancer: An implementation study. Journal of Paediatrics & Child Health, 2020. 56(12): p. 1875-1884.

3. Ullman, A.J., et al., Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care. Journal of Paediatrics and Child Health, 2017. 53(2): p. 123-130.

4. Ullman, A.J., et al., Road map for improvement: Point prevalence audit and survey of central venous access devices in paediatric acute care. J Paediatr Child Health, 2017. 53(2): p. 123130.

5. Ullman, A.J., et al., Global Pediatric Peripheral Intravenous Catheter Practice and Performance: A Secondary Analysis of 4206 Catheters. J Pediatr Nurs, 2020. 50: p. e18-e25.

WHAT’S HAPPENING IN AVA EDUCATION?

The AVA Education department may be small, but we are mighty (busy). A benefit to our size is the ability to innovate and pivot quickly. We read the comments from conference and course evaluations and plan our strategy with your comments in mind. We want to fill the unmet needs and offer the resources you request.

AVA members are busy professionals and students. We recently launched a new education offering, ‘IV League Learning’ with this in mind. The IV League learning series brings relevant topics to you every other Wednesday at 7:30 pm ET. These short (~15 minute) presentations introduce new concepts and keep attendees up to date on a variety of subjects. Go to www.avainfo.org/ ivleaguelearning to see a list of upcoming topics or check out an event you missed.

Clinical Practice Guidelines, led by AVA’s Blake Hotchkiss, is the pinnacle of AVA offerings. This group of dedicated volunteers has invested countless hours in support of this project. The team’s goal is to launch at AVA’s scientific meeting in 2024. The project’s search methods revealed thousands of articles for the teams to screen through to arrive at the most relevant published evidence for guideline development. More information will be shared about the project as the publication date grows closer. This being the first edition, our aim is to deliver the highest quality of evidence-based guidelines possible without exception.

AVA’s ISAVE That Webinar continues to thrive with great speakers and beautiful presentations. Know that AVA webinars are usually free for our members to attend. We have covered some informative content this year, including anatomical location and variations in valves in the venous system, improving the care surrounding short, long, and midline catheters, tissue adhesive and its application in the neonatal population, and vascular access considerations for patients receiving ECMO.

DIRECTOR OF CLINICAL EDUCATION

Judy Thompson, MSNED, RN, VA-BC™

CLINICAL EDUCATION SPECIALIST Blake Hotchkiss, BSN, RN, CCRN, CRNI, VA-BC™

Q & A WITH OPEN AI’S CHATGPT

I’m a big fan of technology and how it makes my life easier. From my phone and watch to my car and bike, technology is always there to provide me with actionable data. But one area where I feel technology hasn’t made a significant impact yet is healthcare. I believe there is a huge gap when it comes to incorporating artificial intelligence in healthcare to improve efficiency.

Recently, I had an appointment with my ophthalmologist, and I ended up waiting for what felt like an eternity. As I sat there, frustrated and impatient, I couldn’t help but think there must be a better way. That’s when I remembered the power of artificial intelligence. In the tech industry, AI has revolutionized many aspects of our lives, from social media to self-driving cars. Why can’t it do the same for healthcare? There is so much potential to improve the system, and I can’t wait to see what the future holds. Open Ai’s ChatGPT is one of the most renowned companies in the field of AI technology, so I asked ChatGPT some questions.

What is AI and its role in healthcare?

ChatGPT: Artificial intelligence (AI) is a field of computer science that involves developing algorithms and systems that can perform tasks that would typically require human intelligence. These tasks include reasoning, learning, perception, and decision-making. Ultimately, AI can help computers learn and improve their ability to perform tasks without being explicitly programmed.

In healthcare, AI has the potential to transform the way we diagnose and treat diseases, as well as how we manage healthcare resources. For example, AI-powered systems can analyze large amounts of medical data to help identify patterns and make predictions about patient outcomes, which can help doctors make more informed decisions and improve patient care. AI can also help automate tasks such as medical image analysis, drug discovery, and clinical decision support, which can help save time and improve accuracy.

There are also potential ethical and privacy concerns around the use of AI in health care. These concerns include ensuring that patient data is kept secure, improving healthcare outcomes, and making healthcare more accessible, and efficient.

Can you cite 5 references to your response?

