Preservation protocol

Nancy Moureau of Teleflex Incorporated tells EHM of the proactive management of vessel health.

“The goal is to proactively drive patient-specific device placement within 24 to 48 hours of admission”
-Nancy Moureau

With more than 3.8 million central venous catheters (CVCs), two million peripherally inserted central catheters (PICCs) and 310 million peripheral intravenous devices sold yearly in the US, vascular access is clearly a high volume, high usage procedure for patients receiving medical treatments. Getting the right intravenous device placed early in the hospital stay can speed treatment and patient discharge while minimizing expenditures.

Vessel health and preservation has become an important issue as patients now come to hospitals more acutely ill, living longer, often having chronic conditions. According to the Centers for Disease Control (CDC) selection of the right device inserted into the right location is paramount to reducing complications, specifically infection.

In 2008 a multidisciplinary task force of vascular access experts created a conceptual model defining a vessel health and preservation protocol. The protocol incorporates a systematic process driving selection and placement of the right line upon admission through end of care.

Steps for protocol implementation include, firstly, right line selection. The vessel health and preservation program is initiated through standing orders allowing line selection within 24 hours. Device selection is based on diagnosis, therapy and pharmaceuticals. The second step is right patient assessment. Once device is selected, patient assessment is performed including admission risk assessment, critical factors/acuity and vein health assessment. Final device selection placed within 48 hours using Central Line Bundle with CLIP checklist. The third is right line/right time daily review. Daily assessment is performed during rounds to determine necessity and evaluate changes in acuity/medications. Central Line Bundle applied to all care and maintenance procedures. The fourth is outcome evaluation. Prior to patient release, compliance to program is measured to evaluate vessel health, complications and provide education to staff.

Selection process

The vessel health and preservation program is initiated through standing orders and patient assessment. The selection process incorporates multidisciplinary aspects through selection of the right device, placement and daily assessment by the physician, nurse and other team members. The goal is to proactively drive patient specific device placement within 24 to 48 hours of admission.

National guidelines such as the CDC and Society for Healthcare Epidemiology (SHEA)/Infectious Disease Society of America (IDSA) 2008 Compendium Strategies (SHEA 2008) are a part of the vessel health and preservation program through insertion and daily assessment of the patient and devices chosen to administer treatment. The Institute for Healthcare Improvement Central Line Bundle in the insertion process is evaluated through the Central Line Insertion Prevention (CLIP) checklist, which measures compliance with the Bundle and other infection prevention practices. Education is ongoing with the vessel health and preservation program providing preventative education in keeping with Joint Commission National Patient Safety Goal 07.04.01 requirement for insertion, care and maintenance training, patient education and a process for implementing this education.

Fast, well-directed treatment following diagnosis is the hallmark of efficiently managed hospital systems. Costs are controlled when patients receive a vascular access plan that is immediately implemented, assessed daily and adapted as needed with evaluation at the end of the process. Using new technology in placement of safety CVCs, such as the Accelerated Seldinger technique, may reduce delays in device access. Roadblocks occur when patients fail to receive a vascular access plan. When peripheral veins for intravenous access are exhausted or develop complications, precious time is lost identifying the right person and device for placement. Process flow is improved when a vessel health and preservation program institutes an intentional selection and placement process with indicators of daily successful function, which will speed the patient to better health and discharge.

A program built with a vessel health and preservation clinical pathway ensures the patients' right to safe and timely drug delivery reinforcing the core message: the right line for the right patient at the right time.

For more information please visit www.piccexcellence.com.

Nancy Moureau is a Vascular Access Consultant, educator, and per diem clinician at Greenville Memorial Hospital in Greenville, SC. She is the founder, and CEO of PICC Excellence, Inc., a corporation established for training, education and consulting of PICC Lines.