The e-news publication of the Association for Vascular Access NOVEMBER 2021 | VOLUME XI | ISSUE 4
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 info@avainfo.org.
Protect Patients • Educate Clinicians • Save Lines
IN THIS ISSUE Page 2
Inside AVA: Notes from the Executive Team
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3M advertisement
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When Sticking is Not An Option
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Have You Been Listening?
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PediNeoSIG
Page 10 Make Like a Suture and Let Go! Page 12 It’s More Than a Line . . . It’s a Person Page 15 Network News Page 17 Thank You Industry Partners Page 18 Welcome to Our Newest AVA Members Page 20 Educational Offerings from AVA Page 21 AVA Academy is Always Open Page 22 ISAVE That Line Page 23 Vessel Health and Preservation: The Right Approach for Vascular Access
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INSIDE AVA:
NOTES FROM THE EXECUTIVE TEAM Guest Column by Judy Thompson | Director of Clinical Education
This column allows the AVA Executive Team to keep you up to date on new member benefits on the horizon, our educational activities, AVA programs, services, advocacy, and other issues of interest. AVA is your professional home, and we always want to hear from you on how we can improve our services. Please email at cbrennan@avainfo.org and thutchison@avainfo.org.
As AVA wraps up 2021 and the second year of the pandemic, this is a good time to review the educational resources available to our members, nonmembers, faculty and students as well as industry partners. Let’s start with the AVA Scientific meeting. Our AVA D-Team did an amazing job with vetting and selecting the educational content of AVASM21. Our volunteers, leadership and Clinical Review Panel provided countless hours of expertise throughout the year to help develop and deliver continuing education (CE) content. As the staff leader of these efforts, I am grateful for their dedication and expertise. An important goal of the AVA strategic plan is to “Create Innovative Best Practice Education.” There are three objectives associated with this goal: 1) create online education for AVA Academy; 2) create print and digital resources; and 3) create larger vascular access visibility. I am pleased and proud to report we have delivered on these goals. Here are some highlights for 2021.
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CREATING ONLINE RESOURCES FOR AVA ACADEMY • Over 11 hours of continuing education with our live webinars on a broad range of high-demand subjects. If you missed the live events, these are on AVA Academy for both CE and non-CE viewing • 30 hours of continuing education with our Onthe-Road webinars delivered in partnership with our Networks and industry partnerships. • Four Industry Roundtables • Two CE webinars held in collaboration with the Canadian Vascular Access Association (CVAA) • 14 new hours of CE courses on AVA Academy, which were curated from some of the highly popular and rated courses from AVASM20 sessions CONTINUED ON NEXT PAGE
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Ultrasound Tran Cleaning and Disinsducer fecti for Vascular Acce on ss Procedures
The Association
for Vascular Access August 2020
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INSIDE AVA, CONTINUED FROM PREVIOUS PAGE CREATE PRINT AND DIGITAL CLINICAL RESOURCES • The American Institute of Ultrasound in Medicine (AUIM) Intersocietal Position Statement was published. This has been broadly accepted with now 19 professional organizations supporting the paper. The 19 organizations represent an estimated 750,000 healthcare professionals • A second position paper on Intraosseous use is scheduled to be in review before the end of the year. • Reviewed five of the 2019 position papers • Use of Visualization reviewed and published • Arterial, CVAD Insertion, ANTT and Ultrasound Guidance is currently being reviewed for revisions by authors • Release in September 2021 of the 2nd Edition of the AVA Resource Guide • Work continues on the Clinical Practice Guidelines, a multi-year project that is using the expertise of six working groups. It is slated for publication in September 2022 • Pediatric/neonatal resources are in development for release in early 2022. Led by Pedi/NeoSIG, the focus of this work is a PICC course, which will be on AVA Academy, and future workshops. A new physical/digital resource book is also in production. Because nearly 90 percent of AVA members provide both adult and pediatric 3 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
services, the pediatric resource guide content was incorporated into the 2nd Edition of the AVA Resource Guide
CREATE LARGER VASCULAR ACCESS VISIBILITY • The Fundamental of Peripheral Intravenous Vascular Access™ launched in the Summer 2021 with the PIV 101 (Basic course). Two pilots were conducted at Marian University and the data is being analyzed for a peerreviewed article for 2022. Three universities are participating in the PIV 101 course with 329 students and faculty signed up. The PIV 201 course will launch in time for inclusion in the Spring 2022 semester. • AVA also renewed it focus on VA-BC™ exam preparation with its series in partnership with Infusion Knowledge. • AVA continued its very popular ISAVE podcast series, producing 10 events in 2021. In addition to the above, the education department continues to innovate. We hope you’ve noticed the new look and feel of our webinars and we’re adding video to our podcasts. We are always looking for ways to support you and your practice. Please send us your wish list for education, we are eager to hear from you. We wish you a happy and safe holiday season.
WHEN STICKING IS NOT AN OPTION Jocelyn Hill, MN, RN, CVAA(c), VA-BC™ | Clinical Nurse Specialist for IV Therapy, Vascular Access and Chemotherapy/ Hematology at St. Paul’s Hospital, Providence Health Care in Vancouver, BC
The insertion of central vascular access device (CVAD) is done with full intention that the CVAD will stay in place for the duration of required clinical indication without complications. Adhesive-based dressings have been part of the standard of care for decades to cover and protect the CVAD site with the assumption that some dressings can fully secure a CVAD.1 Problems can arise when the patient’s disease process, trauma, or skin condition ceases to allow the adhesive to adhere to intact, healthy skin around the CVAD site.2,3 As a result, the clinician is challenged with how to protect and secure the VAD in place without using adhesives in any form, neither the dressing nor the securement device.2,4 The purpose of this article is to highlight an effective strategy and describe how a securement device that is adhesive-free can be used as an option to allow for the surrounding skin to heal once impaired. Two clinical scenarios and situations will be used to provide context and help guide clinical practice.
CLINICAL SCENARIO – 1
A 30 year-old male patient (Mr. A) required a peripherally inserted central catheter (PICC) for home IV antibiotics for 6 weeks. The patient has a chronic condition of atopic eczema on is his hands and arms and he complains of sweating and severe itchiness with adhesive tapes and dressings. Mr. A presented with areas of reddish-pink, raised and scaly areas on his skin to his upper arms where the PICC is to be placed. The insertion procedure occurred with no complications with the use of a subcutaneous anchoring securement system (SASS SecurAcath, Interrad Medical, Plymouth, MN) as the standard of care to prevent catheter pistoning at the site and malposition. The use of the SASS in this particular situation was even more beneficial as the routine care and maintenance of the PICC can now include the use of just gauze and silicone adhesive tape with a light gauze wrap (stockinet) without the skin contact and irritation from an acrylic adhesive found in most semi-permeable adhesive dressings. Using an adhesive dressing was not an option. The skin surrounding the PICC site was still typical for him with symptoms of atopic eczema but he tolerated the SASS well and his symptoms did not worsen during therapy. The patient was able to complete his home IV therapy without any interruptions or complications of catheter-related infection or malposition.