ChatGPT: Certainly! Here are the five references to support my response:

1. Obermeyer, Z., Powers, B., Vogeli, C., & Mullainathan, S. (2019). Dissecting racial bias in an algorithm used to manage the health of populations. Science, 366(6464), 447-453. https:// doi.org/10.1126/science.aax2342

2. Topol, E. J. (2019). High-performance medicine: the convergence of human and artificial intelligence. Nature Medicine, 25(1), 44-56. https://doi.org/10.1038/s41591-018-0300-7

3. Char, D. S., Shah, N. H., & Magnus, D. (2018). Implementing machine learning in health care—addressing ethical challenges. New England Journal of Medicine, 378(11), 981-983. https://doi.org/10.1056/nejmp1714229

4. Rajkomar, A., Dean, J., & Kohane, I. (2019). Machine learning in medicine. New England Journal of Medicine, 380(14), 1347-1358. https://doi.org/10.1056/nejmra1814259

5. Wu, C. Y., Wu, H. T., & Lee, C. C. (2020). Applications of artificial intelligence in health care: A review. Journal of Medical Systems, 44(8), 145. https://doi.org/10.1007/s10916-020-01612-2

AUTHOR:

PAOLO PETINES, BSN, RN, VA-BCTM, LEGACY GOOD SAMARITAN MEDICAL CENTER, OREGON VASCULAR ACCESS NETWORK

Are you a search engine?

ChatGPT: No, I am not a search engine. I am an AI language model created by Open AI, designed to understand, and generate natural language text based on a vast amount of data and algorithms. While I can certainly assist with answering questions and providing information, my capabilities are limited to what I have been trained on and my responses are based on my programmed algorithms and knowledge database, rather than crawling and indexing the internet like a search engine.

How do you generate responses to queries?

ChatGPT: As an AI language model, I generate responses to queries using a combination of algorithms and data. My programming is based on a deep learning neural network architecture that has been trained on a massive amount of text data from various sources, including books, articles, and web pages.

When I receive a query, I analyze the text input and try to understand its meaning and context by using natural language processing (NLP) techniques such as semantic analysis and entity recognition. Then, based on this analysis, I generate a response by using various algorithms such as language generation models and text prediction models to select the most appropriate words and phrases.

My responses are also influenced by my pre-existing knowledge, which is based on the vast amounts of data that I have been trained on. This enables me to provide relevant and accurate information on a wide range of topics.

Based on your response to my first question, did your answer come directly from those references?

ChatGPT: The response to the first question was not directly taken from any of the references I provided. As an AI language model, I use my pre-existing knowledge and programming to generate responses based on my understanding of the topic. However, my responses are informed by my training data, which includes the text of scientific articles and other sources, including the references I provided. In some cases, my responses may incorporate information or ideas that are similar to or inspired by the content of those references.

I am writing an article about AI. Do I need permission to publish your responses?

ChatGPT: As an AI language model, I am programmed to provide responses to your questions and do not own any intellectual property rights to the answers. However, if you plan to use my responses in your story, it is recommended that you check with Open AI, the company that developed and owns the GPT-3.5 architecture, to see if they have any restrictions or guidelines on the use of their technology. Additionally, it is always good practice to give credit to sources you have used in your writing.

Sharing & Publication Policy

This policy allows creators to publish written content, such as a book or short story, that was co-authored with the Open AI API, as long as the content meets certain conditions. The content must be attributed to the creator’s name or company, and the role of AI in creating the content must be clearly disclosed in a way that readers can easily understand. The content cannot violate Open AI’s Content Policy or Terms of Use, and creators should avoid sharing content that may offend others. The creator must take ultimate responsibility for the content being published and should accurately describe the creative process, including the use of ChatGPT to generate draft language that was then reviewed, edited, and revised by the creator. https://openai.com/policies/sharing-publication-policy

As my last question, I asked ChatGPT to write a poem about Vascular Access Specialists. Here is the result.

ODE TO A VASCULAR ACCESS SPECIALIST

A Vascular Access Specialist, so skilled and so wise, With a steady hand and a watchful eye, Inserting catheters and managing lines, Ensuring patients stay safe and fine. A master of access, with training so deep, A true expert in catheter placement and keep. From central lines to ports, they know what to do, To provide the best care and see patients through. With every insertion, they strive for perfection, Sterile and safe, with the utmost attention. Educating patients, with patience and care, Making sure they understand and are aware. They monitor for signs of infection and more, Preventing complications, their job they adore. Helping patients heal and recover well, Their work is vital; there’s no one to tell.

