Volume 4 Issue 1

Welcome to the latest issue of Vascular Access! 

In this issue, we present two articles relevant to quality and safety of vascular access, and one article comparing the outcomes with two extended dwell peripheral catheters. 

One positive shift in health over the past decade is the increased recognition of the benefits of collecting accurate and reliable outcomes data and sharing the results with clinicians and patients, as well as hospital boards and managers¹. To be useful, data needs to be:

• Accurate: trustworthy and sufficient in detail to allow valid conclusions to be drawn.
• Relevant: current, specific, and able to help people make good decisions.
• Accessible: in the hands of those who can use it, when they need it, and in a form they can use.
• Understandable: easy to interpret and accompanied by meaningful analysis¹.

Clinical data registries in vascular access are being used more widely to keep track of devices inserted and clinical outcomes², and the article by Takashima et al. in this issue presents a feasibility study for a CVAD registry in one intensive care unit. Building a registry from the bottom up is a daunting task, and the authors reveal what worked well and not so well in their hospital, making suggestions for future data collection. This interesting paper should provide insights for other vascular access professionals considering undertaking a similar project in their own institutions.

Woods et al. tackle another important quality and safety concern: PIVC dressing and securement from a nursing perspective. Recent audits have demonstrated that a high percentage of dressings are soiled, loose and lifting, predisposing the patient to potential catheter dislodgement and site infection^3-5. Rickard et al. conducted a multicentre RCT of four types of dressing and securement⁶. The paper by Woods et al. describes the results of a sub-study of that trial, in which nurses at one site were invited to participate in a survey to provide their personal perceptions and experiences about the dressing and securement products used in the trial. Feedback from nurses on the performance and acceptability of the products reveals that nurses understand the priorities for dressing integrity but have continued concerns about the available products. Staff reported that the top priorities for dressing and securement products are IV site coverage, stabilisation of the catheter, and securement to the skin. An important take-away message from this paper is the vital need to engage staff in clinical practice changes.

As new catheter products continually enter the market, it’s important that clinicians provide evidence on how these products perform in clinical practice. The paper by Alexandrou and colleagues reports the experience of one central vascular access service that implemented an extended dwell peripheral device program for patients experiencing difficult intravenous access. Following an ultrasound assessment insertion algorithm⁷, they then compared the insertion characteristics and outcomes of two extended dwell peripheral catheters for patients experiencing difficult intravenous access. 

I hope you enjoy this issue of Vascular Access.

Gillian

Author(s)

Gillian Ray-Barruel, RN, PhD Editor-in-Chief Page 1

References

 

1. Duckett S & Jorm C. Strengthening safety statistics: how to make hospital safety data more useful. Grattan Institute, November 2017.
2. Girgenti C & Moureau NL. The need for comparative data in vascular access: The rationale and design of the PICC registry. Journal of the Association for Vascular Access: JAVA 2013; 18(4):219–24. doi: 10.1016/j.java.2013.07.003 
3. Alexandrou E, Ray-Barruel G, Carr PJ et al. International prevalence of the use of peripheral intravenous catheters. J Hosp Med 2015; 10(8):530–3. doi: 10.1002/jhm.2389
4. New KA, Webster J, Marsh NM et al. Intravascular device use, management, documentation and complications: a point prevalence survey. Aust Health Rev 2014; 38(3):345–9. doi: 10.1071/AH13111
5. Russell E, Chan RJ, Marsh N et al. A point prevalence study of cancer nursing practices for managing intravascular devices in an Australian tertiary cancer center. Eur J Oncol Nurs 2014; 18(3):231–5. doi: 10.1016/j.ejon.2013.11.010
6. Rickard CM, Marsh N, Webster J et al. Securing All intraVenous devices Effectively in hospitalised patients — the SAVE trial: study protocol for a multicentre randomised controlled trial. BMJ Open 2015; 5(9):e008689. doi: 10.1136/bmjopen-2015-008689 
7. Sou V, McManus C, Mifflin N et al. A clinical pathway for the management of difficult venous access. BMC Nurs 2017; 16(1):64.