CLINICAL SCENARIO – 2
Figure 1: PICC in situ to upper arm with surrounding rashy skin. Patient has history of atopic eczema. Subcutaneous anchoring securement system (SASS - SecurAcath, Interrad Medical, Plymouth, MN) in place for optimal PICC securement and allows for alternative non-adhesive dressing of dry gauze and silicone tape. Photo courtesy of M. Brodie, Vancouver, BC Canada)
Figure 2: Tunneled silicone CVAD in situ on chest with subcutaneous cuff pulled out from exit site on Day 14
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WHEN STICKING ISN’T AN OPTION, CONTINUED FROM PREVIOUS PAGE post insertion. Surrounding skin has some irritation and for additional comfort, a piece of wound contact layer dressing with silicone is applied under the SASS bottom platform. Photo by J. Hill, Vancouver, BC Canada)
A 70 year-old female patient (Mrs. B) required a tunneled, cuffed CVAD for parenteral nutrition (PN) and infusates. Mrs. B. has been taught how to manage her PN at home as her nutritional requirements are life-long. On insertion of the CVAD by interventional radiology, sutures were used at the site to allow the tissue ingrowth cuff to adhere to the subcutaneous tissue in her upper chest area and a transparent, semi-permeable acrylic adhesive dressing was used to cover and protect the CVAD site. On removal of the sutures at day 14 (standard routine), the CVAD was accidently pulled on and the catheter migrated out by 3 cm with the tissue ingrowth cuff exposed at the exit site. Additionally, the skin surrounding the CVAD exit site was found to be red, itchy and weepy under the dressing. On consultation with the Clinical Nurse Specialist for Vascular Access, a SASS was recommended to eliminate further issues with malposition and to allow the surrounding skin to heal. An alternative to adhesive-type dressings for full securement was necessary. Insertion of the SASS was done without complication. Gauze and silicone adhesive tape was used to protect and cover the site until skin healed around the site. In addition, the patient also reported an increase in confidence that the catheter would not move or retract during cleaning of the skin around the CVAD. This security was an added benefit as she does her own dressing changes. The goal is to keep the CVAD free from complications for an indefinite period of time because of life-long parenteral nutrition requirements.
SKIN IMPAIRMENT / INJURY In both scenarios presented, the patients had clinical indications for vascular access with the importance of therapy that is complication-free and intact skin integrity is important for patients’ quality of life during this time. Medical adhesive-related skin injury (MARSI) is a term that is used to describe a breakdown in skin integrity due to inappropriate use and or removal of adhesive on the skin as well as premature 5 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
placement of a dressing before the skin antiseptic is allowed to dry.3,4,6 Catheter Associated skin injury (CASI) has recently been used to describe skin injury specifically from adhesive used to cover and protect VAD sites and catheters.4 For the most part, the use of adhesive dressings to cover and protect CVADs is effective with the caveat that proper application and removal of the dressing takes place. The use of approved skin antisepsis agents such as chlorhexidine gluconate (CHG) is also a factor in CASI.3,4 The skin antiseptic CHG solution must be completely dry before the contact with adhesive dressing material. Applying the dressing prematurely can create topical issues leading to skin injury. It is incorrectly assumed that patients are “allergic” to CHG and it has been discussed in various vascular access and infusion therapy forums that it is actually rare that patients develop a true CHG allergy.5 It is most likely that they have become sensitive, or reactive, to inappropriate dressing change methods.2,3,4,6 It is well-documented that skin injury from adhesive securement can be painful and cause the preventable catheter-related complications such as malposition and pistoning at the site due to lack of full securement properties.2,7
SASS STRATEGY The use of a SASS is applicable on VADs such as midlines, PICCs and non-tunneled and tunneled CVADs.2,6,7 When tackling patient-specific issues such as MARSI, or CASI, the goals are for the patient experience and care to be positive and optimized respectively. With SASS technology, complete securement is achieved by being anchored under the skin rather than relying on an adhesive dressing stuck on top of skin that has compromised integrity8. The scenarios described speak to different situations where the SASS is inserted at time of CVAD insertion and post insertion when subcutaneous tissue ingrowth cuff adherence has failed. No matter what the indication for the CVAD is, or the duration of the therapy (short term, acute vs. chronic, long-term), proper catheter tip position is extremely important. The SASS helps to prevent accidental tip malposition caused by catheter migrations or dislodgements that CONTINUED ON NEXT PAGE
WHEN STICKING ISN’T AN OPTION, CONTINUED FROM PREVIOUS PAGE occur during routine dressing changes, catheter site care and activities of daily living. 2,7,8,10 In both scenarios, routines for care and maintenance with dressing changes remained consistent with the use of CHG for skin antisepsis (with emphasis on full dry time) and the use of sterile 2x2 gauze and silicone-adhesive tape to secure the gauze covering the SASS and site – for Mrs. B, the addition of a wound contact layer dressing with silicone was used under the SASS platform for comfort on the chest. In scenario 1, this routine was done for the duration of short-term therapy and adhesive securement and cover dressings were not used. In scenario 2, the SASS remains in place providing good securement and we were able to use a transparent, semi-permeable, adhesive dressing to cover the site and area once the surrounding skin was fully healed. Mr. A received care from community nursing for the weekly PICC dressing changes and nurses were able to easily perform the procedure in the home without fear of accidently retracting the catheter at all. For Mrs. B, it has become a lot easier for her to do her own dressing changes as she is able to confidently clean her CVAD site fully by lifting up the catheter in the SASS without fear of pulling or migration at the site. With the SASS, the PICC was stabilized throughout Mr. A’s course of treatment and the PICC and SASS were removed at end of therapy. Mrs. B continues to rely on the SASS to fully secure her CVAD despite the subcutaneous tissue ingrowth cuff on the catheter not being under her skin and this is of great importance and benefit to her as she continues her parenteral nutrition indefinitely at home.
