Presentation is loading. Please wait.

Presentation is loading. Please wait.

Venous Access Devices in Clinical Practice An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies.

Similar presentations


Presentation on theme: "Venous Access Devices in Clinical Practice An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies."— Presentation transcript:

1 Venous Access Devices in Clinical Practice An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies

2 Useful to Know Venous Access is essential.Venous Access is essential. Establishing and maintaining reliable access is a priority.Establishing and maintaining reliable access is a priority. EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital.EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital. The choice of which VAD to use is a collaborative process. The choice of which VAD to use is a collaborative process.

3 Access is essential Infusion therapies play a major role in the treatment plan for almost every disease process. Need for IV therapy is one of the criteria for provider approval of hospital admission.

4 2 types of devices PIVs short catheters (less than 3 inches) placed in the veins of the upper extremities. CVADs long catheters whose terminal tip position is in the central veins.

5 Venous Access Devices PeripheralPeripheral Most appropriate device for short term therapies (less than 5 days) that are nonirritating. Central When ordered meds have pH greater than 9.0 or less than 5.0, osmolality greater than 500 mOsm. Ordered meds/fluids are known irritants PN with dextrose con- centration greater than 10%. IV inotropes Vesicants

6 Peripheral IVs Placed by the nursing staff on the units 24/7 with the assistance of the IV Team for those patients that are difficult sticks. Placed by the nursing staff on the units 24/7 with the assistance of the IV Team for those patients that are difficult sticks. IV Team is in house 7 days a week from 8AM-7:30PM. IV Team is in house 7 days a week from 8AM-7:30PM. Pager # Pager #

7 CVADs Are placed by multiple physician and non-physician providers throughout the hospital based on the type of device that is required.

8 3 Types of CVADs Non-tunneledNon-tunneled TunneledTunneled ImplantedImplanted

9 Nontunneled Inserted by percutaneous stick into the internal jugular, subclavian, femoral or upper arm veins.Inserted by percutaneous stick into the internal jugular, subclavian, femoral or upper arm veins.

10 Tunneled The catheter is tunneled under the skin to a vein in the neck or chest. A cuff near the exit site anchors the catheter in place.The catheter is tunneled under the skin to a vein in the neck or chest. A cuff near the exit site anchors the catheter in place.

11 Implanted Surgically inserted under the skin in the upper chest or the arm and appears as a bump under the skin.

12 CVADs Non-tunneled Temporary triple lumen, PICCs Tunneled Powerline, Hickman, Broviac Implanted Mediport, Portacath

13 Which VAD? The goal is to choose a device with the lowest risk of complications (infectious and noninfectious) which will last the duration of therapy or be managed with minimal replacements.

14 Appropriate VAD Selection Minimizes patient discomfort, morbidity and mortalityMinimizes patient discomfort, morbidity and mortality Decreases health care costs associated with delays of therapy and increased LOS.Decreases health care costs associated with delays of therapy and increased LOS. Enhances therapeutic benefits for patients with minimal impact on ADLs.Enhances therapeutic benefits for patients with minimal impact on ADLs.

15 Patient Experience

16 " A good beginning makes a good end." Louis Lamour

17 Planning is essential Starts with the first IV order Discuss on rounds…..with the patient.

18 What type of access device is the most appropriate for the patient? Duration of therapyDuration of therapy Characteristics of the infusatesCharacteristics of the infusates Available insertion sitesAvailable insertion sites Existing co-morbiditiesExisting co-morbidities Impact on ADLsImpact on ADLs

19 Duration of Therapy < 5-7 days – peripheral IV< 5-7 days – peripheral IV >7 days 7 days<2 weeks (in house patients) temporary CVAD 1-6 weeks – PICC1-6 weeks – PICC >6 weeks – Tunneled or Implanted>6 weeks – Tunneled or Implanted

20 Type of infusates pH < 5pH < 5 pH > 9pH > 9 Osmolality > 600Osmolality > 600 Caustic or vesicant medicationsCaustic or vesicant medications

21 Available insertion sites Consider CVAD placement when: Peripheral IV access cannot be initiated or maintained in the upper extremities.Peripheral IV access cannot be initiated or maintained in the upper extremities. IVs blow or last only a few hours. IVs blow or last only a few hours. No lower extremity IVs. No lower extremity IVs. The patient has a history of being a difficult stick and has required central access in the past.The patient has a history of being a difficult stick and has required central access in the past.

