Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes

Bell, Jon A.; Spencer, Timothy R

doi:10.1177/1129729820924554

Cited by 19 publications

(18 citation statements)

References 46 publications

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“…It is important to note that an increasing number of tools have been developed for predicting difficult venous access, both for pediatric [ 24 – 26 ] and adult patients [ 19 , 27 – 29 ]. Additionally, there has been a marked increase in the availability and acceptance of ultrasound-guided assessment and cannulation [ 30 , 31 ], sparking the formation of vascular access teams [ 32 ]. The European Society of Anesthesiologist published guidelines recommending the early identification of difficult venous access through validated tools, as well as the use of ultrasound [ 33 ].…”

Section: Discussionmentioning

confidence: 99%

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

et al. 2022

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Background A peripheral venous catheter (PVC) is the most widely used device for obtaining vascular access, allowing the administration of fluids and medication. Up to 25% of adult patients, and 50% of pediatric patients experience a first-attempt cannulation failure. In addition to patient and clinician characteristics, device features might affect the handling and success rates. The objective of the study was to compare the first-attempt cannulation success rate between PVCs with wings and a port access (Vasofix® Safety, B. Braun, abbreviated hereon in as VS) with those without (Introcan® Safety, B. Braun, abbreviated hereon in as IS) in an anesthesiological cohort. Methods An open label, multi-center, randomized trial was performed. First-attempt cannulation success rates were examined, along with relevant patient, clinician, and device characteristics with univariate and multivariate analyses. Information on handling and adherence to use instructions was gathered, and available catheters were assessed for damage. Results Two thousand three hundred four patients were included in the intention to treat analysis. First-attempt success rate was significantly higher with winged and ported catheters (VS) than with the non-winged, non-ported design (IS) (87.5% with VS vs. 78.2% with IS; PChi < .001). Operators rated the handling of VS as superior (rating of “good” or “very good: 86.1% VS vs. 20.8% IS, PChi < .001). Reinsertion of the needle into the catheter after partial withdrawal—prior or during the catheterization attempt—was associated with an increased risk of cannulation failure (7.909, CI 5.989–10.443, P < .001 and 23.023, CI 10.372–51.105, P < .001, respectively) and a twofold risk of catheter damage (OR 1.999, CI 1.347–2.967, P = .001). Conclusions First-attempt cannulation success of peripheral, ported, winged catheters was higher compared to non-ported, non-winged devices. The handling of the winged and ported design was better rated by the clinicians. Needle reinsertions are related to an increase in rates of catheter damage and cannulation failure. Trial registration ClinicalTrials.gov, Identifier: NCT02213965, Date: 12/08/2014.

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Section: Discussionmentioning

confidence: 99%

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

et al. 2022

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“…Certain centres have instituted a DIVA workflow which calls upon a specialized vascular access team to perform ultrasound-guided peripherally-inserted central catheter cannulation emergently. [33] Such a protocol would, however, require significant resources to muster and may inadvertently delay resuscitation until help arrives.…”

Section: Early Escalationmentioning

confidence: 99%

Management of difficult intravenous access: a qualitative review

Ng¹,

Mark²,

Lateef³

2022

World Journal of Emergency Medicine

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Establishing peripheral intravenous access (PIV) is one of the most ubiquitous and crucial steps in managing critically ill patients. Yet only 74% of first attempts during emergency resuscitation in adults [1] are successful and this falls to an even-more-dismal 33% in difficult intravenous access (DIVA) patients. [2] A perennial challenge faced by clinicians, DIVA impacts patient outcomes adversely by causing downstream delays in both diagnoses (difficulty in obtaining blood specimens and administering intravenous contrast for advanced imaging) and therapy (provision of parenteral fluids, blood products or drug administration to facilitate procedures such as sedation or rapid-sequence intubation). [3] Failed cannulation attempts often cause patient and clinician alike considerable frustration and distress and may lead to complications like thrombophlebitis, infection and haematoma. [4] Moreover, time-to-cannulation averages 2.5-13.0 min for most patients but can take up to 30 min to hours in DIVA cases. [5] As DIVA patients tend to distract disproportionately more time and attention of the attending emergency physicians, this inevitably compromises the care of other patients.Although there is no consensus or universallyaccepted definition, DIVA is commonly defined as either two or more failed attempts by an experienced operator using traditional landmark-based methods BAcKGRound: A perennial challenge faced by clinicians and made even more relevant with the global obesity epidemic, difficult intravenous access (DIVA) adversely impacts patient outcomes by causing significant downstream delays with many aspects of diagnoses and therapy. As most published DIVA strategies are limited to various point-of-care ultrasound techniques while other "tricks-of-the-trade" and pearls for overcoming DIVA are mostly relegated to informal nonpublished material, this article seeks to provide a narrative qualitative review of the iterature on DIVA and consolidate these strategies into a practical algorithm. MEtHodS:We conducted a literature search on PubMed using the keywords "difficult intravenous access", "peripheral vascular access" and "peripheral venous access" and searched emergency medicine and anaesthesiology resources for relevant material. These strategies were then categorized and incorporated into a DIVA algorithm. RESuLtS:We propose a Vortex approach to DIVA that is modelled after the Difficult Airway Vortex concept: starting off with standard peripheral intravenous cannulation (PIVC) techniques, progressing sequentially on to ultrasound-guided cannulation and central venous cannulation and finally escalating to the most invasive intraosseous access should the patient be in extremis or should best efforts with the other lifelines fail. concLuSIon: DIVA is a perennial problem that healthcare providers across various disciplines will be increasingly challenged with. It is crucial to have a systematic stepwise approach such as the DIVA Vortex when managing such patients and have at hand a wide repertoire of techniques t...

