Improving Care for DVA Patients in an Acute Care Hospital, Part 2 of a 2-part series
A lack of standardized practice in IV placement and inconsistent availability of advanced-skilled vascular access nurses was identified at a 275-bed public district hospital. The gap included a lack of set standards to identify patients with poor peripheral vascular access and absence of clear expectations in the hospital policy to guide nurses when to seek the assistance of those with advanced vascular access placement skills. To address the gap in practice, a performance improvement project was piloted on four medical/surgical units to evaluate the effect of implementing a nurse-driven protocol for placement of vascular access on DVA patients. The protocol guided the nurse to consider calling for an advanced-skilled nurse to assist with IV placement once a DVA patient was identified. Otherwise, if attempts were made to place an IV, the nurse was to limit the number to no more than two per nurse and four attempts total before calling for assistance. This was intended to prevent deplete syntax viable peripheral veins and avoid unnecessary escalation to the need for a PICC or other CVAD. A retrospective in-depth analysis was completed following the protocol implementation. Clinically significant findings included decreased time from the call for assistance to successful placement of difficult IVs, as well as higher first-time attempt success rates and longer catheter dwell times when guide-wire assisted peripheral IV catheters were inserted by specialty vascular access nurses. Opportunities for cost savings were identified by decreasing the number of attempts required to place an IV, fewer IV restarts, and prevention of advancement to more invasive lines. The results demonstrate the value of translating evidence in VAD placement into practice and leveraging technology to improve patient care.