22 Chemical Phlebitis

23 Infiltration

24 Extravasation

25 PICC Thrombosis

26 Co-morbidities and Device Selection Certain types of CVADs may be contraindicated based on pre- existing conditions.Certain types of CVADs may be contraindicated based on pre- existing conditions. Chronic Kidney Disease, Hypercoaguable syndromes, preexisting venous stenosis, thrombosis, etc.Chronic Kidney Disease, Hypercoaguable syndromes, preexisting venous stenosis, thrombosis, etc.

27 Impact on ADLs Availability of care giver assistance.Availability of care giver assistance. Dressing requirements and catheter stability.Dressing requirements and catheter stability. Use of mobility aids.Use of mobility aids. Work and home activity limitations.Work and home activity limitations.

28 When, how and by whom will the device be placed? PIVs Unit staff and IV Team CVADs Nontunneled – resident staff, PICC nurses, interventional radiology, anesthesia Nontunneled – resident staff, PICC nurses, interventional radiology, anesthesia Tunneled – Interventional radiology, peds surgery Implanted – Interventional radiology

29 When to Order? Based on patient need and ordered therapiesBased on patient need and ordered therapies Early decision making and placement of an appropriate device is correlated with positive clinical outcomes and decreased length of stay.Early decision making and placement of an appropriate device is correlated with positive clinical outcomes and decreased length of stay. Remember: PICC, tunneled and implanted device placement requires lead time of 1-3 days. Do not wait until day of discharge to order lines for home infusion.Remember: PICC, tunneled and implanted device placement requires lead time of 1-3 days. Do not wait until day of discharge to order lines for home infusion.

30 Which device to order? Temporary Nontunneled: Best for short term facility based access (less than 14 days) Best for short term facility based access (less than 14 days) Long term Nontunneled: Typically used for 1-6 weeks of therapy. (PICCs) May be used in the home setting. Typically used for 1-6 weeks of therapy. (PICCs) May be used in the home setting.

31 Which device to order? Tunneled catheters:Tunneled catheters: More permanent device best used for dwell times > than 4-6 weeks or when a PICC is contraindicated. More permanent device best used for dwell times > than 4-6 weeks or when a PICC is contraindicated. Ports:Ports: Most beneficial when long term intermittent therapies are needed. Most beneficial when long term intermittent therapies are needed.

32 How to order CVADs For PICCs:For PICCs: Search PICC in CPOE Search PICC in CPOE Select PICC Procedure (Adult and Ped) from the order menu. Select PICC Procedure (Adult and Ped) from the order menu.

33 How to order Tunneled or Implanted devices:Tunneled or Implanted devices: Search CVAD:Search CVAD: CVAD-insert tunneled w/o port >5 years CVAD-insert tunneled w/o port >5 years CVAD-insert tunneled with port >5 years.

34 VAD Placement Decisions An integral part of the treatment plan Collaborative in nature Coordinated effort of multiple providers

35 Resources PatientPatient Consult services (nephrology, infectious disease)Consult services (nephrology, infectious disease) PICC RN: PICC RN: VIR: consult pager VIR: consult pager Home Infusion Nurse: Home Infusion Nurse: CCM and Social WorkersCCM and Social Workers

36 Useful to Know Venous Access is essential.Venous Access is essential. Establishing and maintaining reliable access is a priority.Establishing and maintaining reliable access is a priority. EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital.EARLY access planning prevents IV related complications and negative outcomes for patients and the hospital. The choice of which VAD to use is a collaborative process. The choice of which VAD to use is a collaborative process.


Download ppt "Venous Access Devices in Clinical Practice An overview of guidelines and services for maximizing outcomes for patients receiving intravenous therapies."

Similar presentations


Ads by Google