A Vascular Access Team's Journey to Central Venous Catheter and Arterial Line Placement

Abstract

Background: The frequency with which vascular access specialists (VASs) are placing peripherally inserted central catheters (PICCS) has allowed for the improvement and expansion of the skill set by using advanced insertion techniques such as the modified Seldinger technique and ultrasound for real-time imaging. The use of real-time imaging has decreased complications such as arterial puncture and has improved success rates. Due to this positive influence on patient outcomes, many VASs are moving to the placement of central venous catheters (CVC). Method: We describe the service improvement process of expanding a vascular access team (VAT) practice to include the placement of CVCs and arterial lines in a large community hospital in Illinois. We also outline the history of vascular access and the journey of a VAT. Results: By following a methodic approach toward implementation of practice expansion, our VAT has gone from solely placing PICCS to the placement of CVCs in the internal jugular, axillary/subclavian, and femoral veins and to the placement of arterial lines. Conclusions: VASs have the capacity to positively influence patient safety and outcomes even further by placing CVCs, rather than simply staying with the current scope of practice by placing intravenous lines, midlines, and PICCs. Patient outcomes will improve as VASs move to the placement of CVCs, and the costs associated with potential complications will improve also. Moving to the placement of CVCs is vital to the specialty of vascular access and will continue the breadth and depth of service provided by VASs.

A retrospective analysis of the clinical effectiveness of subcutaneously tunneled femoral vein cannulations at the bedside: A low risk central venous access approach in the neonatal intensive care unit

“…The authors of a 2015 study examining use of the modified Seldinger technique when placing femoral venous catheters in critically ill infants stated that complications such as thrombosis and sepsis can be avoided with asepsis protocols and the risks for major complications are low when catheters are inserted by clinicians who are experts in US-guided vascular access. 24,25 The ability to train and maintain staff qualified to insert CVCs has become a quality measure for many hospitals. [26][27][28][29][30] Risk and complications associated with femoral vein access include DVT, air embolism, and arterial puncture.…”

Pre- and post-review of a standardized ultrasound-guided central venous catheterization curriculum evaluating procedural skills acquisition and clinician confidence

“…Central venous catheterization has traditionally been perceived as a physician-only procedure; however, the levels of confidence across both groups were found to be similar (see Table 1), which demonstrates the opportunity to identify other disciplines within the healthcare organization, and when appropriately trained, can augment current services and resources in quality vascular access delivery. [10][11][12][13][14] The highest number of zero insertion attendees were registered nurses and respiratory therapists, who also represented the largest of the non-physician groups. Due to the changing scope of the healthcare landscape, this data highlight that there is a need to challenge the greater opportunity for clinicians in vascular access or infusion teams with advanced skill sets, to provide facilitywide efficiencies and improvements in ultrasound-guided device placement, which may impact the overall patient experience.…”

“…9 There is a growing number of medical specialties outside of anesthesia that are frequently required to place ultrasoundguided central venous catheters (USG-CVCs), which include a growing number of non-physician inserters. [10][11][12][13][14] Although the blind landmark technique may have been the standard of care for many decades, growing evidence, acceptance and clinician confidence in ultrasound not only aids procedural successes and risk reductions, but allows complete clinical assessment of the vessel and patient prior to the procedure. 15 A blind approach cannot help the clinician in the pre-assessment phase, and ultrasound use can often assist when dealing with intra-procedural difficulties and potential venous anomalies.…”

Recursos Tecnológicos Em Neonatologia: Evidências Sobre a Técnica De Seldinger No Cateterismo Venoso Central

“…A evolução dos produtos e técnicas diminuiu enormemente as complicações associadas à colocação de CVC e aprimorou os resultados e a satisfação dos pacientes. 37 Além de proporcionar uma experiência exitosa e menos traumática ao RN, a incorporação da técnica de Seldinger à prática clínica impacta diretamente no tempo do profissional executante e na diminuição de custos do cateterismo. 38 Apesar de ter surgido há mais de 70 anos, a técnica de Seldinger tornou-se mais difundida e aplicada na Medicina.…”