The success of most medical acute and chronic life-sustaining therapies across all ages and patient populations is dependent on reliable vascular access. Though critical to the provision of life-saving medical therapies, vascular access devices (VADs) are associated with significant risk. Under-reported, under-recognized, and most often ignored, are the infections associated with peripheral vascular access devices (PVADs), such as short peripheral catheters (SPC) and midline catheters (MC). From 2008 to 2011, hospitals across the nation made significant progress in preventing CLABSI, achieving ~50% reduction in those three years. However, the rate of CLABSI has not improved since 2015 despite concerted efforts. The expectation is that CLABSI will decrease significantly by 2020. If IPs cannot identify unrecognized risk factors such as PVAD-BSI that contribute to the flat line in progress, this task may be insurmountable.
Consider the answers to these questions: Do you know your institution’s PVAD incidence rate for BSI? How many of your CLABSIs are PVAD-BSI? How do you diagnose PVAD-BSI? Will clinically indicated SPC site changes increase the risk for SPC-BSI and what are the legal implications? Have you considered that non-sterile insertion of SPCs may increase BSI risk? Have you considered the lack of sterile SPC insertion as a legal liability when all other VADs are inserted with sterile technique? Do we want to continue to ignore the risk of perpetuating antibiotic resistance by the increasing need to treat the very devices we use to treat non-device related infections? Is the use of MCs to avoid CLABSI in the best interest of the patient? You will get answers to these questions and will learn how to:
Evaluate the gaps in the current standards of care for PVADs and consider pathophysiologic-based strategies to improve PVAD patient safety.
Examine the consequences of replacing central venous access with peripheral venous access to avoid CLABSI penalty.
Identify the growing and under-appreciated malpractice risks surrounding PVADs and develop risk management strategies which meet the standard of care and can mitigate liability.
PhD, MS, RN ,
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