How to Prepare for Advancement to Central Venous Access Device Insertion Beyond Peripherally Inserted Central Catheters: Socially Relevant

Amy Bardin-Spencer
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This is especially important when an alternative CVAD is indicated based on medication characteristics, duration of therapies, or anatomical limitations.1 As a resource dedicated to vascular access, it is critical that you have the ability and autonomy to assess and select the most appropriate device every time.2 Equally as important is that CVAD insertion is performed by an expert, using ultrasound with appropriate training, competency, and procedural volume while utilizing best practices.1,3Many clinicians take to social media to ask how to get started and who to ask. Prior to that step, the team should have a well-documented need to justify this clinical advancement. With that, let us review the minimal required considerations. Initially, it is important to identify the gaps within your organization—there are 2 significant gaps to outline to ensure the possible advancement supports the overall organizational goals.First, identify if a gap currently exists in an underresourced care area, patient population, or delay in care. For teams that track clinical outcome data closely, this could be easily identified based on device appropriateness documentation. This requires that your organization utilizes a standardized methodology for device selection and honest recognition when an alternate CVAD is indicated. This tracking will help identify procedural volume, a significant element relevant to advancement as risk is minimized when appropriate as procedural volume supports clinician confidence and competency.Second, identify the gap related to both reported and nonreported organization quality measures. Each organization has quality metrics that drive financial reimbursement related to vascular access which include CRSBI, CLASBI, CABSI, and more recently, hospital-onset bacteremia (HOB). Quality and process improvement initiatives within health care organizations should utilize benchmarks to identify, measure, and guide the process.1,4 Below is a list of questions to get you started. Keep in mind that well-adopted and sustainable programs are guided by established process improvement efforts driven by a need to improve a desired outcome.What are the current reported infection rates?What are the types of bacteremia/pathogen and device sources?Do you have representation on the CLABSI or quality committee?What are the infection prevention goals of your organization?Much like a product change, when considering advancement, you need to fully understand the value this advancement could bring to the organization. Partnering with your infection prevention (IP) department and quality teams is critical. IP teams manage through complex strategies to ensure harm prevention strategies are measured and benchmarks are routinely analyzed. Quality and risk management teams seek opportunities to improve the quality of care provided within the organization and reduce overall risk. These 3 groups should be included as part of your assessment plan when advancing to the insertion of additional CVADs. Both reportable and nonreportable collected harm metrics should be unit specific and by device type. These 2 factors will allow advancement, deployment, and prioritization in the hospital area with the highest risk. Advancement is not a quick process, yet knowing this detail allows teams to develop aligned strategies to augment device care or surveillance to support risk reduction. Several established teams have initiated formalized care, maintenance, and surveillance programs during the gap assessment process. This consideration supports unit-specific awareness and relationships needed to fully understand dynamics and basic practice gaps in all areas of the hospital. For hospitals to get ahead of vascular-access-related harm events, device insertion, management, and removal need a dedicated, systematic, standardized, and reproducible model of care.4VAT design and responsibilities vary between a nonacademic and academic organization.3 Ensure that your team is fully supporting all aspects of CVAD care. This may include daily device follow up, education, unit training, care and maintenance, observation, and catheter occlusion management. Being a comprehensive team establishes your team as an organizational solution; therefore, advancement may have less barriers. Another consideration will be service hours. Teams with limited availability are limited to advance as the need for appropriate vascular access is not limited to 8:00 a.m. to 5:00 p.m. hours.In general, nonacademic hospitals adopt an advancement model at a higher rate due to resource limitations. Academic centers will always have required resident training, and this is not a reason not to have the VAT advance practice.3 Academic centers require a collaborative relationship to ensure the resident training is maintained and supported by evidence-based practice guidelines by experts.5 Your team’s ability to support resident training, mentor new inserters, and educate creates relationships of support and mutual interest. Keep in mind, for academic settings, the team seeking advancement desires the opportunity to insert the most appropriate device on patients already being referred to the VAT for either a peripheral catheter, midline, or PICC.5Assess the current team and team size. Not all individuals want to advance, and it is important that you have the stakeholders with the right attitude on the team. Change is not easy, and it is even harder if team members are not aligned or resourced to cover this advancement. Team size matters, as you do not want to take on additional responsibilities if you do not have enough team members to proactively provide comprehensive vascular access.Only once the need has been fully identified and internal relationships established should the process of advancement be approached. Each professional board has a scope-of-practice position, and these vary slightly by state. Prior to discussing with your professional board, you should have a draft hospital policy, training plan, scope of practice in the surrounding states, and the gap assessment.Finally, you are not alone. 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Abstract