TAKE HOME MESSAGE AND CONCLUSION The clinical situations presented have shown how SASS technology can provide an effective strategy and alternative when skin integrity is compromised. The SASS will provide securement of the catheter with or without an adhesive dressing and can be inserted at time of catheter insertion or post-insertion with proper technique. Once skin integrity is compromised to the CVAD site and surrounding skin, adhesive
dressings and securement may contribute to further injury if they are used.3,4,6 Avoiding unnecessary adhesives for dressings and securement and a period of time without adhesive allows skin healing to take place without the risk of catheter migration or dislodgement. Complications such as skin injury and catheter migration, or malposition, can lead to interrupted treatment impacting overall therapy. To be a vascular access specialist is to be able to expertly conduct routine procedures on typical patients and have the capability to adapt to atypical patients ensuring equally positive outcomes. If every patient and situation were routine, we wouldn’t need specialists. This discussion explored situations that were outside “the norm,” but not unheard of, for patients with CVADs. The increased awareness and adoption of SASS technology for all CVADs can prevent complications such as catheter malposition and help skin to heal when MARSI/CASI occurs.2,4,7,8 Preventing vascular access-related complications such as discussed here, is a priority not just for vascular access specialists, but for everyone on the health care team. This allows for provision of quality patient care and to focus on other aspects of the clinical situation in the patient’s journey to overall therapy, health and well-being.
REFERENCES 1. 3M Infection Prevention. A history of 3M Tegaderm brand. Skin & Wound Care Division 3M Health Care. www.3M.com/Tegaderm . Accessed October 15, 2021. 2. Hawes ML. Vascular access device securement for oncology patients and those with chronic diseases. British Journal of Nursing. 2021 Apr 22;30(8):S20-5. 3. Thayer D. Skin Damage Associated With Vascular Access: Understanding Common Mechanisms of Injury and Strategies for Prevention. Journal of Radiology Nursing. 2021 Mar 1;40(1):61-8. 4. Broadhurst D, Moureau N, Ullman AJ. Central venous access devices site care practices: an international survey of 34 countries. The Journal of Vascular Access. 2016 Jan;17(1):78-86. 5. U.S. Food & Drug Administration. FDA drug safety communication: FDA warns about rare but serious allergic reactions with the skin antiseptic chlorhexidine gluconate. Drug Safety Communication (PDF). Updated
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Watch for the latest from JAVA
Check out our latest edition of:
Have you checked out the Fall Edition of JAVA yet?
AND BE ON THE LOOKOUT THE WINTER EDITION COMING SOON!
Behind on your CEs? AVA members have access to the CE article in each issue of JAVA! Simply read and complete the short quiz to receive 1.0 contact hour. Click here.
Learn more about JAVA here. The Journal of the Association for Vascular Access (JAVA) publishes original peer-reviewed feature articles related to the care and management of patients with vascular access devices. AVA members are the ‘trend-setters’ in the vascular access arena and are keeping up with the most current advancements in the industry.
WHEN STICKING ISN’T AN OPTION, CONTINUED FROM PREVIOUS PAGE February 2, 2017. https://www.fda.gov/drugs/drugsafety-and-availability/fda-drug-safety-communicationfda-warns-about-rare-serious-allergic-reactions-skinantiseptic Accessed October 15, 2021.
anchored securement devices for the securement of venous catheters: current evidence and recommendations for future research. The Journal of Vascular Access. 2021 Sep;22(5):716-25.
6. Fumarola S, Allaway R, Callaghan R, et al. Overlooked and underestimated: Medical adhesive-related skin injuries. Journal of Wound Care. 2020;29(suppl 3c): S1S23.
9. SecurAcath. Instructions for use. Interrad Medical. https:// securacath.com/wp-content/uploads/2020/05/1386002-rF-IFU-SecurAcath-US.pdf . Accessed October 21, 2021.
7. Brescia F, Pittiruti M, Roveredo L, Zanier C, Morabito A, Santarossa E, Da Ros V, Montico M, Fabiani F. Subcutaneously anchored securement for peripherally inserted central catheters: Immediate, early, and late complications. The Journal of Vascular Access. 2021 Jun 17:11297298211025430.
10. McParlan D, Edgar L, Gault M, Gillespie S, Menelly R, Reid M. Intravascular catheter migration: A crosssectional and health-economic comparison of adhesive and subcutaneous engineered stabilisation devices for intravascular device securement. The Journal of Vascular Access. 2020 Jan;21(1):33-8.
8. Pinelli F, Pittiruti M, Van Boxtel T, Barone G, Biffi R, Capozzoli G, Crocoli A, Elli S, Elisei D, Fabiani A, Garrino C. GAVeCeLT-WoCoVA consensus on subcutaneously
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HAVE YOU BEEN LISTENING? ISAVE That Podcast Season 4 End Stage Renal Disease: Education and the Patient’s Perspective The implications of vascular access in hemodialysis go well beyond the vascular access specialist’s perspective. Patients and their families have needs that require special resources, education, and consideration. AVA’s Judy Thompson and Blake Hotchkiss are joined by Terry Litchfield MPA, CPC who shares her unique vantage point as the wife of a dialysis patient and internationally recognized patient advocate. Dr. Michael Serle DMSc, MA, PA-C joins the podcast as we discuss this vulnerable population of patients and how we can make meaningful differences by educating patients and clinicians alike. A special thanks goes to Medtronic for sponsoring this episode of the ISAVE That Podcast.
GFR to Vascular Access Sequelae and Everything in Between Dr. Michael Serle DMSc, MS, PA-C is a global medical training and education specialist for Medtronic as well as a practicing clinician that specializes in vascular access and renal disease. He joins Judy Thompson, AVA’s Director of Clinical Education, to discuss all things renal including GFR in Acute Kidney Injury and Chronic Kidney Disease, vessel health and preservation, and device selection choices and sequelae. Later in the show Dr. Serle discusses his involvement with VASA regarding patient education. Thank you to Medtronic for sponsoring this episode of the ISAVE That Podcast.