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“…The variability observed in the VAT structure from nine institutions and six European countries is dependent on hospital staffing requirements, the VAT being a central or departmental service and the size of the patient population and institution. The VAT is described throughout literature as a group of personnel specifically with advanced knowledge of intravenous access techniques affiliated with VAD insertion and care [16,17]. This includes nurses, doctors, respiratory therapists, radiology technicians and physician assistants from multiple departments in the hospital (vascular surgery, interventional radiology, critical care, nephrology, interventional cardiology, and surgical oncology) [9,16,17].…”

Section: Vat Structurementioning

confidence: 99%

“…The antithesis to a VAT is a general model where groups of nurses, doctors, or any others who have less advanced skills and knowledge in inserting and managing VADs are nonetheless responsible for VAD insertion and management [9,16], and historically, it has been physicians who have inserted VADs. Recently, there has been a shift to nurse-led services with increased importance on the role of the nurse in a VAT [12].…”

Section: Vat Structurementioning

confidence: 99%

“…There is no EU-wide, robust database of complications. Data management and reporting are problematic and integration of best practice across stakeholders is difficult It has been reported throughout the literature that implementation of a VAT requires foundational knowledge and skills in vascular access with quality measures to ensure competency and compliance with evidence-based practices, ( [16]) and that it takes time for full acceptance of a VAT among hospital staff;…”

Section: Vat Developmentmentioning

confidence: 99%

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Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

et al. 2021

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Background: Vascular access by means of intravenous catheters is essential for the safe, effective and cost-efficient delivery of intravenous fluids, antibiotics, nutrition and chemotherapy, but the use of these devices is not without complications. Purpose: A faculty of multidisciplinary European vascular access team (VAT) Leads/Members and experts sought to reframe how the implementation of a VAT could have positive impacts on patients and hospitals. Methods: Interview data from a Faculty of nine VAT Leads/Members and experts from six European countries on the impact of multidisciplinary VATs in modern healthcare were assessed. A literature search was conducted that included Medline ® -cited peer-reviewed articles published in the past 10 years in order to identify impact data and post-implementation of a multidisciplinary VAT that support the benefits to patient safety and satisfaction and to hospital efficiencies reported in the interview program. Results: While VATs vary in structure and function, clarity of purpose and supportive training and education are key. Barriers to the implementation of VATs show commonality across countries, such as lack of investment, insufficient training and lack of awareness. Proven markers of VAT success include rapid referrals, improved patient outcomes and improved organizational efficiency. Standardization of outcomes data capture, processing and reporting are key to monitoring performance against baseline. Awareness of the cost of complications arising from inappropriate choice and placement, and poor care and maintenance, of the vascular access device must be raised. Conclusions:The implementation of VATs can positively impact patient safety and satisfaction, improve organizational efficiencies and cost-effectiveness, and could create new opportunities for in-and outpatient services, beneficial to both patients and institutions.

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Implementing an emergency department vascular access team: A quality review of training, competency, and outcomes

Cited by 19 publications

References 46 publications

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

A comparison of first-attempt cannulation success of peripheral venous catheter systems with and without wings and injection ports in surgical patients—a randomized trial

Management of difficult intravenous access: a qualitative review

Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams

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