Impact assessment following implementation of a vascular access team

Abstract

Background: A vascular access team (VAT) was created in 2018 with the aim of improving vascular access and reducing complications associated with catheters. The impact of the introduction of a VAT in the insertion and maintenance of peripheral insertion central catheters (PICCs) was assessed. The cost-benefit associated with the use of a VAT was evaluated and the satisfaction of patients and professionals interacting with the VAT was measured. Methods: In a prospective study, 275 PICCs inserted by the VAT were assessed for their impact on complications. PICCs were implanted with maximum barrier measures using an ultrasound with IC-ECG. Also, patient and professional satisfaction have been analysed thought a questionnaire over the phone or online, and hospital financial data was used to assess the cost impact of the insertion methodology followed by the VAT versus Anaesthesia Service. Results: The thrombosis rate was 2.5% (7) and the bacteraemia rate was 1.1% (3). The use of the IC-ECG was correlated with a lower complication than the RX + IC-ECG (OR = 3.28, p = 0.021). In addition, there was a high level of perceived satisfaction for the patients surveyed and for the healthcare professionals involved in the care and management of these devices. The calculated saving for the implementation of the VAT was 61.81% compared with PICCs implanted in Anaesthesia Service. Conclusion: Low complication rates and high overall satisfaction scores in patients and professionals were observed, showing that a specialist VAT can have a positive impact in the insertion of PICCs and which also has a clear economic benefit.

A Quality Improvement Initiative to Provide Timely Central Vascular Access in a Neonatal Intensive Care Unit

“…We did not assess fiscal impacts of these changes, but several writers have noted previously that significant cost savings can be achieved by allowing PICCs to be placed at the bedside instead of relying on a team of interventional radiologists located in the IR suite. 20,22,30,34 It is also likely that lowered PIV infiltration and CLABSI rates over time contribute to reductions in the cost of care. 3,42 Calculations of this kind are an important area for consideration in future studies of organizational-level changes.…”

“…[13][14][15][16][17][18] Peripherally inserted central catheters (PICCs) are the preferred choice for longterm central access in neonates due to their extended dwell time, small diameter, and ability to be placed safely and cost effectively. 1,11,19,20 A key concern with obtaining central vascular access in the NICU, however, is time delay. Time delay for central vascular access at any point in the course of treatment can become a factor affecting clinical outcomes for neonates.…”

“…[23][24][25][26] A growing body of literature demonstrates direct and indirect benefits of vascular access teams, including providing evidence-based care, improving patient safety, furthering knowledge, and preventing complications. 20,[26][27][28][29][30][31][32] One of the key benefits reported from the implementation of vascular access teams in recent years is the successful decrease of wait times for obtaining central venous access. 33,34 Notable successes have also been reported in the pediatric context.…”

Current and emerging vein identification technology for phlebotomy and peripheral I.V. cannulation

“…Van Loon et al11 found that the clinician's anticipation and “gut feeling” of difficult access is a major predictor of failed first attempts. Use of adjunctive vascular assessment tools can lead to improved patient outcomes, higher first-attempt success, decreased pain, shorter procedure time, and increased patient satisfaction, as well as improvements for the facility and staff including improved resource utilization, decreased staff burnout, and improved safety 12. These devices help improve accuracy during phlebotomy, particularly in patients with DIVA.…”

Paving the PICC journey: building structures, process and engagement to improve outcomes

“…The value of the VAT expands from mitigating preventable events (eg, deep venous thrombosis, infection) to enhancing patient experience (eg, less attempts to place a peripheral device). 9 In addition, better outcomes help curb the financial risks (eg, hospital-acquired condition penalties) 8 and improve hospital ratings. The VAT's role encompasses placing PICCs and guaranteeing the proper selection of the intravascular device and its appropriate use.…”