AVA Scientific Meeting 2021 and Critical Assessment of Midline Catheter Use for Blood Draws AVA Board of Directors President Jocelyn Hill MN, RN, CVAA(c), VA-BC discusses the AVA Scientific Meeting and the decision to go virtual during the pandemic. Dr. Lorelle Wuerz PhD, MSN, RN, VA-BC, NEA-BC joins us to talk about recent published research on midline catheters and their clinical use to draw blood specimens. As a nursing leader Dr. Wuerz discusses strategies on how to integrate changes and advances in clinical practice into policy and procedures. AVA Scientific Meeting 2021 and Critical Assessment of Midline Catheter Use for Blood Draws
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For more information on the PediNeoSig and how to join: www.avainfo.org/pedineosig
As clinicians, adaptation, flexibility, and ingenuity are characteristics necessary to thrive in the dynamic nature of healthcare, the current times being no exception. Reflecting on the second virtual annual scientific meeting, we are proud of the representation from PediNeoSig. Session content showcased innovation, case studies examining atypical anatomy, vascular access challenges in neonates, and silicone catheter salvage, to name a few. Exemplified in every session was a genuine commitment to best practices and advancing this specialty to achieve optimal outcomes for our patients. However, the virtual
platform is no replacement for impromptu networking at an in-person meeting. We greatly miss those opportunities to connect with you! The PediNeoSig Executive Leadership Committee would like to invite you to take a short survey to help us understand how we can best meet your needs. Additionally, if you are interested in becoming more involved, we encourage you to contact us by visiting our page on the AVA website. Thank you for your continued dedication to our patients – the PediNeoSig vision to promote safe pediatric and neonatal vascular access is supported by the work you do each and every day.
2021 AVA ANNUAL SCIENTIFIC MEETING AT A GLANCE 1,027 Attendees
71% surveyed respondents expressed an intereste in the PediNeo track
98.5% report a positive meeting experience
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207 New Attendees
63% indicate their primary patient focus is pediatrics and/or neonates
MAKE LIKE A SUTURE AND LET GO! Michelle L. Hawes, DNP, RN, CRNI, VA-BC™
Why do we hold on to the suture as a securement device when it was never intended to serve as one? I realize I may be preaching to the choir when it comes to the concept of avoiding sutures. The readers of IV Quarterly are leaders of best-practice in vascular access. The purpose of this article is to add weight to your argument to let sutures go for good. The objective of sutures is wound closure. In manuals on sutures, including which type to use in specific locations, a brief section describes that the suture is not intended to secure external devices.1 How in the world did the suture become standard for securing a multitude of external devices? The answer in the early days of central vascular accesses devices (CVADs) was that the improvisation with sutures to secure the CVAD was considered the best practice.2 Other than first-generation tape, sutures were the only option in the early years and a perfectly acceptable off-label use. As CVADs evolved, suture wings were a standard part of the design and still are. Practitioners placing CVADs would develop their technique for suturing the device. Today, articles discuss the best knots, methods, and suture characteristics that will force the CVAD to stay put.3 There remains the small print in the instructions for use (IFU) that sutures are for wound closure and not intended to secure external devices.4 If the suture is off-label, how can it be included in CVAD kits? Tradition. The suture is not just off-label; it is way-off-label. Using a device or medication offlabel is not illegal by learned intermediaries using current technology to fill a gap.5 The part of that statement that is extremely important is that there is a “gap.” The FDA states that if no other product on the market has been approved for use in the unique situation or treatment, an approved product for a different purpose may be utilized, applying current research and keeping patient safety a priority.
When looking at the Food and Drug Administrations process for labeling medical devices and medication, there are two critical criteria: safety and efficacy.6 Safety must be proven before efficacy is assessed. Simply put, the evaluation of whether a device does what it states it should do can only be quantified after the patient’s safety is established.7 Every engineered securement device currently on the market had to go through the process of establishing safety and efficacy. Sutures have existed for thousands of years as an excellent means of wound closure but have never been labeled to secure external devices. Neither safety, nor efficacy, of sutures for CVAD securement has been assessed by the FDA.8 If presented to the FDA for labeling to secure CVADs, sutures would most likely fail the first step, safety. The practitioner’s risk of needle stick injury would shut down further assessment due to the availability of engineered securement devices with no chance of such injury.9 When an engineered securement devices like SecurAcath, Grip-Lok, Stat-Lock, SecurePort-IV, et al. fail to secure the CVAD or cause medical adhesiverelated skin injury (MARSI), a report is mandatory. The FDA completes follow-up for possible trends, benefitrisk assessments, and recalls. The manufacturer must file a report discussing the reason for failure and potential changes in the device, or education, to avoid a similar failure in the future.10 When a suture fails to secure a CVAD, causes the skin to erode, increases infection at the insertion site, no such report is made. Sutures are not labeled to secure CVADs; therefore, its failure to do so is not alarming to most healthcare professionals. A report CONTINUED ON NEXT PAGE NOVEMBER 2021 10
MAKE LIKE A SUTURE AND LET GO, CONTINUED FROM PREVIOUS PAGE may be made to the hospital’s risk management if there was a bad outcome, but otherwise, a suture letting go, tearing the skin, or causing a pressure wound is viewed as just what happens.
3. Struck MF, Friedrich L, Schlelfenbaum S, Kirsten H, Schummer W, Winkler BE. Effectiveness of different central venous catheter fixation suture techniques: An in vitro crossover study. PLOS Open Access. http://doi. org/10.1371/journal.pone.0222463
Looking at articles that include sutures used for securing CVADs, the primary endpoint is typically efficacy or how long the suture could secure the device.11 The noteworthy fact about considering sutures as a securement success violates two points on their own IFU. The first is using sutures for something other than wound closure, and the second is that non-absorbable sutures should be removed after 3-10 days, depending on the material.1
4. Ethicon, Inc. Ethilon Nylon Suture IFU. Ethicon Inc. a Johnson & Johnson Company. 2009. https://hostedvl106.quosavl. com/qb/
To conclude, sutures were an acceptable improvisation for securing CVADs when no other device was available on the market. The reasoning for using sutures off-label to fill the gap has not existed for decades. There are currently multiple engineered securement devices on the market with better outcomes, systems to report failures, and no risk of needlestick injury. Convenience of the suture in a CVAD kit is not a justification for decreasing patient safety, clinician safety, and device securement. Lastly, there is no need to enhance or create new tying techniques for suturing external devices; just LET GO.
6. US Food and Drug Administration. Step 3: Pathway to approval. Device Development Process. Updated February 9, 2018. https://www.fda.gov/patients/device-development- process/step-3-pathway-approval. Accessed October 10, 2018
I leave you with these missions: 1. Begin reporting the safety and efficacy issues of sutured CVADs to the same entity that you report engineered securement device failures. 2. Demand that sutures be removed from CVAD kits. 3. Request that CVAD kits include an engineered securement device approved by the FDA.
