WoCoVA 2014: sharing best practice The Berlin Congress Centre filled up from 18-20 June 2014 with IV professionals from around the world for the 3rd World Congress on Vascular Access. The theme of the Congress this year was about how to achieve safe and cost-effective venous access in every patient. Julie Smith, Editor of BJN, reports the highlights of the Congress below and emphasises the importance of sharing best practice in IV therapy.
NIVAS at WoCoVA Jackie Nicholson and Lisa Dougherty from the National Infusion and Vascular Access Society (NIVAS), both on the editorial board of this supplement, were in attendance and chosen by WoCoVA to present. Jackie presented her abstract, ‘What is the patient experience of the PICC insertion procedure?’. While the focus is always on the patient, of course, it is sometimes easy for us to forget to ask the patient what they think. The conclusions from the study were as follows: ■■ The context of cancer can be integral to the patient experience of PICC insertion ■■ PICC insertion is generally not a painful procedure ■■ Anxiety related to ‘fear of the unknown’ is natural and may be unavoidable ■■ Explanation from the PICC inserter helps to allay fears and build trust ■■ Patients use a variety of coping strategies when facing the imminent PICC insertion procedure. Full findings of Jackie’s research were published in the BJN NIVAS supplement in 2013 (Nicholson and Davies, 2013). Lisa presented ‘Keeping the path clear: evidence-based recommendations for preventing central venous access device occlusion’. She has discussed this in her editorial (page S3).
S40
Chronic An Initia Kidney Dise as tive in C anada e: Save The Ve Hill MN, Vancou ins! ver, Briti RN, OCN, CVAA (c) sh Co , VA
Vascular access on film The WoCoVA Film Festival was described in the Congress brochure as ‘a visual experience not to be missed’. It was hosted by Jack LeDonne (Surgeon, Greater Baltimore Medical Center, USA) and Peter Carr (Assistant Professor, University of Western Australia). They were joined by various colleagues who had submitted videos of vascular access procedures. This was a fantastic opportunity to share best practice and discuss varying approaches, be they right or wrong. The film festival opened with a montage of horrifying videos of vascular access procedures gone (or done) wrong. I was certainly not the only person in the room to shudder and pale slightly at what we saw. However, the good practice that followed the opening sequence was reassuring and we were all reminded of the excellent work that takes place on a daily basis. This was a reminder of the purpose of WoCoVA—to share best practice, learn from one another and take those lessons home to share with our colleagues.
Poster presentations The quality of posters at WoCoVA 2014 was of an extremely high standard, covering a range from the economics of catheterisation, to patient experience, to the impact of new technology. In the coming issues of the BJN NIVAS supplement, a selection of these posters will be written up into clinical articles. This was a great opportunity for the BJN/ NIVAS team to increase their awareness of changes and developments vascular access and it was encouraging to see so much innovative work and research taking place across the globe.
Jocelyn
lumbia,
Why Sa ve • People with
Canada
chronic hemodia lysis (HD kidney dise ase ) for dise ase man (CKD) may requ agement. 1, 2, ire (AVF) that special acce 3 the arm utilizes a pate ss with a arteriove ) nt periphe nous fistu AVF dilat that is of suffi ral vein cient ion & mat (preferab la uration. 1, 2size & elasticity ly to allow in for e, peri periphe rally inse pheral intraveno venous catheter rted central cath us (IV) lines , vein can s (CVCs) eters (PIC can jeop damage peripheinserted into the C) & central ardize ral & cent subclavia ral vein n • Protecting future AVF creation s that & function successfu arm & central . 1, 2, 3 veins is l crea importa • Saving vein tion & ongoing func nt for the tion of s in pati the pati an AVF. 1, 2, 3 ents ent enforcing with CKD in with CKD start s all with identifyin health carethe theory for health care setti g vein pres professio ervation ngs and nals in with all different clinical areas. 3
Algorit hm
• HD requires
Note re Home IV Other than Infusions: home IV exceptional run throuinfusions shoul cases, d not be lumen, gh HD lines (large highe accessed r infection flushed & used properisk if not of heparwith high conce rly, ntrations Home in / sodium citrate care RNs HD lines will not ). access circum under any stances. for an IV If the only option the renal infusion is the HD line, relevant program at the site will responsibil assum for all arranity, including e gements. costs,
• Venipunctur
Collabo ration
Type of acces required? s Peripheral Options (in order preference of
• In 2009, the
British Colu (BCPRA) mbi & expertsestablished a wor a Provincia l commun from renal, hem king group of Renal Agency clinical standard ity settings to odialysis, IV ther leaders look at apy in pub a reality s and work on HOW vein lished guid acute & in vari s& • In 2010, the ous clinical settingspreservationeline can be . wor 1. Vein Preserva king group deve 2. Reso tion Guid lope urce tool elines for d for the BCP Renal Patie RA: • Reviewed and s for education and nts clinical revised guidance 3 August 2012.
