Background: To reduce excess central line use and provide an option for difficult venous access patients through the introduction of a midline catheter. Methods: Design included prospective monitoring of the implementation of a quality improvement project. The setting was a 576 bed, urban, community, nonprofit, Magnet recognized, level 3 trauma center serving primarily adult patients. Midline and peripherally inserted central catheters were inserted by a specialty nursing team; care and maintenance of all devices were provided by front line staff. Results: Zero midline catheter infections were observed in the 24 months after implementation of the fixed length, power injectable device. Completion of therapy was 80%, the most frequently encountered complication was device dislodgement. Conclusions: Adoption of a vascular access nurse led midline catheter program, coupled with device selection algorithms expanded the ability to select the right device for the patient, while decreasing excess central line usage without additional increased risks to the patient.

Background: A large, urban community hospital developed an insertion bundle to support the safe implementation of a policy of extended dwell time (clinical indication) for inpatient peripheral intravenous lines (PIVs). Methods: Internal evaluation of practices through direct observations as well as evidence-based guidelines and historic data on PIV-related bloodstream infections helped drive the bundle elements. A surveillance plan was in place to continue measurement of these outcomes during the postimplementation period. Results: At 12 months following implementation, the organization documented a 37% reduction (P = .03) in primary bacteremias (combining PIV and central line-associated bloodstream [CLABSI] infections) and a 19% percent reduction in PIV bloodstream infections. CLABSI rates were also reviewed, as 20% of CLABSI were noted to also have peripheral access present during the year prior to implementation. CLABSI standardized infection ratios for the publicly reported intensive care units decreased from 1.3 to 0.32 (P = .02). In addition, intravenous line start kit use decreased 48% during the year following bundle implementation. Conclusions: Careful planning and development of an education bundle and an insertion bundle in a community hospital setting allowed for longer dwell times and a trend of decreased bloodstream infections.

BackgroundData regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset.MethodsA modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices.ResultsA total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes.ConclusionWe developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.