REFERENCES 1. Ethicon, Inc. Wound closure manual. Ethicon Inc. a Johnson & Johnson Company. 2005. http://www.uphs.upenn.edu/ surgery/education/facilities/measey/wound_closure_ manual.pdf. Accessed June 10, 2021 2. Kalso E. A short history of central venous catheterization. Anaesthesiologica Scandinavica. 1985:29(s81): 7-10.
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5. US Food and Drug Administration. Off-Label and investigational use of marketed drugs, biologics, and medical devices – information sheet. https://www.fda.gov/ regulatory-information/search-fda-guidance-documents/ label-and-investigational-use-marketed-drugs-biologicsand-medical-devices. Published September 12, 2018. Accessed October 10, 2018. https://www.fda.gov/ regulatoryingormation/guidances/ucm126486.htm
7. Van Norman GA. Drugs, devices, and the FDA: Part 2. An overview of approval processes: FDA approval of medical devices. JACC: Basic to Translational Science. 2016;1(4):277278. https://doi.org/10.1016/j.jacbts.2016.03.009 8. US Food and Drug Administration. Surgical sutures – Class II special controls guidance document for industry and FDA staff. U.S. Department of Health and Human Services. Document issued on: June 3, s003, Updated July 2, 2018. https://www.fda.gov/medical-devices/ guidance-documents-medical-devices-and-radiationemitting-products/surgical-sutures-class-ii-special-controlsguidance-document-industry-and-fda-staff#10. Accessed June 10, 2021. 9. Occupational Safety and Health Administration. Bloodborne pathogens and needlestick prevention, engineering controls. US Department of Labor. nd. https://www.osha.gov/ bloodborne-pathogens/evaluating-controlling-exposure. Accessed October 15, 2021. 10. US Food and Drug Administration. Medical device reporting (MDR): How to report medical device problems. U.S. Department of Health and Human Services. Updated October 20, 2020. https://www.fda.gov/medical-devices/ medical-device-safety/medical-device-reporting-mdr-howreport-medical-device-problems#howtoreport. Accessed October 15, 2021 11. Karpanen TJ, Casey AL, Whitehouse T, Timsit JF, Mimoz O, Palomar M, Elliott TSJ. A clinical evaluation of two central venous catheter stabilization systems. Annals of Intensive Care. 2019;9(49).
IT’S MORE THAN A LINE … IT’S A PERSON Swapna Kakani and Erik Samarpan
Control. When we are patients, we lose all agency of control. We become patients because illness has taken over us, the first evidence of losing control. If the illness is severe enough, we have to go to the hospital and if warranted we get admitted. Actions are done to us quickly. When I am admitted I feel I have lost my battle over control. I am vulnerable, exposed, and weak. Which is ironic, because it is when I am admitted into the hospital that I have to be my strongest and appear with my battle gear. My name is Swapna Kakani. 32 years ago, I was born with Short Bowel Syndrome. Since day 2 of life, I have received either supplemental or total parenteral nutrition, to live. Consequently, I have had 31 central venous catheters. 26 of which have been infected with either bacterial or fungal infections. My first CVC infection was at 2 months old, and my last (hopefully!) infection was 4 months ago. Ironically both infections were from gram negative rod bacteria. Over the last 3 decades, I have seen all versions of central venous care inside and outside the home. This most recent infection was unique for me and highlighted the gap with which we continue to struggle. This infection was my first CVC infection in 14.5 years. I believe one of the reasons as to why I have been able to avoid an infection for this long is because of my dedication to learning my standard of care to keep my catheter clean, safe, and secure. I became committed to learning from clinical presentations, to advocating for the supplies I needed, to improving the technique my father taught me decades ago, and to surrounding myself around a clinical team specialized in long-term TPN patients like me. I did my own catheter care, rarely letting others touch the catheter, I would ask for peripheral IVs for anesthesia, I stopped drawing blood from the catheter, and I mastered my home technique, regardless of the inconvenience. 14.5 years later I had control over an aspect of my life that brought such fear and unknown. Growing up I had at least one infection every year. I never knew when an infection would strike. Fever and chills would consume my body suddenly; I would have to be pulled out of
school and rushed to the hospital. We would find out it’s an infection, and the catheter had to be removed in the operating room. A traumatic sequence I still remember today. This infection like the 25 before showed itself abruptly. I started to have trouble concentrating and following my boss’s words during our team zoom call. I felt malaise and I knew the chills were around the corner. Within an hour, my heart rate jumped to 116. Although I have sub-specialty care, it is not local. Due to my symptoms, I had no choice but to go to the local hospital and have my care managed by my local primary doctor and my infectious disease doctor. I called my home infusion team who is out of state and went to the ER. I had a gut feeling I would have to advocate.
I did not want to relinquish my control. I had successfully kept this catheter infection free for 5.5 years since it was placed. It was in a location I liked. It gave me nutrition to allow me to thrive. In the ER, I gave strict instructions to the nurses, reading from text messages from my home infusion team, and speaking from experience. The words read in CAPS, “For blood cultures DO NOT WASTE.” Sure enough the nurses wanted to flush 10 cc of saline and waste 10 cc of blood before drawing for tests. They were used to wasting 10 cc before drawing blood for blood work. Another nurse said, “I never understood why we wasted.” I explained to them the importance of getting the blood from the catheter CONTINUED ON NEXT PAGE
NOVEMBER 2021 12
IT’S MORE THAN A LINE … IT’S A PERSON, CONTINUED FROM PREVIOUS PAGE itself in case it was infected and how the protocol for blood cultures from a CVC is different than for routine blood tests from a CVC. Proper technique for drawing blood cultures was a new advocacy topic for me. I remembered I am in battle, I have to be prepared for anything. Hours later the lab called to tell us the unfortunate news, my blood cultures were positive. I had to be admitted. The entire time I was in the ER, as we waited for tests to come back, I kept telling myself internally, I am fine, I feel better. My fever is down, my chills are gone, and my heart rate is down. I maintained this self-talk because I was trying to avoid the next step, a hospital admission, where more will be done to me. I will have less control over the plethora of protocols and healthcare exchanges. I was transferred to the floor at midnight. An hour prior I had been given vancomycin. Although I warned the team, I developed red man’s syndrome as I did as a child, and I had to be given IV Benadryl. In a Benadryl slumber, I was wheeled into my new room. I purposely focused my energy to keep one eye open, listening to the ER nurse repeat my summary and transfer orders, making sure nothing was glaringly wrong. The nurse did her initial check and turned off the lights. I thought I could finally sleep for the night. She came back into the room abruptly and turned on all the lights. She shouted, “I have to change your dressing now, it is protocol with individuals with CVCs.” I am shocked! Now? I remember the power of my voice. I say, “I change my own dressings. I changed it yesterday. Please state that I am going against medical advice and denying the care.” Thankfully she accepted. At times, we must think beyond protocol and consider the patient experience. To me,a dressing change for the patient with a fresh dressing and clean site, at midnight after spending hours in the ER, was not a priority. Two days later blood cultures had to be drawn again. The nurse comes in to draw them. I ask, “Please do not flush with saline and waste the initial 10 cc of blood. Use the first 10 cc of blood you are able to draw back.” She asks why. I try to explain the reasoning, but my voice is not as strong. She responds, “But