In today’s health care landscape, vascular access teams (VATs) are often tapped to increase appropriate device utility or independently seek ways to insert various central venous access devices (CVADs) not limited to peripherally inserted central catheters (PICCs). This includes all models of VAT models (APRN, NPs, RN, RT, RRT) seeking to provide a dedicated resource when a PICC is not appropriate for the patient. This is especially important when an alternative CVAD is indicated based on medication characteristics, duration of therapies, or anatomical limitations.1 As a resource dedicated to vascular access, it is critical that you have the ability and autonomy to assess and select the most appropriate device every time.2 Equally as important is that CVAD insertion is performed by an expert, using ultrasound with appropriate training, competency, and procedural volume while utilizing best practices.1,3Many clinicians take to social media to ask how to get started and who to ask. Prior to that step, the team should have a well-documented need to justify this clinical advancement. With that, let us review the minimal required considerations. Initially, it is important to identify the gaps within your organization—there are 2 significant gaps to outline to ensure the possible advancement supports the overall organizational goals.First, identify if a gap currently exists in an underresourced care area, patient population, or delay in care. For teams that track clinical outcome data closely, this could be easily identified based on device appropriateness documentation. This requires that your organization utilizes a standardized methodology for device selection and honest recognition when an alternate CVAD is indicated. This tracking will help identify procedural volume, a significant element relevant to advancement as risk is minimized when appropriate as procedural volume supports clinician confidence and competency.Second, identify the gap related to both reported and nonreported organization quality measures. Each organization has quality metrics that drive financial reimbursement related to vascular access which include CRSBI, CLASBI, CABSI, and more recently, hospital-onset bacteremia (HOB). Quality and process improvement initiatives within health care organizations should utilize benchmarks to identify, measure, and guide the process.1,4 Below is a list of questions to get you started. Keep in mind that well-adopted and sustainable programs are guided by established process improvement efforts driven by a need to improve a desired outcome.What are the current reported infection rates?What are the types of bacteremia/pathogen and device sources?Do you have representation on the CLABSI or quality committee?What are the infection prevention goals of your organization?Much like a product change, when considering advancement, you need to fully understand the value this advancement could bring to the organization. Partnering with your infection prevention (IP) department and quality teams is critical. IP teams manage through complex strategies to ensure harm prevention strategies are measured and benchmarks are routinely analyzed. Quality and risk management teams seek opportunities to improve the quality of care provided within the organization and reduce overall risk. These 3 groups should be included as part of your assessment plan when advancing to the insertion of additional CVADs. Both reportable and nonreportable collected harm metrics should be unit specific and by device type. These 2 factors will allow advancement, deployment, and prioritization in the hospital area with the highest risk. Advancement is not a quick process, yet knowing this detail allows teams to develop aligned strategies to augment device care or surveillance to support risk reduction. Several established teams have initiated formalized care, maintenance, and surveillance programs during the gap assessment process. This consideration supports unit-specific awareness and relationships needed to fully understand dynamics and basic practice gaps in all areas of the hospital. For hospitals to get ahead of vascular-access-related harm events, device insertion, management, and removal need a dedicated, systematic, standardized, and reproducible model of care.4VAT design and responsibilities vary between a nonacademic and academic organization.3 Ensure that your team is fully supporting all aspects of CVAD care. This may include daily device follow up, education, unit training, care and maintenance, observation, and catheter occlusion management. Being a comprehensive team establishes your team as an organizational solution; therefore, advancement may have less barriers. Another consideration will be service hours. Teams with limited availability are limited to advance as the need for appropriate vascular access is not limited to 8:00 a.m. to 5:00 p.m. hours.In general, nonacademic hospitals adopt an advancement model at a higher rate due to resource limitations. Academic centers will always have required resident training, and this is not a reason not to have the VAT advance practice.3 Academic centers require a collaborative relationship to ensure the resident training is maintained and supported by evidence-based practice guidelines by experts.5 Your team’s ability to support resident training, mentor new inserters, and educate creates relationships of support and mutual interest. Keep in mind, for academic settings, the team seeking advancement desires the opportunity to insert the most appropriate device on patients already being referred to the VAT for either a peripheral catheter, midline, or PICC.5Assess the current team and team size. Not all individuals want to advance, and it is important that you have the stakeholders with the right attitude on the team. Change is not easy, and it is even harder if team members are not aligned or resourced to cover this advancement. Team size matters, as you do not want to take on additional responsibilities if you do not have enough team members to proactively provide comprehensive vascular access.Only once the need has been fully identified and internal relationships established should the process of advancement be approached. Each professional board has a scope-of-practice position, and these vary slightly by state. Prior to discussing with your professional board, you should have a draft hospital policy, training plan, scope of practice in the surrounding states, and the gap assessment.Finally, you are not alone. Your AVA networks are here to support questions, as there are many states that have successfully advanced practice.
