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Vascular Access Essentials Vascular Access Team. Introduction Aims: Introduce Vascular Access Team Discuss long term vascular access options Demonstrate.

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Presentation on theme: "Vascular Access Essentials Vascular Access Team. Introduction Aims: Introduce Vascular Access Team Discuss long term vascular access options Demonstrate."— Presentation transcript:

1 Vascular Access Essentials Vascular Access Team

2 Introduction Aims: Introduce Vascular Access Team Discuss long term vascular access options Demonstrate care and maintenance of Vascular Access Devices Risks and appropriate referral The role of Vascular Access in TPN Key messages

3 Vascular Access @ UHCW Past - Long term Vascular Access options limited - No patient assessment or follow up -Limited data on the insertions, removals and complications of long term vascular access devices -As a result… Patients go from this…To this…

4 Vascular Access Team Timeline Vascular Access Team Jan 2014 Appointment of Vascular Access Lead CNS Co-ordination of existing Hickman line service Introduction of Nurse-led PICC line service Jan 2014 Appointment of Lead CNS Apr 2014 Introduction of PICC insertion Introduction of bedside PICC placement June 2014 Increase in Hickman line sessions May 2014 Feb 2014 Training of anaesthetists July 2014 1 st expansion of team with Vascular Access Practitioner August 2014 Sept 2014 Roll out of Biopatch Introduction of Nautilus ECG tip location

5 Vascular Access Team Lead Vascular Access CNS Vascular Access Practitioner Anaesthetic Lead Vascular Access Coordinator Anaesthetists Radiologists

6 Vascular Access Team Service Delivery… -Longer term Vascular Access Devices (PICC/Mid, Hickman, Ports) -Planned longer term treatment e.g. Chemotherapy, Nutrition, Intravenous antibiotic therapy -Can deliver both an inpatient and Outpatient service for insertion Our team is not able to deliver… -Insertion of short term multi lumen CVC’s -An emergency access service -Peripheral cannulation service

7 Vascular Access Team

8 Vascular Access options Peripheral Lines Midlines Central lines PICC lines Hickman lines


10 Which Line? Vascular Access DeviceIndications Midlines -mid-long term peripheral access (> 10 days) - Administration of drugs with a pH of between 5-9 non-irritant/ vesicant drugs Peripherally Inserted Central Catheter (PICC) Single and multiple lumina -Intermediate to long-term (>10 days) central venous access -examples long term IVABX, TPN, Chemo -Irritating/vesicant solutions that require greater haemodilution blood taking Tunneled CVC Anchoring Cuff (Hickman) Single and multiple lumina -Long-term central venous access (>6-8weeks) -Frequent or continuous access -examples long term TPN, Chemo -Irritating/vesicant solutions that require greater haemodilution

11 ‘Right Line- Right Time’- Vessel Health Preservation

12 Vessel Health Preservation- Right Line- Right Time Why be specific about line choice?

13 Risks of Vascular Access Vascular Access Risks Venous Stenosis Trauma caused by repeated line insertion may impact on stenosis Infection Multiple placement of vascular access devices increases risk of infection There is a clear link between thrombosis and infection Thrombosis Multiple central venous devices increase risk of thrombosis x4 Placement of a line impacts on 2 of Virchows triad Upto 60% of UEDVT’s are asymptomatic Think patient risk factors

14 Complications of long term vascular access Infection- suspected line sepsis Blood Culture from peripheral arm and Line (all lumens) Look for other sources… If Blood cultures positive and line is removed Tip must be sent for MC+S Think about sources- Lines are often removed unnecessarily.

15 Complications of long term Vascular Access Thrombosis or Upper arm DVT Risk increases with the number of lines placed Signs and symptoms don’t always appear Swelling along arm (including hand) Pain Treatment if suspected- Ultrasound Doppler of Upper arm Leave Line in if it still works Treat with Therapeutic Clexane

16 Reducing the risk- Care and Maintenance Clinical Indication- prompt removal Aseptic technique for all interaction with VAD’s Pulsative flushing- ESPECIALLY AFTER BLOOD TAKING Weekly maintenance until line removed Daily review including documentation

17 Bionectors Needle free means ‘needle free’ Self sealing spring mechanism keeps the fluid pathway closed until a syringe or giving set opens the pathway Needles will damage the internal structure of the bionector and potentially fracture the line Bionectors are replaced every 7 days as part of line maintenance

18 Drug administration Scrub the HubAspirateFlush

19 Obtaining venous blood samples Scrub the HubAspirateAttach adapter and vacutainer Flush

20 TPN

21 Reducing the Risk- Appropriate referral “I need a line for a patient on long term antibiotics…” “How long is the course?” “Well they have had 4 weeks out of 6 already, but now it’s becoming difficult to cannulate them” Place yourself in the patients shoes. Early referral reduces risk, but there must be a plan for treatment.

22 Reducing the risk- Appropriate referral “I have a patient who needs a line for TPN…” Have you discussed the patient and referred to nutrition team? “not yet…” Vascular Access decisions are made based on length of therapy and patients treatment plan. An appropriate line cannot be placed without a plan

23 Reducing the risk- Appropriate referral “I need Urgent Access for a poorly patient. They need blood, Albumin IV fluids and antibiotics as they are severely unwell and deteriorating” Appropriate device choice. Long term vascular access devices would not meet the needs of this patient. They need a short term CVC to get through the acute phase.

24 What do we need to know- referral Key information is required at referral to ensure safe and effective Vascular access. On referral the following information is required. Previous history of DVT Warfarin INR status Clotting/ bleeding problems Other invasive devices- namely pacemakers Previous history of Central Vascular Access Infection risks Upper extremity complications e.g. trauma to neck/ upper body Indication for the line requested- specific drug regime

25 How to Refer CRRS Radiology Request Modality: Vascular Access Choose line type Answer Questions with as much detail as possible

26 Vascular Access Team Contact: Sharron Oulds Vascular Access Lead CNS Ext 25900 Early referral for longer term vascular access improves patient safety.

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