13 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
wasting 10 cc is how we have always done it.” I try to explain again. I can tell however I am not convincing. Her tone tells me her way is right. I felt defeated and lost my passion for trying. I stopped talking. The blood cultures came back positive. Because the cultures were drawn improperly and were drawn before targeted antibiotics were started, I asked if they could be drawn again. The doctor agreed. The next day, another nurse comes in to draw cultures. I ask again, “Please do not flush with saline and waste the initial 10 cc of blood. Use the first 10 cc of blood you are able to draw back.” Again this nurse asks why. He had never heard that before. I felt like a broken record. He stared at me, and asked, “Are you sure?” He left to get more supplies. At that time, I went to google. I was desperate! I needed to cite my reasoning. I told him what I found. He went one step further and looked at the archived protocols in the hospital’s database. After a few minutes, he said, “Oh you are right, it says it right here.” The blood cultures came back negative. 3 days later I left the hospital with my central venous catheter intact and a 14 day home IV antibiotic course. I cannot help but think how powerless I am in a hospital bed. At the end of the day during a hospital admission, I will always be the patient. Everything I mastered for almost 15 years, was almost gone in a second because of statements such as; “That is what we have always done.” Or “It is protocol … I do not know why” instead of statements such as; “What is the patient’s goal?”, “How can we work together?”, or “What is the reason behind this action?” 26 central venous catheter infections are grained into my head. The trauma from the collection of hospitalizations can be overwhelming. As a child, I cried uncontrollably before every trip to the operating room. Even as a child, I knew I would lose all agency of sense and control. And wake up with pain. As a result, I have learned to cope by focusing on how I can minimize chaos, the unknown, and fear. I try to be part of the medical team. I actively engage in filling the gaps of healthcare delivery. I want to be able to look at myself in the mirror and know I did CONTINUED ON NEXT PAGE
IT’S MORE THAN A LINE … IT’S A PERSON, CONTINUED FROM PREVIOUS PAGE everything I could regardless of the outcome. As an adult, it gets harder to be the advocate with the big A because now I am the patient and my own caregiver. I must balance the exhaustion of illness with speaking up, alongside taking care of myself to live for tomorrow. It is my healthcare experiences that motivate me to continue to advocate and speak up despite how hard it is in hopes of making another child or adult’s experience better than mine. It has been an honor to join the Association for Vascular Access as a board member and a member of the Beyond Acute Care Special Interest Group (BACSIG). By growing BACSIG, sharing our stories, and initiating change, we hope stories like mine and Jose are anecdotes of the past. Jose’s story was previously described in IQ (“Best Expectations, Worse Outcomes: A Patient and Family Experience with Rural Home Infustion”, November 2020, February 2021, May 2021). Today we have an update on Jose. As an adult who knows the child’s vascular access experience intimately, I admire Jose for his actions. Recently, Jose, who has Muscular Dystrophy, was admitted to a major, world class pediatric medical facility for Partial Ligament removal and insertion of partial plates into both feet. In pre-op, you could hear from a mile away, “STOP!” As the Anesthesiologist was getting ready to access Jose’s peripheral IV, he swiped the injection cap quickly, with one pass, with an alcohol pad,
completely ignoring the process of scrubbing the hub for at least 5-10 seconds. The physician, startled at Jose’s reaction, asked “What gives?!” The entire operating room staff were puzzled and as shocked as the physician. Jose, only a child, had been trained for such an event repeatedly by his home infusion staff. Instead of a text message he had the instructions already ingrained into his head. He knew the correct process and the reasoning behind the action. The physician did not let Jose speak. He looked at his colleagues instead. The colleagues shrugged in confusion. The physician proceeded to scrub the hub again with one pass. Jose was then put to sleep for surgery. Jose received a doll after the surgery. He named the doll “The Bad Doctor.” Jose spoke up, he was his strongest advocate, and of all places, in the operating room. But for Jose, his awareness and knowledge of correct protocol, his armor, was not enough. Actions were done to him quickly and without much acknowledgement of the patient experience. It is time for us to change how we engage about vascular access between providers, patients, and family members. We, as healthcare team members and vascular access specialists, must take ownership of every line at every access point. *We welcome your comments and feedback. If you are interested in joining the Beyond Acute Care Special Interest Group please fill out the volunteer application on the AVA website and reach out to Gwen Coney, chair of BACSIG, at gconeyrn@gmail. com.
NOVEMBER 2021 14
NETWORK NEWS FLAVAN Diana Melton, MSHA, RN, CRNI, VA-BC™ | FLAVAN President Meagan Capen, CPNP-AC, MSN,VA-BC™ | FLAVAN President-Elect Caitlin Soldati, BSN, RN, VA-BC™ | FLAVAN Secretary Crystal Penna BSN, RN, | FLAVAN Treasurer
FLAVAN has continued to collaborate with GulfVAN to provide live Webinars for our members! In May we covered, Tissue Adhesive for Vascular Access Devices: A New Standard of Care for Improved Outcomes and in August, Mitigating risk of extravasation with power injection! Our members continue to engage through learning at home, but are looking forward to future in person meetings! FLAVAN awarded scholarships to FLAVAN members Al Villacampa and Rena Lott to attend the virtual AVA Scientific Meeting in September 2021! They
will present their experience to FLAVAN members between January-March 2022! FLAVAN member Chris Cavanaugh RN, MSN, CRNI, VA-BC™, petitioned for and obtained the October 5th, 2021, Vascular Access Specialty Day Proclamation for Orlando from Mayor, Buddy Dyer! For more FLAVAN news and upcoming events please visit our website by clicking the link FLAVAN and don’t forget to like us on Facebook!
AVA currently has 52 active networks The Association for Vascular Access is committed to providing an opportunity for members to broaden their knowledge of vascular access and related fields through networking opportunities and education. AVA Networks offer vascular access professionals the opportunity to network with other professionals in their area of expertise. Network meetings offer educational sharing opportunities, continuing education credits, dinner meetings and quality dynamic speakers.