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如何准备中心静脉通路装置插入超越周围插入中心导管:社会相关
在当今的医疗保健领域,血管通路小组(VATs)经常被要求增加适当的设备效用或独立寻找方法插入各种中心静脉通路装置(cvad),而不限于外周插入中心导管(picc)。这包括所有增值模型(APRN、np、RN、RT、RRT),当PICC不适合患者时,寻求提供专用资源。当根据药物特征、治疗持续时间或解剖学限制指示替代CVAD时,这一点尤为重要作为一个致力于血管通路的资源,你每次都有能力和自主地评估和选择最合适的设备是至关重要的同样重要的是,在利用最佳实践的同时,由专家进行CVAD插入,使用具有适当培训、能力和程序容量的超声。许多临床医生在社交媒体上询问如何开始以及向谁询问。在这一步之前,团队应该有一个充分的文件证明这种临床进展的必要性。在此基础上,让我们回顾一下所需的最低考虑因素。首先,确定组织内部的差距是很重要的——要列出两个重要的差距,以确保可能的进步支持组织的总体目标。首先,确定目前在资源不足的护理领域、患者人数或护理延误方面是否存在差距。对于密切跟踪临床结果数据的团队,这可以根据设备适当性文件轻松识别。这要求您的组织在指示替代CVAD时使用标准化的方法进行设备选择和诚实识别。这种跟踪将有助于确定手术量,这是与进展相关的重要因素,因为在适当的情况下,手术量可以最大限度地降低风险,因为手术量可以增强临床医生的信心和能力。其次,确定与报告的和未报告的组织质量度量相关的差距。每个组织都有质量指标来驱动与血管通路相关的财务报销,包括CRSBI、CLASBI、CABSI,以及最近的院发菌血症(HOB)。卫生保健组织内的质量和过程改进计划应该利用基准来识别、度量和指导过程。下面是一些问题,你可以从这些问题开始。请记住,良好采用和可持续的计划是由建立的过程改进工作指导的,这些工作是由改进期望结果的需要所驱动的。目前报告的感染率是多少?菌血症/病原体和器械来源的类型是什么?你们在CLABSI或质量委员会中有代表吗?贵组织的感染预防目标是什么?就像产品变更一样,在考虑发展时,您需要充分了解这种发展可能给组织带来的价值。与您的感染预防(IP)部门和质量团队合作至关重要。知识产权小组通过复杂的战略进行管理,以确保衡量危害预防战略,并定期分析基准。质量和风险管理团队寻求机会提高组织内提供的护理质量并降低总体风险。这3组应包括在您的评估计划的一部分,当推进到插入额外的cvad。可报告和不可报告收集的危害指标都应该是特定于单位和设备类型的。这两个因素将允许在风险最高的医院区域进行推进、部署和优先排序。进步不是一个快速的过程,但了解这些细节可以让团队制定一致的战略,以加强设备护理或监测,以支持降低风险。在差距评估过程中,一些已建立的团队已经启动了正式的护理、维护和监督计划。这种考虑有助于充分了解医院所有领域的动态和基本实践差距所需的单位特定意识和关系。对于医院来说,要提前处理与血管通路相关的伤害事件,设备的插入、管理和移除需要一个专门的、系统的、标准化的和可复制的护理模式。在非学术组织和学术组织中,增值税的设计和职责是不同的确保您的团队完全支持心血管疾病护理的各个方面。这可能包括日常器械随访、教育、单元培训、护理和维护、观察和导管闭塞管理。作为一个全面的团队,你的团队是一个组织解决方案;因此,晋升的障碍可能更少。另一个考虑因素是服务时间。时间有限的小组只能提前,因为对适当血管通路的需求不限于上午8点到下午5点。
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来源期刊
JAVA - Journal of the Association for Vascular Access
JAVA - Journal of the Association for Vascular Access Medicine-Medicine (miscellaneous)
CiteScore
1.10
自引率
0.00%
发文量
22
期刊介绍: The Association for Vascular Access (AVA) is an association of healthcare professionals founded in 1985 to promote the emerging vascular access specialty. Today, its multidisciplinary membership advances research, professional and public education to shape practice and enhance patient outcomes, and partners with the device manufacturing community to bring about evidence-based innovations in vascular access.
期刊最新文献
Care Bundles and Peripheral Arterial Catheters: A Scoping Review The Difference between Quality Improvement and Human Subject Research: Foundational Support Unsafe: Sutures as an Unnecessary Risk for Clinicians and Patients: Editor’s Message President’s Message 2022 Association for Vascular Access Scientific Meeting: Poster Abstracts
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