Vessel Health & Preservation: Integration of Guidelines into Clinical Practice


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Vessel Health & Preservation: Integration of Guidelines into Clinical Practice

  1. 1. Vessel Health and Preservation:Integration of Guidelines into Clinical PracticeI t ti f G id li i t Cli i l P ti Moderators: Nancy Trick, RN, CRNI Nancy Moureau BSN CRNI, CPUI Moureau, BSN, CRNI
  2. 2. How It All Started A Vascular Access Summit convened to discuss and establish an evidence-based practice for device selection that preserves patient vessels and results in better outcomes. Members of the summit included: M d t Moderators:  Nancy Trick, RN, CRNI Nancy Moureau, BSN, CRNI, CPUI Thomas Nifong, MD Michael Doll, MPAS, PA‐C,  Penn State College of Medicine Penn State College of Medicine FAPACVS Jessica Wallace, RN, NP Gesinger Medical Center UCLA Medical Center Matthew Leavitt, MD Cathy Perry, MSN, RN University of MI Vanderbilt Medical Center Vanderbilt Medical Center Laurie Benton, RN, PA‐C Steven Gordon, MD Texas A & M University Medical Cleveland Clinic Lorelei O’Donnell, MSN, RN, CRNI, Ced Connie Bigger, RN, BSN, CRNI University of MI Health Sciences Munson Medical Center
  3. 3. The Basics of the VHP Program g Right Line Benefits • Pathways provide – Choosing the best vascular access device consistency of care based on assessment of prescribed therapy and duration inserting the most appropriate • Intentional selection process device with the lowest risk preserves veins for future needs of patient Ri ht Patient Right P ti t • Process implements Best Practice Guidelines – Selection based on patient conditional factors and long-term needs • Education and compliance with guidelines results in – Assess veins, choices and history reduced infection rates Right Time • Fewer vascular access devices promote greater – Perform insertion as soon as possible (within patient satisfaction 48 hours) of beginning of treatment plan • Applied in stages at multiple – Remove device as soon as treatment institutions complete; Evaluation dailyPractice Recommendations: Assessment and Device Selection for Vascular Access, RNAO 2008
  4. 4. Vessel Health and Preservation Pathway y VHP provides a pathway that leads to the best device selection given the  patient diagnosis, treatment plan, acuity and vessel health VHP is an  evidence based  evidence based process forDevice Selection Device Selection Device  Device Daily  and Patient  Placement Using  Evaluation Assessment Assessment Guidelines • Right Line     Prompt removal  Monitoring and  • Right Patient   when VAD no  compliance  • Right Time longer necessary measures
  5. 5. Right Line and Right Patient g g
  6. 6. Right Time for Insertion Assessment and Outcomes g
  7. 7. Application of Guidelines with VHP Provide Education Implement Central Line  Use Central line Checklist           Bundle Practices (IHI and  SHEA 2008 (NHSN 2009)  CDC 2011) • Annual infection  • Hand hygiene • Use checklist for all CVC  prevention education for  • Select insertion site  insertions all clinicians who insert  based on risk  • Ensure compliance of  or care for CVCs or care for CVCs assessment – avoid id bundle through observer  b dl h h b • Education upon hire for  femoral evaluation during  all clinicians who work  • Use maximal barriers  insertion with CVCs and protection • Empower observer to  • Evaluate to ensure  l • Chlorhexidine with  stop procedure if  d if understanding and  alcohol for skin  compromised compliance disinfection • Competency assessment • Evaluate daily and  remove device promptly  when not neededReferences: 1. Marschall J, Mermel LA, Classen D, Arias KM, Podgorny K, Anderson DJ, Burstin, Calfee DP, Coffin SE, Dubberke ER, Fraser V, Gerding DN, Griffin FA, Gross P, Kaye KS, Klompas M, Lo E, Nicolle L, Pegues DA, Perl TM, Saint S, Salgado CD, Weinstein RA, Wise R, Yokoe DS. Strategies to Prevent Central‐Line Associated Bloodstream Infections in Acute Care Hospitals: Supplement Article SHEA/IDSA Practice Recommendations. 2008 29 Supp 1: S22‐S30.2. Institute for Health Care Improvement (, Getting Started Kit Central Line Bundle: Preventing Central Line Infections How‐to Guide p3, July 2008.   3. CDC. Guidelines for the Prevention of Intravascular Catheter Related Infections. 2011‐guidelines‐2011.pdf .                             
  8. 8. Implementing the VHP System through Process and Clinical Application Evaluate Vascular Access  Establish education and Evaluate and monitor for  Processes to Identify Gaps  Processes to Identify Gaps outcome goals improved communication  i d i ti and Need for Vessel  with HCW Health and Preservation  Evaluate for Compliance  and Improvement with  and Improvement with Select Unit and Present  S l t U it d P t Re‐education as Needed  Educate VHP Program to Meet Goals Evaluate Select Select device that  promotes preservation of promotes preservation of  veins and patient  resources Promote Better  Communication  Assess Insert Between HCW through  Educate Inserters and  Daily Rounds Unit Staff on Vessel  Health and Preservation   Assess applying  Implement the Tools  guidelines to daily goals  and Process in One Unit Insert device using best  and processes and processes practice bundles