So, here’s to the Vascular Access Nurse, For the care they give, we’re grateful, of course. For the countless lives, they touch and enhance. We thank them, we honor them, and we give them a chance.

ChatGPT

By Open AI

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PROLONGED USE OF A TUNNELEDCUFFED CENTRAL VENOUS ACCESS DEVICE

AUTHORS: JOANNE DALUSUNG & SARAH PALYA

In the post-acute space, unique situations arise in the care of long-term vascular access devices. In this article, AVA’s Beyond Acute Care Special Interest Group (BAC-SIG) members investigate the challenges in the care and maintenance of a 5.5-year-old Broviac.

BACKGROUND

Over a decade ago, my son, Gus, then age 7, had his first central line placed due to dysmotility that led to intestinal failure. “Functionally short gut,” he has several medical and behavioral complications that make it exceptionally difficult to keep a central line safe and operative. As someone with autism and is non-verbal, Gus often communicates his wants and emotions physically. One of the greatest challenges of his care is managing his self-injurious actions when he experiences abdominal pain from intestinal failure. At the time his first central line was placed, these behaviors were incessant and heartbreaking to endure. More than that, they were very difficult to prevent, putting his central line in certain danger. Since Gus will need central access for the rest of his life, keeping his catheter safe became my mission. I ultimately want Gus to have the best quality of life possible, and I know that vascular access is at the heart of making that possible. There is tremendous gravity in the knowledge that every decision we make regarding his central access has the potential to shape his long-term outcome.

Thus far, Gus has been very fortunate to have only 4 central catheters placed in over 11.5 years of use, varying from 14-18 hours a day. To the best of our knowledge today, all his access is still viable. Our success in these demanding circumstances can be attributed to how his lines have been secured and protected. His current line is a single-lumen tunneled Left IJ, 6.5Fr catheter. This 5.5-year-old line continues to work well and is utilized 14 hours a day for parenteral nutrition, bi-weekly blood draws, and periodically for iron infusions.

After the 5-year birthday of his catheter, serious questions arose about the potential for adverse events like catheter fracture during removal:

• Are we increasing the risk of an adverse event by not proactively replacing his aging line?

• Do the risks of a conservative approach outweigh the potential benefits to his long-term vascular access?

• Is there an existing framework or protocol for evaluating this situation?

Gus’s team and I are in a fortunate position to be able to weigh the risks and benefits and consider the best course of action (or in-action) for his catheter. Knowing what an important decision this is, I brought the question to Joanne Dalusung, one of my counterparts in BAC-SIG, for her assessment of our options.

DISCUSSION

Guidelines on appropriate vascular access devices (VADs) of choice according to the intended duration of use are well-defined.1-3 On the contrary, there appears to be a lack of information about how many years tunneled catheters can remain in place and functional. Tunneled vascular access devices, like Broviac, are recommended for use if needed for more than three months or longer, like for parenteral nutrition. The most common complications include infection, thrombosis, and catheter fracture, which are widely published and may result in catheter removal. Catheter-related bloodstream infection (CRBSI) is the most common complication of home parenteral nutrition, associated with mortality.4,5 A study by Dibb and colleagues in 2014 showed how implementing catheter care protocols and training nurses, patients, and caregivers help minimize the occurrence of CRBSI.5 Additionally, the study emphasized VAD salvage, if infected, can be achieved by an initial standardized protocol tailored to the patient's clinical condition and microbiological sensitivities.4, 5

How long is too long?

Removing a functional catheter after five years of indwelling time lacks evidence and is not widely recommended. However, available evidence on the risk of keeping tunneled lines too long is related to the difficulty of removing the line when no longer needed. Published reports of calcification around the catheter, fractured catheter, or stuck catheter are found in the literature. Vellanki and colleagues found that only 0.92% of all permanent hemodialysis catheters removed in a ten-year period resulted in a “stuck catheter” requiring invasive removal.6 A study by Kojima and colleagues reported that implanted vascular access devices connected to Groshong silicone catheters accessed using the internal jugular vein have a greater fracture risk than ports connected to polyurethane catheters.7 It is unclear if the findings of these two studies can be generalized to a patient using a long-term Broviac for PN. The decision to keep the catheter should be discussed if keeping the VAD outweighs the risks of removal after long-term use between the vascular access specialist, a surgeon, the patient, and the caregivers.