hospitaliz ucted to show ed or at laborato when ry.
Import ant info about my I am a renal veins patient. NO IVs or blood If IV or draws blood draw on my my other is require RIGHT / LEFT arm. d, use my arm. If a long-te hand veins rm centra interna or l line l jugula r line. Use is required, No BPs use tunnel PICC line on ed (if fistula fistula or graft as last resort. or graft arm in place).
Health
Authority
Fraser Health Renal Interior Health Northern Health Vancouver Island Health Vancouver Providence Coastal Health/ Health Care BC Children’s Renal ProgramProvincial
Percutaneo tunelled us – Noncatheter non-cuffed catheter) (temporary – No Home acute settin IV, g only
For Blo od Work st
Contact information label
side)
Card (enlarg
ed)
*
in the hospit
If requir ed for antibiotics be given only, can they via method another (see Note 1)?
Give antibi another otics by method
Tunne catheter lled cuffed (permanent catheter) – Ok Home IV for
Yes
No
Is tunne catheter lled cuffed an optio n?
No Last resor t: PICC line In order • Brach of preference: • Basilicial vein • Cephalicvein vein If possib mappingle, complete vein a decisi prior to makin on. g best vein. Save the
www.bcre nalagency. ca/patient s/vascular -access
and/or IVs
Use as small a needle (genera as possibl l rule: 22 e gauge or smaller
Yes
• Renal ience • Home Team: • ChronicHD nurses • PeritoneaKidney Disease clinic staff • Renal Educl Dialysis clinic staff ators • Renal Direc
Acute Care tors/Manager s
• Nurses: acutTeam:
Commun ication Tools Guideline
‘Save the e care, ICU, Veins’ post OR, PACU er , ER Wall et card surgeons Nephrologists, other spec, Internal MedicineVascular Invit e to ‘Train ialist phys , ER, and • Radiolog the Train icians webinar er’ • Transplany team Commun t clinic team Distributi ity Team • Family Phys : through on of tools icians Health • Commun Authority ity IV Educ • Private Labo ators/Clin ratories icians IV Educ
/teams • Physicianators s:
Wristba nd for CKD
Patient
BCPRA (2012) . Vein for Renal Patients Preservation Guidel (draft). Vancouver: ines Author.
Websit e
CHOICE Veins on the backs of the hands nd Forea rm (if fistula veins in the domin or CHOICE non-a ccess graft in place, ant arm arm) use rd
Poster (to be posted
Target Aud
Note 1: Alternative Antibiotic Metho ds for In patien Administrati on ts elimination with renal failure advantageo of certain antibi , delayed otics can aminoglycosus. In partic be ular, cephalospor ides, and most vancomycin , ins can maintain be dosed effecti to administered ve levels when 3 times HD treatm per week at each achieve ent. Most quino system lones can administratio ic levels n just as with oral route. The well options selection of one as with an IV , when medically of these can obviat appropriate venous e the need for , access. a separa te
Veins in the elbow of the CHOICE dominant arm
Bedside
Usual care
Contact patient’s physician attending to potentialdiscuss other options
PICC
duration?
