DEVELOPING A VASCULAR ACCESS TEAM: IMPLEMENTING AN EVIDENCE-BASED PRACTICE TO IMPROVE IV THERAPY

Purpose:
Patients were not proactively assessed for the proper vascular access device. Selection was reactive with placements being performed by radiology at increased cost. Best practice supported early selection of the proper device to complete proposed IV therapy without interruption or complication.

Significance:
Reliable vascular access impacts patient care, patient satisfaction and risk management. Multiple venipunctures negatively influence patient satisfaction and can lead to delays in therapy. Irritant and vesicant medications pose a risk for extravasation with resulting disfigurement and disability.

Strategy and Implementation:
The evidence suggested that proactive assessment completed by a Vascular Access Team would accomplish the organization's goals: (1) decrease PICC line placements in radiology by 50%; (2) increase patient satisfaction related to IV placement, and; (3) decrease extravasation injuries by 75%. Three RNs were selected to staff the team. Members were prepared using a combination of didactic and clinical training. Each member was trained in ultrasound-guided placements used in conjunction with a tip locating system. Using established criteria, the team evaluated patients for appropriate access devices based on planned IV therapies. The team developed standing order sets for the care of PICC lines and revised policies for the management of central venous catheters to reflect the most contemporary clinical practice. The team members began to monitor all central line placements for compliance with best practice.

Evaluation:
From February 2008 to March 2009, the team has placed 1229 PICC lines, replacing 91% of the volume done in radiology with a savings of $527,000. LOS for this population was reduced by 2.75 days and patient satisfaction increased to the 60th percentile. Extravasation injuries decreased by 80%.

Implications for Practice:
The Vascular Access Team has contributed positively to patient outcomes and management. Staff have become increasingly engaged in the proactive identification of vascular access needs and in implementing evidence-based interventions in the care and management of central venous catheters.