The Infusion of Nursing Society and Association of Vascular Access guidelines do not recommend routine replacement of tunneled catheters within a certain period. There appears to be a lack of existing framework or protocol for evaluating this situation. A review of the literature did not show any results for duration of a long-term Broviac or other VAD. However, a wealth of evidence is provided on circumstances under which it should be removed. Vessel health preservation and patient preference are recommended in vascular access device selection. Standards of practice such as catheter salvage with antibiotics and anticoagulation for catheter-related thrombosis are used to avoid the need for removal and reinsertion of new VAD if vascular access is still needed.4, 5, 8 There should be an equal emphasis on patient

education about insertion and removal of a VAD. In the absence of indications for removal, like treatment completion and infection, the patient's preference is suggested as the primary consideration, as in the case presented above.

CONCLUSION

Currently, the available evidence supports keeping a functional vascular access device and only removing it when clinically indicated. To better understand the useful lifespan of a longterm vascular access device, one needs to weigh the cost and benefit of maximizing the dwell time of the device versus the risk of complications. The authors recommend conducting additional longitudinal research to understand better the risks and benefits of proactive replacement versus maximizing the useful lifespan of a long-term CVAD. There is limited data on how long a VAD can remain in place after insertion, placing the burden of decision-making regarding removal on the patient, caregiver, and managing clinical team.

REFERENCES

1. Gorski LA. A look at 2021 Infusion Therapy Standards of practice. Home Healthcare Now. 2021; 39(2): 62–71. https://doi.org/10.1097/nhh.0000000000000972.

2. Association for Vascular Access. Resource guide for vascular access, 2nd ed. Herriman, UT: Association for Vascular Access; 2021.

3. Chopra V, Flanders SA, Saint S, Woller SC, O'Grady NP, Safdar N, Trerotola SO, Saran R, Moureau N, Wiseman S, Pittiruti M, Akl EA, Lee AY, Courey A, Swaminathan L, LeDonne J, Becker C, Krein SL, Bernstein SJ. The Michigan Appropriateness Guide for Intravenous Catheters (MAGIC): Results from a multispecialty panel using the RAND/UCLA appropriateness method. Annals of Internal Medicine. 2015; 163(6): S1– S24. https://doi. org/10.7326/m15-0744.

4. Edakkanambeth Varayil J, Whitaker JA, Okano A, Carnell JJ, Davidson JB, Enzler MJ, Kelly DG, Mundi MS, Hurt RT. (2017). Catheter salvage after catheter‐related bloodstream infection during home parenteral nutrition. Journal of Parenteral and Enteral Nutrition. 2017; 41(3): 481-448. https://doi.org/10.1177/0148607115587018.

5. Dibb MJ, Abraham A, Chadwick PR, Shaffer JL, Teubner A, Carlson GL, Lal S. (2014). Central venous catheter salvage in home parenteral nutrition catheter-related bloodstream infections. Journal of Parenteral and Enteral Nutrition. 2014; 40(5): 699–704. https://doi. org/10.1177/0148607114549999.

6. Vellanki VS, Watson D, Rajan DK, Bhola CB, Lok CE. The stuck catheter: a hazardous twist to the meaning of permanent catheters. J Vasc Access. 2015; 16(4): 289-93. https://doi. org/10.5301/jva.5000392.

7. Kojima S, Hiraki T, Gobara H, Iguchi T, Fujiwara H, Matsui Y, Mitsuhashi T, Kanazawa S. Fracture of totally implanted central venous access devices: A propensity-score-matched comparison of risks for groshong silicone versus polyurethane catheters. The Journal of Vascular Access. 2016; 17(6): 535–541. https://doi.org/10.5301/jva.5000606.

8. Naik V, Mantha S, Rayani B. Vascular access in children. Indian Journal of Anaesthesia. 2019; 63(9): 737. https://doi.org/10.4103/ija.ija_489_19.

NAVIGATING VASCULAR ACCESS AS A FAMILY: A FATHER-DAUGHTER JOURNEY OF ADVOCACY, EDUCATION, AND INNOVATION.

AUTHOR: EMILY LEVY

The following manufacturer-patient interview is a branded article. The information presented in this interview is the opinion of the author(s) and patient(s) and not necessarily the view of the Association for Vascular Access. AVA expects the reader to investigate any manufacturer’s claims regardless of the forum. AVA appreciates the partnership with manufacturers to improve the lives of patients. Intravascular Quarterly invites other manufacturers to present their stories in this way.