Do You Know Where Your Nearest Network Is? w w w. ava i n f o . or g / n e t w or k s
15 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
2021 BOARD OF DIRECTORS PRESIDENT
SECRETARY
JOCELYN GRECIA HILL, MN, RN, CVAA(C), VA-BC™
RUSSELL NASSOF, JD
PRESIDENT-ELECT
JON BELL, RN, MSN, VA-BC™
DIRECTOR-AT-LARGE
TONYA HEIM, MHA, MSN, RN, NEA-BC
TREASURER
TONJA STEVENS, RN, VA-BC™
DIRECTOR-AT-LARGE
STACI HARRISON, DNP, RN
DIRECTOR-AT-LARGE
MONTE HARVILL, MD
PRESIDENTIAL ADVISOR
LORI KACZMAREK, MSN, RN, VA-BC™
DIRECTOR-AT-LARGE
SWAPNA KAKANI, MPH
DIRECTOR-AT-LARGE
CHELLIE (MICHELLE) DEVRIES, MPH, CIC, VA-BC™
DIRECTOR-AT-LARGE
MARKETING MANAGER & ANALYTICS DIRECTOR
CLINICAL EDUCATION SPECIALIST
kmaisel@avainfo.org
bhotchkiss@avainfo.org
NAEL MHAISSEN, MD
AVA STAFF CHIEF EXECUTIVE OFFICER
CATE BRENNAN, MBA, CAE cbrennan@avainfo.org
BLAKE HOTCHKISS, BSN, RN, CCRN, CRNI, VA-BC™
KAYCE A. MAISEL
CHIEF OPERATIONS OFFICER
TONYA HUTCHISON, CAE
DIRECTOR OF CLINICAL EDUCATION
thutchison@avainfo.org
JUDY THOMPSON, MSNEd., RN, VA-BC™ jthompson@avainfo.org
CORE VALUES RESPECT AVA believes treating others with respect will ensure a safe and healthy environment.
ACCOUNTABILITY AVA believes in setting and meeting timely deadlines and working together with our members, volunteers and other partners to pursue outcomes that help patients.
INTEGRITY AVA aspires to have a foundation of honesty and integrity in everything we do.
TEAMWORK AVA believes working together to unleash everyone’s potential will achieve exceptional results.
EXCELLENCE AVA creates a lasting and positive impact within vascular access through excellence in all endeavors.
MISSION
To lead healthcare by protecting patients and providers to improve lives
VISION
NOVEMBER 2021 16
A world with safe vascular access
ANGEL
2021 ANGEL PARTNERS: Lineus Medical • MightyWell • SterileCare
2021 STRATEGIC PARTNERS: Access Vascular • Adhezion • Eloquest Healthcare • Genentech • Hampton House Medical • Interrad/SecurAcath • Parker Laboratories • StatSeal (Biolife, LLC)
2021 ENTERPRISE PARTNERS:
3M • AngioDynamics • B. Braun Medical BD • PDI • Smiths Medical • PFM Medical • Teleflex
ACADEMY
Thank you to our loyal Industry Partners for sharing AVA’s mission. Email partner@avainfo.org to design a program that becomes an indispensable instrument for advancing education, awareness, adoption and expansion. 800.792.9079 EXT. 105 | PARTNER@AVAINFO.ORG | WWW.AVAINFO.ORG
Welcome
to our Newest
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NOVEMBER 2021 18
AVAILABLE NOW
RESOURCE GUIDE FOR VASCULAR ACCESS
The 2021 AVA Resource Guide for Vascular Access: AVA's Recommended Study Guide for Vascular Access Board Certification provides an overview of basic vascular access knowledge and covers essential elements that clinicians implement on a daily basis. Throughout the Resource Guide, readers have access to high definition images, videos, illustrations and engaging animations that give them a greater understanding of the concepts. The guide may be used to prepare for the vascular access board certification examination (VA-BC™), as well as serve as a resource throughout professional practice.
AVA MEMBER PRICE: $99 digital only $129 print only $159 bundle (print and digital) NON AVA MEMBER PRICE: $129 digital only $169 print only $199 bundle (print and digital)
Check out the Resource Guide https://www.youtube.com/channel/ sneak peak videos on UCP3i3q44bvmVdjjUclt9esw our YouTube channel!
PURCHASE IT ONLINE TODAY! Digital Access: • Not a downloadable file. It is not printable and is for view on your device only. The digital access is not shareable with another account. You will receive a redemption key and an access link after purchase. • Corrections and incremental updates to version one will automatically populate your digital copy (no additional charge) 19 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
Educational Offerings from AVA
Educational Offerings from AVA
Available anywhere you get your podcasts
I Save That Podcast
• Streaming on Spotify, SoundCloud, iTunes, Stitcher, Google Play Music, iHeart Radio, Pandora, Amazon Music •
Journal of the Association for Vascular Access I Save That Podcast
• Published quarterly • Streaming on Spotify, SoundCloud, iTunes, Stitcher, Google Play Music,3,000 iHeart Radio, Pandora, • Approximately subscribers Amazon Music •
Journal of the Association for Vascular Access
Intravascular Quarterly (IQ) • Published quarterly
• Approximately 3,000 subscribers • Published quarterly • E-newsletter sent to AVA members
ACADEMY ACADEMY
Intravascular Quarterly (IQ) • Published quarterly
• E-newsletter sent to AVA members AVA Academy
• Continuing Education courses ALL available on demand • AVA Procedural courses, webinars, scientific meeting Academy sessions, etc. • Continuing Education courses ALL available on demand • Procedural courses, webinars, scientific meeting sessions, etc.
AVA Resource Guide for Vascular Access
Resource Guide for Vascular • AVA Prepare for the VA-BC™ exam, Access as well as serve as a • Prepare for the VA-BC™ exam, as well as serve as a resource throughout professional resource throughout professional practice practice
Learn more at www.avainfo.org Learn more at www.avainfo.org
NOVEMBER 2021 20
AVA Academy is always open!
ACADEMY
The Association for Vascular Access (AVA), in collaboration with The Clinician Exchange (TCX), launched a new, best-in-class learning management system tailored to aspiring and established vascular access clinicians. Providing cutting edge training, critically-acclaimed presentations from scientific meetings, journal review courses and much more, AVA Academy is a groundbreaking initiative that advances the heart of AVA’s mission – Protect the Patient | Educate the Clinician | Save the Line. Academy curriculum is now available to the public, and to active AVA members at a discount.
