The Importance of the Need for Early Vascular Access Identification

This article discusses the need and benefits of early PICC placement by discussing evidence based practice and patient satisfaction. The VA-BC (Vascular Access Board Certification) nurse provides a high level of standardized care for vascular access in adult and pediatric patients. This article specifically deals with the pediatric population. I believe that as a VA-BC I have made a difference in the children that have received PICC and IV insertions.

The Importance of the Need for Early Vascular Access Identification

Approximately two years ago my role as a Hematology/Oncology RN changed to that of a Vascular Access Specialist at a children's hospital in Florida. This new and exciting journey has brought much growth, not only personally, as I have taken on the challenge of learning a whole new set of skills, including ultrasound for peripherally inserted central catheters or as it is commonly referred to PICC placement.

Previously, I viewed central lines as a tool to obtain labs and give medications, including chemotherapy. However, after studying this fascinating field and becoming a V.A.-B.C. (Vascular Access Board Certified) R.N., I realize there is so much more involved with the maintenance and placement of central lines. Central lines are a great tool in the fight against many disease processes. Early identification of the need for a central line is paramount to avoid numerous intravenous attempts, vein preservation, and increasing patient satisfaction.

When patients are admitted to the hospital, whether expected or as the of result of an unexpected Emergency Room visit, there is a good chance the treating physician knows if long term IV therapy might be needed. Too many times the order for a PICC line placement is not received until days into therapy, or longer in some cases. This causes the patient to have numerous IV sticks.

Typically, we would like an IV to be patent for at least a few days. However, certain medications have a high or low PH value, and depending on the PH and osmolality of the medication being administered, this can lead to vein irritation which may cause painful infiltrates and IV's not lasting more than a day or two, or in some cases even hours!

A great resource is the pharmacist who knows how irritating a medication may be. Knowing this information will help the caregiver act as a patient advocate, suggesting central line placement as soon as possible. Our patients will appreciate our advocacy in asking their physicians to address this issue sooner, before numerous "sticks" may occur.

Vein preservation is another benefit of early identification for the need of a central line. As stated earlier, some of these medications are more irritating than others, causing the IV's to become infiltrated or painful. This leads to a new attempt at an IV which may mean multiple IV sticks. Multiple IV sticks diminish the success of a PICC line insertion, especially in the infant population where ultrasound guidance cannot always be used. When the selection of usable veins is diminished, the chance of successful PICC placement decreases.

Patient satisfaction must be considered when it comes to vascular access. Success with IV insertions and minimizing IV sticks is an evidenced based patient satisfier. This truth is compounded in the pediatric population because no one likes to see their child getting "stuck." The need for a central line should be addressed on admission. Very young patients might need sedation for the PICC procedure. Early identification for PICC needs will assist the nurse to better plan for necessary sedation. For example, if the patient is having a sedated procedure, the PICC line insertion can be planned for the same time to minimize the amount of sedations needed for the patient.

Discharge begins on admission. As soon as we as caregivers identify the need for IV therapy of 5 or more days, we need to start thinking PICC or central line placement. To facilitate this need for assessment, it is important to provide education for nurses and physicians regarding the importance of early vascular access needs. The type of IV medication that will be delivered also needs to be considered, some medications are too irritating to be infused through peripheral veins. Addressing the need for vascular access on admission will increase patient satisfaction, preserve veins, and minimize numerous IV attempts.

References:

Centers for Disease Control. (2014) Retrieved December 8, 2014 from CDC - Page Not Found

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Beverly Sampson, BSN, RN,

About Beverly Sampson, BSN, RN,

I have been practicing nursing for 20 years. Have been specializing in pediatrics for 10 of those years. Currently the Vascular Access Nurse at a Children's Hospital in Florida.

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Specializes in LTC, assisted living, med-surg, psych.

I'm so glad to see this subject addressed. My sister was in the hospital a few months ago and had to stay for eight days. During this time she had to have her IV changed at least once per day, as her veins blow easily and they were giving her IV ABX. I suggested a PICC, but the physician didn't want to order it as "she'll only be here a few days". So she wound up getting poked over and over again, and of course with terrible veins there were only a few places they could put an IV in the first place. Toward the end they had to put one in her foot. Ridiculous.

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Specializes in Nephrology, Cardiology, ER, ICU.

Very important article for parents of peds pts too. My youngest granddaughter who was 2 1/2 years ago had a hemorrhagic CVA in June due to an undiagnosed Chiari I malformation. She had emergency brain surgery, trach/peg, central line placement, PICC line and spent 2.5 months in the PICU. It was a nightmare.

The peds nurses and APNs were fantastic. My granddaughter ended up with a DVT from the PICC line unfortunately and this is a common complication.

However, it is still very important that vascular access for critically ill children be chosen with care.

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Excellent article! As a fellow Peds RN I totally agree with this. Whenever we have a patient who is a difficult "stick" and they are expected to be receiving a long course of strong antibiotics, frequent labs, or other vein-related interventions, I start to bug the docs every time they round about considering a PICC. I know there are risks of infection, but our unit in particular has a stellar record at avoiding infections and I point this out, too. It is inhumane and traumatic in today's world of modern medicine to expose a child to multiple pokes, IVs going bad after just a few doses of a stronger med, and the risk of tissue damage from these vesicants. The previous poster brought up DVTs and this is a legitimate risk that reminds us that there is no perfect solution . . . but some solutions are better than others for certain situations.

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Very important article for parents of peds pts too. My youngest granddaughter who was 2 1/2 years ago had a hemorrhagic CVA in June due to an undiagnosed Chiari I malformation. She had emergency brain surgery, trach/peg, central line placement, PICC line and spent 2.5 months in the PICU. It was a nightmare.

The peds nurses and APNs were fantastic. My granddaughter ended up with a DVT from the PICC line unfortunately and this is a common complication.

However, it is still very important that vascular access for critically ill children be chosen with care.

I am truly sorry for what your grand-daughter went through. That truly does sound like a nightmare. Chiari malformations are scary and dangerous, and I'm sorry she has had to endure this.

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Specializes in ICU.

I really do wish we would line people right away. Some of our docs are good about this, others aren't. It really should happen for most people.

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Specializes in Nephrology, Cardiology, ER, ICU.

Thanks for the kind words. My granddaughter presented with altered LOC and agonal respiration - there was initial concern for partial airway obstruction so after two peripheral IVs were placed (on the first stick as she was a very healthy little girl), they took her emergently to the OR for a bronch and controlled intubation.

She got two femoral lines placed within 12 hours of admission for which I was very grateful.

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