Novel Multidisciplinary Vascular Access Team Helps to Improve ICU Workflow Amidst Covid-19 Pandemic.

OBJECTIVE: The surge in critically ill patients has pressured hospitals to expand their intensive care unit capacities and critical care staff. This was difficult given the country's shortage of intensivists. This paper describes the implementation of a multidisciplinary central line placement team and its impact in reducing the vascular access workload of ICU physicians during the height of the COVID-19 pandemic. METHODS: Vascular surgeons, interventionalists, and anesthesiologists, were redeployed to the ICU Access team to place central and arterial lines. Nurses with expertise in vascular access were recruited to the team to streamline consultation and assist with line placement. RESULTS: While 51 central and arterial lines were placed per 100 ICU patients in 2019, there were 87 central and arterial lines placed per 100 COVID-19 ICU patients in the sole month of April, 2020. The ICU Access Team placed 107 of the 226 vascular access devices in April 2020, reducing the procedure-related workload of ICU treating teams by 46%. CONCLUSIONS: The ICU Access Team was able to complete a large proportion of vascular access insertions without reported complications. Given another mass casualty event, this ICU Access Team could be reassembled to rapidly meet the increased vascular access needs of patients.

Development of a Peripheral Intravenous Access Training Program for Nurses in the Pediatric Intensive Care Units.

PURPOSE: Obtaining vascular access in the pediatric population can be challenging, with insertion success rates varying widely based on patient and practitioner associated factors. Difficulty establishing peripheral intravenous access can delay treatment, which can be detrimental in emergent situations. Nurses who are trained in vascular access yield a much higher first attempt success rate, which decreases resource utilization, time to intervention, and complication rate. Fewer insertion attempts can also result in improved outcomes including decreased length of stay and better patient and family perception of pain. DESIGN AND METHODS: The Vascular Access Service at our institution developed an extensive training program, which included three stages: didactic learning, simulation training, and insertion validation. RESULTS: During the first three months of 2020, there were 54 ultrasound-guided peripheral IVs placed in the pediatric intensive care units, 100% of which were placed by the vascular access service. In the first three months of 2021, 63 ultrasound-guided peripheral IVs were placed, 100% of which were placed by pediatric intensive care unit nurses. Of those placed by pediatric intensive care unit nurses, 52 (82.5%) were placed following their ultrasound-guided peripheral IV training. First time insertion success rates were 86.5% with competency in a diverse patient population of widely varying ages. CONCLUSIONS: Programs that include repeated simulation experiences may facilitate greater learning and thus increase the confidence of the nurses trained. Improving staff skills for vascular access has promoted independent bedside practice and contributed to a culture of quality and safety for the pediatric patient population.

Impact of a Peripheral Vascular Access Service on Device Use.

BACKGROUND: More than 1 billion peripheral vascular access devices are inserted annually worldwide with potential complications including infection, thrombosis, and vasculature damage. Vasculature damage can necessitate the use of central catheters, which carry additional risks such as central catheter-associated bloodstream infections. To address these concerns, one institution used expert nurses and a consult request system with algorithms embedded in the electronic medical record. OBJECTIVES: To develop a uniform process for catheter insertion by means of a peripheral vascular access service dedicated to selecting, placing, and maintaining all inpatient peripheral catheters outside of the intensive care units. METHODS: Descriptive analysis and χ2 analysis were done to describe the impact of the peripheral vascular access service. RESULTS: In 2018, 6246 consults were reviewed. Of these, 26% did not require vascular access. Similarly, in 2019, 7861 consults were reviewed, and 35.3% did not require vascular access. Use of central catheters decreased from 21% in 2017 to 17% in 2018 and 2019. CONCLUSIONS: The peripheral vascular access service allowed patients to receive appropriate peripheral vascular access devices and avoid unnecessary peripheral catheter placements. This may have preserved patients' peripheral vasculature and thus prevented premature central catheter placement and contributed to an overall decrease in central catheter days. With the peripheral vascular access service, peripheral vascular access devices were selected, placed, and maintained by experts with a standardized process that promoted a culture of quality and patient safety.

Adapting a vascular access service (VAS) to meet the needs of the COVID-19 pandemic.

The novel coronavirus 2019 (COVID-19) pandemic has placed an unprecedented strain on healthcare systems and frontline workers worldwide. The large influx of these high acuity patients has placed pressure on services to modify their operations to meet this increased need. We describe how the Vascular Access Service (VAS) at a New York City academic hospital adopted a team-based approach to efficiently meet increased demand for vascular access devices, while ensuring safety and conserving personal protective equipment.

A comprehensive vascular access service can reduce catheter-associated bloodstream infections and promote the appropriate use of vascular access devices.

This study describes the role of a novel vascular access service in the reduction and prevention of central line-associated bloodstream infections (CLABSIs). We conducted a retrospective analysis of data obtained over a span of 24 months after implementation of our vascular access service. We identified a progressive decline in the CLABSI rate and standardized infection ratio (SIR) in 2017 (rate, 1.75; SIR, 1.25) and in 2018 (rate, 1.037; SIR, 0.91). The reduction in CLABSIs was attributed to appropriate triage, insertion, and maintenance of vascular access devices.