By valuing and incorporating the patient's perspective, vascular access stakeholders can deliver meaningful, personalized care aligned with the patient's overall well-being and lifestyle needs. In this insightful patient-interview article, Emma and her father, Mark, discuss their experiences with long-term and acute vascular access. Emma relies on a central line for chronic condition management, while Mark underwent ten weeks of IV antibiotics to treat sepsis from a spinal lipoma abscess. The family graciously shares their challenges, successes, and support systems they leaned on for in and outpatient life with central lines to bring the patient experience to the center of vascular access education. The experiences shared by Mark and Emma underscore the significance of the need for patient education, adopting new product innovations, and access to appropriate patient resources when navigating vascular in outpatient care.

Emma needs frequent infusions to treat her Postural Orthostatic Tachycardia Syndrome (POTS) Dysautonomia, Hereditary Angioedema (HAE), and Mast Cell Diseases. Additionally, Emma's diagnosis includes Gastroparesis and GI dysmotility. She depends on a G-tube alongside her central line to meet her nutritional and hydration needs. POTS is a condition characterized by an abnormal increase in heart rate upon standing, accompanied by symptoms such as dizziness and fatigue1. Hereditary HAE is a rare genetic condition characterized by low levels of dysfunctional C1-INH protein in the blood. A skin reaction often accompanied by hives makes HAE a potentially life-threatening disorder resulting from a genetic defect2. Mast Cell Disease is characterized by the abnormal activation and accumulation of mast cells, immune cells involved in allergic reactions. This can lead to many symptoms, including skin rashes, gastrointestinal issues, respiratory problems, and systemic symptoms3. Emma receives three to five infusions per week of fluids and medications, crucial in managing her symptoms and improving her quality of life. She shared, "I rely on my port for IV fluids and medication treatment, whether at home or in cancer or infusion center."

Before having her port placed, Emma received treatments through peripheral intravenous catheters (PIVC)s three to five times a week. Emma and her care team recognized the significant risk of potential access loss and prioritized vein preservation to ensure the ongoing availability of her treatments. Although her doctor eventually ordered a port, Emma struggled to find a specialist to place the central line. Emma recalls her experience: "Getting connected to a physician who would place my port was difficult, despite recommendations. But once connected, my health history and the port placement plan were well explained and received.” Seeking additional support, Emma reached out to Mighty Well, which led to a pivotal connection with Dr. Gregory Schears, an AVA Member and Mighty Well advisor from the Mayo Clinic. Dr. Schears successfully placed Emma's port, overcoming the reluctance of local

specialists due to her complex medical background. Emma's unwavering determination to advocate for the best line for her quality of life ultimately led her to the help she deserved. While Emma’s need for vascular access is long-term, her father, Mark, never expected to switch roles from being a parent-caregiver to needing vascular access himself. One day, Mark became septic, and his medical team and family were unsure why. Testing revealed that he had a lipoma wrapped around his spine that led to an abscess. A lipoma is an expected, non-cancerous growth of fat cells that forms a lump under the skin. Lipomas can occur anywhere on the body where fat cells are present, but they are commonly found on the neck, shoulders, back, and arms4. While lipomas are usually harmless and do not require treatment, he became septic due to the lipoma creating an abscess on his spine. His treatment plan required the utilization of a PICC for ten weeks of IV antibiotic therapy.

Mark shares, "My PICC placement was urgent, limiting my interaction with a vascular access specialist. However, I recognize the importance of their expertise in ensuring safe and effective care...I received treatment in the hospital and later at a [outpatient] cancer center… communicating with my caregivers over the phone made it difficult to understand my treatment plan fully." Mark acknowledges that Emma's lived experience with vascular access, combined with prior knowledge from a manufacturer and AVA's patient education partnership, in addition to the publication Ultimate Guide to PICCs for Patients and Caregivers6, helped to ease his transition into outpatient life with a PICC. He said, “Their resources provided me with valuable insights into caring for my central line. Having a support system was crucial during this challenging time." Emma continues, "Mighty Well and AVA have empowered me to be an advocate for myself and my vascular access care. Their tools and resources have given me the skills to advocate effectively. Not only do Mighty Well products empower me, but their dedicated team has truly made an investment in my life." She encourages patients and caregivers to educate themselves and utilize the available resources distributed by Mighty Well and AVA’s partnership.

