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Identifying Gaps in Nursing Care of Access Devices

Credits: None available.

Purpose: Over the past several years, workload of the vascular access team (VAST) has grown, with disproportionate focus on peripheral intravenous line (PIV) insertion. This has caused role confusion with the bedside nursing units. Anecdotal nursing care problems are also frequently identified by VAST but have not yet been well quantified. Data analysis is needed to determine the issues in order to develop a plan moving forward. This project aimed to identify the major nursing opportunities related to insertion and care of PIVs and central lines.

Description: VAST incident reports and a VAST productivity spreadsheet were evaluated. Data was analyzed from 80 inpatient incident reports for all access devices during FY21. Incidents were organized into several broad categories and sorted according to whether they were related to nursing care. Productivity data also reviewed from VAST team regarding IV insertions and complications.

Results: 59% of reported incidents were related to nursing care or lack of adherence to policy. Major identified issues included dressing/cap changes are not performed, infusions are not stopped after infiltration, medication/TPN infusion errors are occurring, and VAST is not notified of presence of central lines, resulting in missed care. At least 7 incidents affected the VAST workload. VAST is being consulted for the majority of PIV placements, despite almost half of their insertions being classified as “simple.” This consumes 13% of their total productivity.

Evaluation: Additional education regarding IV insertion/maintenance would benefit nursing staff. Recommend developing a plan to reeducate nurses and increase PIV insertion competencies. Unit nurse champions could facilitate this education, respond to incident reports, and support communication between VAST and nursing (Goodfriend et al., 2020). Recommend increasing engagement from current champions to accomplish these goals. VAST teams are beneficial in the reduction of central-line associated bloodstream infections (CLABSI) (Holder et al., 2020). The current process is for the VAST team to change all central line dressings outside of ICU. Recommend increased training on PIV insertions for unit nurses to relieve workload from VAST so they can continue to focus on difficult sticks and insertion/maintenance of central lines.

Evidence-based references
1. Goodfriend, L., Kennedy, S., Hein, A., & Baker, R. (2020). Implementation of a vascular access experience program to train unit-based vascular access champions. Journal of Infusion Nursing, 43(4), 193-199. https://doi.org/10.1097/NAN.0000000000000373
2. Holder, C., Overton, E., Kalaf, S., Wong, D., Holdsworh, J., Yun, M., Schreck, D., Haun, P., Omess, S., Whitson, M., Ott, D., Mitchell, R., & Steinberg, J. (2020). Impact of expansion of vascular access team on central-line–associated bloodstream infections. Infection Control and Hospital Epidemiology, 41(S1), s260-s260. https://doi.org/10.1017/ice.2020.825



Credits: None available.

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