>3 weeks
for CKD is to ensu patients re disse urce . minatio • The guideline tools through out the n and awarene and website province ss for easy tools are avai .³ lable on access.³ The ultim the BCP ate goa RA l is to save veins in pati Targetin ents with g Key Gro CKD. ups
Stage 1, 2 or 3 (eGFR ≥ 30)
incidence : subclavian vein of centra (high l vein stenos is)
Programs
Card
size, reverse
For patien or graft ts with an AV for dialys fistula is: • No blood arm with pressures in the • No needl the access or elbow e punct ures in the forear of the arm m with the access
1 2 3
Stage 4 or (eGFR < 5 30)
Tunne Percutaneolled / us CVC Anticipated
end up
educate
of the reso
Tunne Percutaneolled / us or PICC? CVC
NIVAS at WoCoVA Jackie Nicholson and Lisa Dougherty from the National Infusion and Vascular Access Society (NIVAS), both on the editorial board of this supplement, were in attendance and chosen by WoCoVA to present. Jackie presented her abstract, ‘What is the patient experience of the PICC insertion procedure?’. While the focus is always on the patient, of course, it is sometimes easy for us to forget to ask the patient what they think. The conclusions from the study were as follows: ■■ The context of cancer can be integral to the patient experience of PICC insertion ■■ PICC insertion is generally not a painful procedure ■■ Anxiety related to ‘fear of the unknown’ is natural and may be unavoidable ■■ Explanation from the PICC inserter helps to allay fears and build trust ■■ Patients use a variety of coping strategies when facing the imminent PICC insertion procedure. Full findings of Jackie’s research were published in the BJN NIVAS supplement in 2013 (Nicholson and Davies, 2013). Lisa presented ‘Keeping the path clear: evidence-based recommendations for preventing central venous access device occlusion’. She has discussed this in her editorial (page S3).
S40
Chronic An Initia Kidney Dise as tive in C anada e: Save The Ve Hill MN, Vancou ins! ver, Briti RN, OCN, CVAA (c) sh Co , VA
Vascular access on film The WoCoVA Film Festival was described in the Congress brochure as ‘a visual experience not to be missed’. It was hosted by Jack LeDonne (Surgeon, Greater Baltimore Medical Center, USA) and Peter Carr (Assistant Professor, University of Western Australia). They were joined by various colleagues who had submitted videos of vascular access procedures. This was a fantastic opportunity to share best practice and discuss varying approaches, be they right or wrong. The film festival opened with a montage of horrifying videos of vascular access procedures gone (or done) wrong. I was certainly not the only person in the room to shudder and pale slightly at what we saw. However, the good practice that followed the opening sequence was reassuring and we were all reminded of the excellent work that takes place on a daily basis. This was a reminder of the purpose of WoCoVA—to share best practice, learn from one another and take those lessons home to share with our colleagues.
Poster presentations The quality of posters at WoCoVA 2014 was of an extremely high standard, covering a range from the economics of catheterisation, to patient experience, to the impact of new technology. In the coming issues of the BJN NIVAS supplement, a selection of these posters will be written up into clinical articles. This was a great opportunity for the BJN/ NIVAS team to increase their awareness of changes and developments vascular access and it was encouraging to see so much innovative work and research taking place across the globe.
Jocelyn
lumbia,
Why Sa ve • People with
Canada
chronic hemodia lysis (HD kidney dise ase ) for dise ase man (CKD) may requ agement. 1, 2, ire (AVF) that special acce 3 the arm utilizes a pate ss with a arteriove ) nt periphe nous fistu AVF dilat that is of suffi ral vein cient ion & mat (preferab la uration. 1, 2size & elasticity ly to allow in for e, peri periphe rally inse pheral intraveno venous catheter rted central cath us (IV) lines , vein can s (CVCs) eters (PIC can jeop damage peripheinserted into the C) & central ardize ral & cent subclavia ral vein n • Protecting future AVF creation s that & function successfu arm & central . 1, 2, 3 veins is l crea importa • Saving vein tion & ongoing func nt for the tion of s in pati the pati an AVF. 1, 2, 3 ents ent enforcing with CKD in with CKD start s all with identifyin health carethe theory for health care setti g vein pres professio ervation ngs and nals in with all different clinical areas. 3
Algorit hm
• HD requires
Note re Home IV Other than Infusions: home IV exceptional run throuinfusions shoul cases, d not be lumen, gh HD lines (large highe accessed r infection flushed & used properisk if not of heparwith high conce rly, ntrations Home in / sodium citrate care RNs HD lines will not ). access circum under any stances. for an IV If the only option the renal infusion is the HD line, relevant program at the site will responsibil assum for all arranity, including e gements. costs,
• Venipunctur
Collabo ration
Type of acces required? s Peripheral Options (in order preference of
• In 2009, the
British Colu (BCPRA) mbi & expertsestablished a wor a Provincia l commun from renal, hem king group of Renal Agency clinical standard ity settings to odialysis, IV ther leaders look at apy in pub a reality s and work on HOW vein lished guid acute & in vari s& • In 2010, the ous clinical settingspreservationeline can be . wor 1. Vein Preserva king group deve 2. Reso tion Guid lope urce tool elines for d for the BCP Renal Patie RA: • Reviewed and s for education and nts clinical revised guidance 3 August 2012.
hospitaliz ucted to show ed or at laborato when ry.