One of the primary concerns for Mark and his family revolved around managing his lumens at home while carrying out his daily activities. They were worried that the lumens could become entangled with household items or that their dog might unintentionally pull on the lines, leading to dislodgement or infection. He shares, “A stockinette was given upon discharge from the hospital. However, no lumen caps were provided. It was explained that the hospital did not use them, and they did not provide any value. This was a concern my family had due to the risk for infection it posed.” Mark was frustrated by the stockinette given by the hospital to cover his PICC and contain the lumens and extension tubing. As a replacement for

stockinette, Emma helped Mark acquire Mighty Well’s innovative textile-based secondary catheter securement device, the PICCPerfect® Pro. The PICCPerfect® Pro offers several advantages to PICC care and management in clinical settings, including potential cost and time savings. The PICCPerfect® Pro is used to store the external lumens of the catheter. When used correctly, PICCPerfect® Pro supports, stabilizes, and improves the care and cleanliness of the catheter and reduces the need to use tape on the skin.

In a Quality Initiative from a regional health center in Iowa, the clinicians reported improved dressing integrity compared to the standard of care, reduced frequency of dressing changes, and decreased catheter-related complications after implementing the PICCPerfect® Pro. These benefits were assessed by comparing variables such as dressing lifespan, preemptive dressing changes, and complications like dislodgement, infiltration, or infection pre- and post-implementation5.

Mark enthusiastically shares his experience with the PICCPerfect® Pro, saying, "It was an awesome product! The cover was discrete and size-inclusive, which was important for me as a large male. It provided a great layer of protection and stayed securely in place." Reflecting on ineffective alternatives, Mark says, "The stockinette given by the hospital continually rolled up and compromised the dressing. This caused bleeding and dressing issues. In contrast, the PICCPerfect® Pro cover kept my line safe and secure, ensuring longer-lasting dressings." Emma's motivation to assist her dad in obtaining a PICCPerfect® Pro stemmed from her frustration with vascular access and infusion specialists suggesting he use a cut-off sock to protect his life-saving device. Emma explains, “Healthcare professionals recommend patients cut up socks, a useless product to cover it like a stockinette to ‘protect’ their lines. Those items are false advertisements. It would be useful and resourceful and, in the patient and doctors’ best interest, to distribute a product that can improve the patient experience.” Emma and Mark's experience highlights the need for innovative additional PICC securement products that address the everyday challenges patients and clinicians face. Their story emphasizes the importance of finding solutions that improve the overall experience of managing vascular access, meeting the needs of both patients and clinicians.

Emma and Mark's stories underscore the significance of patient-centered care and the power of advocacy through being informed, consumers. In addition, their journeys highlight the importance of patient education, product innovation, and robust support systems in navigating long-term and acute vascular access complexities. By sharing their experiences, Emma and Mark have provided invaluable insights that can inspire clinicians, industry, and patients alike to enhance the quality of care in vascular access.

REFERENCES:

1. Postural Orthostatic Tachycardia Syndrome (POTS). Cleveland Clinic. September 9, 2022. Accessed May 25, 2023. https://my.clevelandclinic.org/health/diseases/16560-postural-orthostatictachycardia-syndrome-pots

2. (2020, September 28). Understanding Hereditary Angioedema. American Academy of Allergy Asthma and Immunology. Retrieved May 25, 2023, from https://www.aaaai.org/tools-for-thepublic/conditions-library/allergies/understanding-hereditary-angioedema

3. Systemic Mastocytosis. Mayo Foundation for Medical Education and Research. November 20, 2020. Accessed May 25, 2023. https://www.mayoclinic.org/diseases-conditions/systemicmastocytosis/symptoms-causes/syc-20352859

4. Lipoma. Mayo Foundation for Medical Education and Research. February 11, 2022. May 25, 2023. https://www.mayoclinic.org/diseases-conditions/lipoma/symptoms-causes/syc-20374470

5. Gomez, M. D. M. (2023, May 12). PICCPerfect® Pro Case Study: Read more about our Quality Initiatives Study Results with a Regional Health Center in Iowa. Mighty Well. Retrieved May 25, 2023, from https://mighty-well.com/pages/research

6. Cruz, K., RN, BSN, Levy, E., & Gomez, M. D. M. (2022, February 24). Ultimate Guide to PICCs for Patients and Caregivers: Reviewed by the Association for Vascular Access (AVA). Mighty Well. Retrieved May 25, 2023, from https://cdn.shopify.com/s/files/1/1356/3483/files/Mighty_Well_s_ Ultimate_Guide_to_PICCs_Approved_by_AVA_2.pdf?v=1679586385

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RESOURCE GUIDE FOR VASCULAR ACCESS

The 2021 AVA Resource Guide for Vascular Access: AVA's Recommended Study Guide for Vascular Access Board Certi cation 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 de nition 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 certi cation examination (VA-BC™), as well as serve as a resource throughout professional practice.

