A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices

Martillo, Miguel; Zarbiv, Samson; Gupta, Renu; Brito, Amy; Shittu, Atinuke; Kohli‐Seth, Roopa

doi:10.1016/j.ajic.2019.08.019

Cited by 12 publications

(15 citation statements)

References 8 publications

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“…Nurse-led vascular access teams show promise as a model to achieve hospital efficiencies and improve patient outcomes [18]. There has been initial skepticism about the feasibility of a nurse performing a traditional medical procedure [18]; however, there is increasing evidence of successful, dedicated nurse-driven VATs [6,[11][12][13].…”

Section: Vat Structurementioning

confidence: 99%

“…Therefore, a CRC not only negatively affects patient outcomes but also the care of a bloodstream infection also increases hospital costs by thousands of dollars [11]. It has been estimated that a single case of CRBSI adds 7 to 20 days to hospital length of stay, and the economic cost per bacteremic survivor have been reported to range from 40 to 56 USD 000 in additional cost, with total costs reaching as much as 2.3 USD billion in US intensive care units alone each year [1,6,10,23,24].…”

Section: Observed Benefits To Vatmentioning

confidence: 99%

“…As a result of VAT-led intervention and reduced use of central lines, many evidence-based studies show that CRBSIs and CLABSIs fall by up to 70% and 90%, respectively [6,10,11,13,24].…”

Section: Observed Benefits To Vatmentioning

confidence: 99%

“…The most common catheter-related complications (CRCs) are infection, malfunction, thrombosis, and IV failure [1,4]. There is an overall catheter failure rate of 35% to 50%, which results in thrombosis, phlebitis, infiltration, occlusion/mechanical failure, dislodgment, infiltration and extravasation, and infection [1,[5][6][7]. Among the CRCs, catheterrelated bloodstream infection (CRBSI) have one of the highest healthcare burdens in terms of costs, patient length of stays, and morbidity with an attributable mortality ranging from 12% to 25% [4,[8][9][10].…”

Section: Introductionmentioning

confidence: 99%

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Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

et al. 2021

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Background: Vascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications. Purpose: A faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals. Methods: Interview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline ® -cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program. Results: While VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised. Conclusions:The implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in-and outpatient services, beneficial to both patients and institutions.

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Section: Vat Structurementioning

confidence: 99%

Section: Observed Benefits To Vatmentioning

confidence: 99%

“…As a result of VAT-led intervention and reduced use of central lines, many evidence-based studies show that CRBSIs and CLABSIs fall by up to 70% and 90%, respectively [6,10,11,13,24].…”

Section: Observed Benefits To Vatmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

et al. 2021

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“…6 Evidencebased VAD selection requires a clear understanding of the individual patient's needs and risks, vascular health preservation concepts, urgency of needed therapy, skill of the inserter, available VAD options, and length and nature of the prescribed therapy. 6,8,23,24,62 Once a VAD is placed either peripherally or centrally, it should be managed with the utmost care for prevention and early recognition and treatment of VAD-related complications. 4,7,8,10,23,55 Table 5 provides a summary of evidencebased peripheral intravenous access management.…”

Section: Clinical Summary Of MC Use In Critical Carementioning

confidence: 99%

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

Nickel

2021

Critical Care Nurse

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Background The goals of infusion therapy are to preserve vascular health and safely deliver needed treatment. Achieving these goals is challenging in critical care because of the complexity of the treatment required. Daily justification of retaining an existing central venous catheter also creates urgency to change to a peripheral vascular access device. The midline catheter has had a resurgence in use because of the need for a long-term peripheral vascular access device not linked to central catheter–associated bloodstream infection risk. Objective To review the characteristics of midline catheters, the benefits and risks of midline catheters, and current evidence regarding midline catheter use in critical care. Results Research related to midline catheters has greatly expanded the body of knowledge regarding vascular access device selection and midline catheter use. Discussion Although the quality and results of research on vascular access devices vary widely, a more accurate safety profile is emerging to illustrate how midline catheter use can support the goals of infusion therapy. Conclusions Optimizing vascular access device selection requires recognition that every vascular access device can cause patient harm. Although the midline catheter appears to fill an important niche in infusion therapy, use of the midline catheter should be carefully evaluated. Midline catheters should not be used as a catheter-associated bloodstream infection prevention strategy, should be inserted to administer peripherally compatible solutions, and should be considered for short-term continuous vesicant therapy only in emergent situations until more definitive vascular access can be achieved.

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The role of hospital‐based vascular access teams and implications for patient safety: A multi‐methods study

Quinn,

Horowitz,

Krein

et al. 2023

Journal of Hospital Medicine

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BackgroundPeripherally inserted central catheters (PICCs) and midline catheters are often placed by nurse‐led vascular access teams (VATs). While some data regarding the effectiveness of these teams exists, less is known about their structure and function.ObjectivesTo examine the roles, functions, and composition of VATs related to the use and management of PICC and midline catheters.MethodsA descriptive, multi‐method study that included an online survey of 62 hospitals participating in a quality improvement consortium and qualitative interviews with 74 hospital‐based clinicians in 10 sites. Interviews were recorded, transcribed, and analyzed using a rapid analysis and matrix approach. The survey, which contained closed‐ended, categorical questions, was analyzed using frequencies and percentages.ResultsMore than 77% (n = 48) of hospitals had an on‐site VAT. The average team size was seven nurses; their primary function was device insertion. Interview findings revealed that teams varied in characteristics and functions. Interviewees described the broad role that teams play in device insertion, care and removal, and in educating/training hospital staff. However, we found that teams' role in decision making, particularly related to appropriate device selection, was limited and, in some cases, met with physician resistance.ConclusionsTo realize the full benefit of VATs, changes in hospital culture, along with an increased willingness from physicians to integrate VAT nurses in decision making, may be needed. Future interventions aimed at engaging and empowering teams appear necessary.

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A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices

Cited by 12 publications

References 8 publications

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

Does the Midline Peripheral Intravenous Catheter Have a Place in Critical Care?

The role of hospital‐based vascular access teams and implications for patient safety: A multi‐methods study

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