Import ant info about my I am a renal veins patient. NO IVs or blood If IV or draws blood draw on my my other is require RIGHT / LEFT arm. d, use my arm. If a long-te hand veins rm centra interna or l line l jugula r line. Use is required, No BPs use tunnel PICC line on ed (if fistula fistula or graft as last resort. or graft arm in place).
Health
Authority
Fraser Health Renal Interior Health Northern Health Vancouver Island Health Vancouver Providence Coastal Health/ Health Care BC Children’s Renal ProgramProvincial
Percutaneo tunelled us – Noncatheter non-cuffed catheter) (temporary – No Home acute settin IV, g only
For Blo od Work st
Contact information label
side)
Card (enlarg
ed)
*
in the hospit
If requir ed for antibiotics be given only, can they via method another (see Note 1)?
Give antibi another otics by method
Tunne catheter lled cuffed (permanent catheter) – Ok Home IV for
Yes
No
Is tunne catheter lled cuffed an optio n?
No Last resor t: PICC line In order • Brach of preference: • Basilicial vein • Cephalicvein vein If possib mappingle, complete vein a decisi prior to makin on. g best vein. Save the
www.bcre nalagency. ca/patient s/vascular -access
and/or IVs
Use as small a needle (genera as possibl l rule: 22 e gauge or smaller
Yes
• Renal ience • Home Team: • ChronicHD nurses • PeritoneaKidney Disease clinic staff • Renal Educl Dialysis clinic staff ators • Renal Direc
Acute Care tors/Manager s
• Nurses: acutTeam:
Commun ication Tools Guideline
‘Save the e care, ICU, Veins’ post OR, PACU er , ER Wall et card surgeons Nephrologists, other spec, Internal MedicineVascular Invit e to ‘Train ialist phys , ER, and • Radiolog the Train icians webinar er’ • Transplany team Commun t clinic team Distributi ity Team • Family Phys : through on of tools icians Health • Commun Authority ity IV Educ • Private Labo ators/Clin ratories icians IV Educ
/teams • Physicianators s:
Wristba nd for CKD
Patient
BCPRA (2012) . Vein for Renal Patients Preservation Guidel (draft). Vancouver: ines Author.
Websit e
CHOICE Veins on the backs of the hands nd Forea rm (if fistula veins in the domin or CHOICE non-a ccess graft in place, ant arm arm) use rd
Poster (to be posted
Target Aud
Note 1: Alternative Antibiotic Metho ds for In patien Administrati on ts elimination with renal failure advantageo of certain antibi , delayed otics can aminoglycosus. In partic be ular, cephalospor ides, and most vancomycin , ins can maintain be dosed effecti to administered ve levels when 3 times HD treatm per week at each achieve ent. Most quino system lones can administratio ic levels n just as with oral route. The well options selection of one as with an IV , when medically of these can obviat appropriate venous e the need for , access. a separa te
Veins in the elbow of the CHOICE dominant arm
Bedside
Usual care
Contact patient’s physician attending to potentialdiscuss other options
PICC
duration?
>3 weeks
for CKD is to ensu patients re disse urce . minatio • The guideline tools through out the n and awarene and website province ss for easy tools are avai .³ lable on access.³ The ultim the BCP ate goa RA l is to save veins in pati Targetin ents with g Key Gro CKD. ups
Stage 1, 2 or 3 (eGFR ≥ 30)
incidence : subclavian vein of centra (high l vein stenos is)
Programs
Card
size, reverse
For patien or graft ts with an AV for dialys fistula is: • No blood arm with pressures in the • No needl the access or elbow e punct ures in the forear of the arm m with the access
1 2 3
Stage 4 or (eGFR < 5 30)
Tunne Percutaneolled / us CVC Anticipated
end up
educate
of the reso
Tunne Percutaneolled / us or PICC? CVC
