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Vascular Access Strategies in Intensive Care Units: Antimicrobial + Power Injectable Devices
Purpose: The Vascular Access Team decided to address two questions: 1) Are our patients experiencing too many intravenous attempts? 2) Does our existing policy reflect evidence-based best practice? Project: The Team worked with our Quality Improvement department using the Plan/Do/Check/Act cycle to guide our inquiry. Data collection required alternative strategies since not all services where patients receive intravenous catheters were using the electronic medical record. Initially the data abstracted was hard to interpret resulting in redesigning the electronic nursing flow chart. The assessment of intravenous catheters was changed to include the Infusion Nurses Society Standards of Practice. The phlebitis and infiltration standardized scales were added to the nursing flow chart. Also added was documentation on the number of successful and unsuccessful attempts. The staff was educated about the new documentation by the Vascular Access Team. Results: Resulting data forwarded to the Team showed lack of venipuncture proficiency on first attempt and an increase in unscheduled restarts, supporting the Team’s assumption. Implications: The existing policy didn’t address the number of attempts per patient; it allowed each clinical staff member two attempts per patient, which could result in five or more total attempts per patient. Conclusions: Review of the data and the existing policy prompted the Vascular Access Team to propose and implement a new policy reflecting current best practices in the insertion of intravenous lines.
Vascular Access Strategies in Intensive Care Units: Antimicrobial + Power Injectable Devices Mauro Pittiruti, Antonio La Greca, Daniele Biasucci, Giancarlo Scoppettuolo
a mycotic aneurysm and one with multi-microbial sepsis after peri-hepatic packing for post-traumatic liver injury. All patients received high-volume infusions. The trauma patient successfully underwent multiple contrast-enhanced liver CT scans via his power-injectable line. All patients had negative paired blood cultures at days 7 and 15, as well as negative catheter cultures after planned removal at day 15. Implications: Antimicrobial+power injectable vascular access devices inserted within “extended” indication may be an effective part of a comprehensive vascular access strategy in high-risk environments and patients. Conclusion: Antimicrobial +power injectable vascular access devices are effective tools in improving critically ill patients care.
Vessel Health and Preservation: Selection Rights and Dashboard Nancy Moureau Vessel Health and Preservation is the foundation for selection of the right line, inserted by the right trained clinician, monitored by educated providers for removal at the right time. Selecting the right device incorporates a knowledge of the guidelines, standards and evidence for application with the right patient for the right line. Insertion requires a trained and skilled clinician to perform the process of placement without complications taking into account specific patient conditional factors. This presentation will establish a vascular access dashboard for device selection across all levels of care. Daily assessment includes evaluation of device function, observations for complications and necessity. Application of the “Rights” of vascular access is key to limiting complications and gaining the best outcomes for satisfied patients complete the treatment process.
Working Smarter, Not Harder
Background: Recent guidelines and practices are extending indications of antimicrobial catheters and power injectable devices. The critically ill patient deserves peculiar attention because of his high risk of catheter-related bloodstream infection (CR-BSI), the need for high volume infusions and frequent contrast-enhanced radiological studies. Purpose: To evaluate the role of combined antimicrobial and power-injectable devices as part of a vascular access strategy in an Intensive Care Unit (ICU). Case Description: Based on the 2014 update of SHEA Guidelines, a comprehensive strategy including extended indications to antimicrobial+power injectable devices was implemented in the Cardiothoracic and General Intensive Care Units of our Hospital. The clinical data of the first four patients receiving a 7.5 Fr chlorhexidine coated and power injectable catheter were collected and reviewed. All patients underwent removal of their catheter at 15 days and planned paired peripheral/central blood cultures at day 7 and day 15 after insertion, in the context of a local 6-months surveillance plan. Results: There were three postoperative cardiothoracic patients with septic shock after valvular surgery, one with
Dovette DeVore Background: Healthcare has become a culture of ‘more with less’. More patients, higher acuity, less training and less time, not to mention less money. Purpose: We need to make providing the best patient care for optimal patient outcomes easier. Project Description: By utilizing a locking storage box attached to the IV Pole, one per patient we save time, have FDA compliant storage at the bedside, eliminate infections and provide best practice education at the point of use. Results: By utilizing the locking storage box attached to the IV Pole, we have shown a time savings of 3-6 minutes per IV flush administration, clinicians and patients immediately implemented/ learned best practice for VAD care, and medications were stored per FDA guidelines. Implications: Vascular access as well as wound cares; saving time and eliminating infections as well as fines from accrediting agencies. Conclusions: We need to make caring for our patients easier. Working smarter, not harder.
