Unlocking the Power of Vascular Access Teams: A Strategy to Reduce Catheter-Related Bloodstream Infections
The reduction and ultimate prevention of catheter-related bloodstream infections (CRBSIs) is a key step to improving overall inpatient outcomes. And specially trained vascular access clinicians are key to making that reality possible.
Bloodstream infections are a life-threatening challenge to the patient and a costly burden to the healthcare system increasing hospital stay, morbidity, mortality, and health services costs. The most recent estimate of their cost from the Agency for Healthcare Research and Quality ranges from $18,000 to $90,000.1
Numerous studies2-5 have linked complications associated with vascular access devices to the skill and knowledge not only of the individual performing the insertion but also of those responsible for the care and maintenance of the line. Further evidence has shown that specialized education in infection control practices can reduce such complications.6-8 The value of a dedicated, fully trained team was a highlight of the PIV5Rights initiative where Steere et al showed that results with the vascular access specialist team reflected insertion first-stick proficiency at 96% success compared to traditional inserters at 33%.9 Steere et al also validated overall proficiency of the trained vascular access team providing daily maintenance of the line with 89% of catheters reaching completion of treatment.
One recently presented poster exemplifies the significance of having a properly staffed team of vascular access specialists in the quest to reduce CRBSIs. In her poster at the Association for Vascular Access Annual Scientific Meeting (AVA 2023, Portland, OR; Oct. 14-17, 2023), Molly Judge, BSN, RN, CRNI, VA-BC and colleagues shared data from a retrospective analysis of data collected at their 364-bed regional academic health center in the Midwest. Of note, this poster was recognized as third among the 10 posters voted the People’s Choice Award!
Their key finding was that CRBSIs could be prevented with a fully staffed vascular access team of certified specialists.
It all started in 2014 when their CRBSI cases skyrocketed after their vascular access team (VAT) had been cut to 1.5 FTEs, down from 2.5 FTEs. Based on their own data collection, half of CRBSIs were occurring in lines placed by the VAT. By 2017, VAT staffing had increased to 6 FTEs with Vascular Access Board Certification (VA-BC), and they had started 2-person PICC placement as well as VAT performing routine maintenance of all central lines.
Other changes included use of a subcutaneous anchor securement system (SASS)10 to prevent micro-pistoning and malposition of the catheter; and incorporating tissue adhesive at the insertion site to promote hemostasis and prevent the need for premature dressing changes.
Their data showed that there were no CRBSIs identified in the 3729 lines placed by members of their vascular access team since 2017; CRBSIs did occur in lines placed by other hospital staff.
The authors concluded: By maintaining an adequately staffed and certified VAT, patient harm related to vascular access therapy can be reduced and potentially even eliminated.
Eloquest Healthcare is committed to providing solutions that can help improve catheter securement and decrease complications while reducing unnecessary costs. For more information about SASS or to request an evaluation, please contact your sales consultant or complete this form.
References:
- Agency for Healthcare Research and Quality. “Estimating the Additional Hospital Inpatient Cost and Mortality Associated with Selected Hospital-Acquired Conditions. Published November 2017. Available at https://www.ahrq.gov/hai/pfp/haccost2017-results.html. Accessed Nov. 25, 2023.
- Fong N, Holtzman S, Bettmann M, Bettis S. Peripherally Inserted Central Catheters: Outcome as a Function of the Operator. Journal of Vascular & Interventional Radiology. 2001;12(6):723-729.
- McGee D, Gould M. Preventing Complications of Central Venous Catheterization. New England Journal Medicine. 2003;348(12):1123-1133.
- Lennon M, Zaw N, Pöpping D, Wenk M. Procedural Complications of Central Venous Catheter Insertion. Minerva anestesiologica. 2012;78(11):1234-1240.
- Mourad M, Kohlwes J, Maselli J, Auerbach A. Supervising the Supervisors—Procedural Training and Supervision in Internal Medicine Residency. Journal of General Internal Medicine. 2010;25(4):351-356.
- Coopersmith C, Rebmann T, Zack J, et al. Effect of an Education Program on Decreasing Catheter Related Bloodstream Infections in the Surgical Intensive Care Unit. Critical care medicine. 2002;30(1):59-64.
- Eggiman P, Harbarth S, Constantin M, Touveneau S, Chevrolet J, Pittet D. Impact of a Prevention Strategy Targeted at Vascular-access Care on Incidence of Infections Acquired in Intensive Care. Lancet. 2000;355(9218):1864-1868.
- Eggiman P, Pittet D. Overview of Catheter-related Infections with Special Emphasis on Prevention Based on Educational Programs Clinical Microbiology and Infection. 2002;8(5):295-309.
- Steere L, Ficara C, Davis M, Moureau N. Reaching One Peripheral Intravenous Catheter (PIVC) Per Patient Visit With Lean Multimodal Strategy: the PIV5Rights™ Bundle. Journal of the Association for Vascular Access. 2019; 24 (3): 31–43. doi: https://doi.org/10.2309/j.java.2019.003.004
- Nickel B, Gorski L, Kleidon T, Kyes A, DeVries M, Keogh S, Meyer B, Sarver MJ, Crickman R, Ong J, Clare S, Hagle ME. Infusion Therapy Standards of Practice, 9th Edition. J Infus Nurs. 2024 Jan-Feb 01;47(1S Suppl 1): S1-S285. doi: 10.1097/NAN.0000000000000532.