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• Not a downloadable le. 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)

CLABSI REDUCTION: IMPROVING DRESSING COMPLIANCE

AUTHORS:

VICKIE GRIFFIS, MSN, RN, CCRN, AND ANITA “GAIL” CANTRELL, RN,VA-BCTM

As a member of the Adult Vascular Access Team (AVAT), who performs daily rounding and surveillance on all central lines every day, we noticed a trend. As we rounded and found a breached dressing, we kept hearing similar responses from the bedside staff. “I knew you guys would be rounding, so I just saved the dressing for you to change.” And then more frequently, “I haven’t done a central line dressing in quite a while; I’m just not comfortable doing it.”

As this was occurring more and more, we decided it was time to act. Recognizing their lack of confidence and competency in performing a dressing change, an opportunity for quality improvement presented itself. At this moment in time, our central line dressing compliance was at 87.4%, and the central line bloodstream infection rate was 0.90/1000 catheter days.

Therefore, an opportunity was knocking. INS Standard: 42.3. Site Care, including skin antisepsis and dressing changes, is performed at established intervals and immediately if the dressing integrity becomes compromised (e.g., lifted/ detached on any border edge or within the transparent portion of dressing; visibly soiled; the presence of moisture, drainage, or blood) or compromised skin integrity is present under the dressing 1

We decided to initiate this Quality Improvement (QI) Project with 2 primary goals.

1. Improve dressing compliance rates-

• Nurses would be educated on how to assess dressings and determine if a dressing was breached.

• Nurses would be educated on how to perform a central line dressing change appropriately.

2. Decrease central line-associated bloodstream infections (CLABSI).

Our steps in the planning process included:

• An Action Request was submitted to Shared Governance to propose a practice improvement in which the bedside nurse will change a breached central line dressing as soon as possible. The action request was sent to the Practice Council for review. This request was approved.

• A subcommittee then met to discuss potential interventions and actions to address the problem. From this meeting, the importance of hands-on training became apparent and was preferred.

• The team leaders, Vickie Griffis and myself met to discuss how the education would be completed. This education would include the rationale for this project, current compliance rates, and a demonstration of a central line dressing change done by AVAT.

• The team leads then met with the management teams of the floors on which we focus our education to discuss plans and goals.

• Education began in April 2022.

CONCLUSION

We are a year into the QI project and have completed approximately 60% of the targeted audience. We have seen positive results with increased compliance and decreased CLABSI rates. As we continue with the project, we hope to see further positive impacts at our facility and better outcomes for our patients.

The QI project team goal | Compliance rate by month

REFERENCES

1. Gorski LA HL, Hagle ME, et al. Infusion therapy standards of practice. J Infus Nurs. 2021;44(1):S119 doi:10.1097/NAN.0000000000000396

Figure 1, Central Line Dressing Change Compliance

Figure 2, CLABSI Rate Report

Hours of exclusive audio interviews with the authors discussing their areas of expertise are embedded into this version of the book, as well as animated videography capturing elements from actual vascular access procedures. AVA has also elevated the overall readability, and through Apple, Amazon and Barnes & Noble has added note-taking and flash card functionality for readers.

Copyright 2023 Association for Vascular Access. All rights reserved.

Disclaimer: AVA (Association for Vascular Access) is a professional organization of vascular access professionals dedicated to improving vascular access practice and patient outcomes through education and other means. AVA publishes this periodic electronic newsletter for our membership and other interested parties for information purposes only. AVA distributes this electronic newsletter with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the IQ publication. AVA is not giving advice and does not subscribe to guarantee the accuracy or efficacy of the information provided. Privacy Policy and Unsubscribe Information -AVA maintains strict rules of confidence with regards to your email address and all other personal contact information. We will not, under any circumstances, sell, transfer, or provide your email address to any third party for any reason. Email lists are compiled on an opt-in basis by AVA for the sole purpose of distributing the IQ newsletter. AVA does not condone or participate in the distribution of unsolicited email. If you feel that you have received an email transmission from AVA in error, please contact AVA at and ask to be removed from the list. All removal requests are addressed promptly.

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