2016
j
Vol 21 No 4
j
JAVA
j
263
Vascular Access Strategies in Intensive Care Units: Antimicrobial + Power Injectable Devices Mauro Pittiruti, Antonio La Greca, Daniele Biasucci, Giancarlo Scoppettuolo
a mycotic aneurysm and one with multi-microbial sepsis after peri-hepatic packing for post-traumatic liver injury. All patients received high-volume infusions. The trauma patient successfully underwent multiple contrast-enhanced liver CT scans via his power-injectable line. All patients had negative paired blood cultures at days 7 and 15, as well as negative catheter cultures after planned removal at day 15. Implications: Antimicrobial+power injectable vascular access devices inserted within “extended” indication may be an effective part of a comprehensive vascular access strategy in high-risk environments and patients. Conclusion: Antimicrobial +power injectable vascular access devices are effective tools in improving critically ill patients care.
Vessel Health and Preservation: Selection Rights and Dashboard Nancy Moureau Vessel Health and Preservation is the foundation for selection of the right line, inserted by the right trained clinician, monitored by educated providers for removal at the right time. Selecting the right device incorporates a knowledge of the guidelines, standards and evidence for application with the right patient for the right line. Insertion requires a trained and skilled clinician to perform the process of placement without complications taking into account specific patient conditional factors. This presentation will establish a vascular access dashboard for device selection across all levels of care. Daily assessment includes evaluation of device function, observations for complications and necessity. Application of the “Rights” of vascular access is key to limiting complications and gaining the best outcomes for satisfied patients complete the treatment process.
Working Smarter, Not Harder
Background: Recent guidelines and practices are extending indications of antimicrobial catheters and power injectable devices. The critically ill patient deserves peculiar attention because of his high risk of catheter-related bloodstream infection (CR-BSI), the need for high volume infusions and frequent contrast-enhanced radiological studies. Purpose: To evaluate the role of combined antimicrobial and power-injectable devices as part of a vascular access strategy in an Intensive Care Unit (ICU). Case Description: Based on the 2014 update of SHEA Guidelines, a comprehensive strategy including extended indications to antimicrobial+power injectable devices was implemented in the Cardiothoracic and General Intensive Care Units of our Hospital. The clinical data of the first four patients receiving a 7.5 Fr chlorhexidine coated and power injectable catheter were collected and reviewed. All patients underwent removal of their catheter at 15 days and planned paired peripheral/central blood cultures at day 7 and day 15 after insertion, in the context of a local 6-months surveillance plan. Results: There were three postoperative cardiothoracic patients with septic shock after valvular surgery, one with
Dovette DeVore Background: Healthcare has become a culture of ‘more with less’. More patients, higher acuity, less training and less time, not to mention less money. Purpose: We need to make providing the best patient care for optimal patient outcomes easier. Project Description: By utilizing a locking storage box attached to the IV Pole, one per patient we save time, have FDA compliant storage at the bedside, eliminate infections and provide best practice education at the point of use. Results: By utilizing the locking storage box attached to the IV Pole, we have shown a time savings of 3-6 minutes per IV flush administration, clinicians and patients immediately implemented/ learned best practice for VAD care, and medications were stored per FDA guidelines. Implications: Vascular access as well as wound cares; saving time and eliminating infections as well as fines from accrediting agencies. Conclusions: We need to make caring for our patients easier. Working smarter, not harder.
2016
j
Vol 21 No 4
j
JAVA
j
263