Aug 11, 2013

Vascular Access

Let's talk Vascular Access.  


Here's a little write up synopsis of the issues surrounding the topic of “Vascular Access”. (VA) It’s a huge topic but I’ll try to summarize.  And I’ll try not to hurt your head.  Ha.  

First, let me start with my involvement which will show you why I’m passionate about it.  

With the first 5 kids, they all had multiple IVs, surgeries, etc. yet never had any troubles with VA so I never thought anything about it.  Then along came Manny.  He has terrible veins and they’re difficult to access so I was introduced to the VA team at our children’s hospital.  Every time he was admitted we would see them numerous times as they helped start IVs and other tasks.  They could get an IV placed usually the first try.  Our team isn’t always there so we had to use “regular” nurses for multiple placements.  Those were typically very torturous.  Hours of poking and prodding.  Literally 3-4 hours was not uncommon.  Some of his first words were learned during needle sticks.  

When he ended up with a Central Line, our dependence upon the VA team went into hyperdrive.  It’s also when the difference between a VA nurse and a regular floor nurse became even more apparent.  Basic things were neglected.  His life in jeopardy numerous times for lack of training.  

It was at that point that I got more involved about how to train the staff so my son and the other kids didn’t face the same horrible incidents.  I was introduced to an organization called AVA (Association for Vascular Access).  I’ve written articles for their journal JAVA.  And I’m the keynote speaker at their National Conference in Nashville in September.  I’m going to be inducted on their Foundation’s Board in November.  I’m also their Spokesperson for the “Community”.  Tuesday, for example, we’re shooting a video that will be presented at the Conference.  I’ll be doing spots on other TV shows, etc.  I’m even writing more children’s books on the topic of VA as I feel it’s best way to get information across simply.

So as you can see, I’m more than knee deep!  

The issues as I see it.  

Myth:  Nurses are taught VA in nursing school.  Truth:  Nursing schools are not required in any way to teach anything related to VA.  Our goal is to require a National Standard curriculum in every nursing school.

Myth:  VA is not all that common, it’s minor.  Truth:  Floor nurses in hospitals were given a survey.  According to them, 50-60% of their day is spent on something related to VA.  And most wish they had specific training. This is goal two.  

Myth: Safety and Regulatory Boards (Such as JCO) oversee VA issues.  Truth:  They have policies on everything from fire extinguishers to paperwork.  There are no requirements for VA.  This needs to be changed.  We propose a yearly competency requirement for every floor nurse on top of inservice trainings.  

Myth:  Standards of care are set and followed.  Truth:  Very few standards of care are set for the world of VA.  Much discrepancy exists nationwide in carrying out the basic care of an IV all the way up to the care of Central lines.  Patients’ lives are at risk unnecessarily due to the lack of these standards of care.  Our goal is to provide studies that will give national standards. 

Myth:  Every hospital has a VA team.  Truth:  Very few hospitals actually have a dedicated VA team.  And those who do often do not have 24/7 coverage.  Our goal is to have a subspecialty in Nursing schools of VA so the field will expand and more hospitals will have this necessary but often overlooked specialty.  

Myth:  It’s not all that important.  Truth:  Many hospitals are using a model of “patient satisfaction” for payment and other incentives.  VA is often one of the issues that highlight the difference between a “good” score and a “negative” score.  Our goal is to help hospitals increase their ratings by having qualified nurses performing the VA tasks.  

Myth:  VA is very rare.  No one really needs this service.  Truth:  The vast majority of people who enter the ER, are admitted or have surgery will receive a VA device.  

Myth:  Everyone is trained.  Truth:  The person starting my IV could be doing this for the billionth time or it could be their first time.  Neither have to disclose that to me.  I personally have proposed that there be some way to identify those who have passed a certain level of VA training (say on their ID badge).  And for those of us who have critically ill patients of Central line patients that they could request to have only VA approved/certified nurses caring for their line.  

Numbers are available for most of my claims.  These are the types of topics that we discuss at the board meetings.  I personally was HORRIFIED to know that nurses aren’t required to learn anything in nursing school.  I had no clue it was 50% plus of their day.  I had no idea there were no training classes or requirements to prove competency!  It’s the reason I decided I needed to get involved as an Advocate.   

Personally, I would love to see this topic highlighted.  I talk about Manny’s issues and how close to death he’s been several times due to nurses not knowing the basics.  I talk about the times I had to stop him from “bleeding out” while in the hospital with a Cardiac ICU nurse and a Charge nurse just standing there.  (I was trained on what to do by the VA team and they were not.)  I also talk about how my examples are of a 4 year old but this could just as easily be my 46 year old husband post surgery or a 66 year old mother with dementia.  This affects all of us. It’s time to start the conversation with the public about how to protect ourselves and be armed with the right knowledge of what to look for, what our rights are, etc.  

It’s certainly not a “sexy” sounding topic.  But it truly will affect most of us at one point in our lives or another.  

*Disclaimer ... though I'm newly involved in the world of VA, these are my experiences and conclusions as I see them.  They may or may not reflect the opinion of AVA (but I can guarantee they pretty much do. LOL).  

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