Looking to further your education but struggling to find the time amidst a busy work schedule? AVA Academy is always open! It's our mission to create greater public awareness of vascular access and to empower our members with significantly more educational resources, networking opportunities, and advocacy tools in support of and dedication to the patients that we are entrusted to serve.
AVA Academy is now open to all curious minds Choose and enroll in your classes today!
View Course Catalog
Launch My Courses
• Review course content, outlines and objectives
• Sign in to your personal AVA Academy Account
• Purchase courses
• Launch your courses
• Add courses to your personal Course List
• Take quizzes
• Available to Members, Non-members and all site visitors with a Guest Account
• Available to Members and Non-members with a Guest Account
• If you're not an AVA member, consider Joining AVA or you may create a Guest Account at no charge
• You will need to sign in to the AVA website prior to clicking Launch My Courses above
Learn more at www.avainfo.org/AcademyLaunch
You probably already know about the ISAVE That Line campaign AVA launched in 2006 to bring crucial principles of vascular access device management directly to the bedside. Putting patients first, ISAVE encourages and emphasizes a “back to basics” approach, essential to reducing the risk of infection and improving the management of all vascular access devices.
On the cliniciancentered version, ISAVE stands for:
I
Implement insertion care and maintenance bundles
S
Scrupulous hand hygiene
A
Always disinfect every needleless connector
V
Vein Preservation
E
Ensure Patency
Introducing our NEW addition to the ISAVE family that supports this program from the ground level: A patientfriendly version. Written and edited by patients and caregivers, this new resource is completely FREE as a downloadable PDF. Please share and distribute this resource in your facilities, with your colleagues, on your social media platforms, with your patients and with your family. We simply ask that you not amend it without prior permission from AVA.
On the patientcentered version, ISAVE stands for:
I
Inform us right away
S
See us check your IV often
A
Ask us to clean our hands
V
Value your veins
If you’d like laminated full-size sheet versions of this patient asset already printed, we have those available for sale in the AVA store in packs of 10 for $25.
E
Expect us to follow basic rules
Click here to purchase yours.
A Guide For Patients and Families
Remember, purchasing official ISAVE assets directly helps AVA advance its mission, which is Protect the Patient | Educate the Clinician | Save the Line. You can also support the AVA Foundation, which focuses on advancing Education, Research and Innovation in vascular access.
Take the pledge, be involved and join AVA in our mission to keep our patients free of infection!
Find out more online.
I
NFORM US RIGHT AWAY IF YOUR IV SITE HAS ANY
S A V E
S welling T emperature Change O ozing P ain
OF THE FOLLOWING:
EE US CHECK YOUR IV OFTEN
Is it working? Is there Swelling, Temperature change, Oozing, Pain? Is your IV dressing clean, dry and not peeling? Is your IV still needed?
SK US TO CLEAN OUR HANDS
Expect us to wash our hands or use hand sanitizer when going in and out of your room.
ALUE YOUR VEINS
We have technology to help us place your IV. If you are not getting IV fluids or medicines, you might not need an IV. Protect your IV from accidently getting pulled out.
XPECT US TO FOLLOW BASIC RULES:
We will talk with you about your IV needs. We will select the best IV for your care. We will choose the best site for your IV. We will ask for help if we cannot get your IV after 2 attempts. We will clean your skin before inserting your IV. We will scrub the end of your IV every time we use it.
www.avainfo.org
The information presented in this PDF is free to download and share and made available by The Association for Vascular Access (AVA) strictly for educational purposes. This document is meant to provide general information and understanding of Vascular Access devices and procedures. It is not meant to provide specific medical advice. AVA, it's Board of Directors, staff and members are not liable for outcomes associated with your care. AVA encourages the use of this document for Vascular Access education, provided it is not modified. Please share it with clinicians, patients and their families and attribute this resource to AVA. You may also include the links to our additional resources (if applicable). AVA's informational resources educate these clinicians, patients and their families to ensure they receive safe Vascular Access care. Feel free to print, post and share this document within your healthcare institution, as well as on social media. If you have questions, please contact ava@avainfo.org.
Stay up on the latest at www.avainfo.org/isavethatline
The special enhanced edition of Vessel Health and Preservation: The Right Approach for Vascular Access is now available to purchase.
Get yours today for just $9.99! 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.
1,500
00
23 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER
CALL FOR MANUSCRIPTS
We invite you to submit original manuscripts in the field of Vascular Access. We are interested in receiving manuscripts on clinical practice, education and research related to vascular access including articles on vascular access manufacturing and technology, and vascular access care and maintenance issues in hospitals, home settings, hospice, and alternative care facilities. We also invite submissions to our Patient/Consumer Perspective column where we ask you to share personal stories or “lessons learned” about caring for, living with or having a vascular access device. In about 1000 words and in conversational style, present your story. You can submit on behalf of someone or encourage them to write it themselves.
FOR COMPLETE INSTRUCTIONS SEE:
Information for Authors at www.avajournal.com Or contact the JAVA Editor at JAVAEditor@avainfo.org
Advertise to the Market You’ve Been Looking For . . .
Advertising space available on AVAinfo.org The Second Edition of the ‘Chart of Pediatric CVC Maintenance Bundles’ IS AVAILABLE AT AVAINFO.ORG/STORE
GET YOURS TODAY! Printed full color with gloss UV coating 13” x 19” size Package of 5 Members: $40 Non-members: $50 Shipping included
DO YOU LIKE WHAT YOU READ HERE? Would you like to be part of this publication? Do you have something interesting, informative or new going on in your place of practice? Have you cared for a special or interesting patient? Do you or your colleagues have new or innovative ways of doing things? Have you been to or presented to any meetings or conferences?
WE INVITE YOU TO SUBMIT FOR PUBLICATION Writing a submission does not mean that you have to write the next great American novel. It is more about presenting pertinent information in a brief, fun and creative way. Please submit to ava@avainfo.org
SUBMISSION DATES ARE: FEBRUARY 1 deadline for submissions for February issue MAY 1 deadline for submissions for May issue AUGUST 1 deadline for submissions for August issue NOVEMBER 1 deadline for submissions for November issue
Visit our website www.avainfo.org
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Copyright © 2021 Association for Vascular Access. All rights reserved.
F O R C O M M E N T S OR S U G G E S T I O N S , P L E A S E S U B M I T T O AVA @ AVA I N F O . OR G 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 info@avainfo.org and ask to be removed from the list. All removal requests are addressed promptly.
