Anxious and Distraught Cancer Patient and how the Vascular Access clinician pacified the patient and placed the correct Vascular Access device is the focus of this Nurse Clinicians in Action. Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have treated.  These cases generally involve challenging situations or intriguing patient history and may involve more than one Vascular Wellness clinician as our clinicians have the ability to consult each other, including the on-call clinician whose serves as a clinical escalation path, via real-time HIPPA compliant communication.  The diversity of these situations is why we believe that our clinicians, as a group, are the most experienced and best trained and supported vascular access providers and why our clients trust us to provide superior care to our mutual patients.

Anxious and Distraught Cancer Patient – The Clinical Case

This case took place in a hospital with a patient that recently underwent major gut (gastrointestinal) surgery, resulting from an unexpected complication from his colon cancer.  Not only was the patient in great pain, he was angry, bitter and sad as he just learned from his managing physician that he had only 3-6 months to live.  He had been battling cancer against the odds for a long time and he knew that this was a losing battle.  In addition, the patient’s wife was distraught, adding to the intensity of the situation.  With respect to Vascular Access, due to his medications, his peripheral IV’s had failed causing swelling and the physician requested the Vascular Wellness clinician to place a Peripherally Inserted Central Catheter (PICC).  The clinician placed the PICC and confirmed proper placement using the Ultrasound, Sherlock and ECG (the Tip Confirmation System); however, the line did not have great blood return indicating an issue.

Anxious and Distraught Cancer Patient – Diagnosis and Treatment

A chest X-ray showed that the PICC line looped in his upper arm with the tip barely in the Superior Vena Cava (SVC) where it needed to be, likely due to the patient’s physical and emotional condition.  The managing physician and Vascular Wellness clinician consulted and decided to remove the PICC line and place it again but this time, on the left side which is the less direct route to the SVC and more difficult.  The Vascular Wellness clinician requested help and another, more experienced Vascular Wellness clinician who was serving the same hospital, joined her at the bedside to assist.  Despite the difficulty of the procedure and the intensity of the situation which included the patient threatening violence and lawyers, the clinicians successfully placed the PICC on the left side and at the same time, de-escalated the situation.

The “success” was not just defined by the line placement but that both the patient and his wife were much calmer and relaxed at the end of the procedure.   The stress had left the room as both the clinicians and the patients engaged in delightful conversations about food and family.  The patient commented that he couldn’t wait to eat Toaster Strudel, but only from the oven not the microwave, which is how it is served best.

The Clinician checked on him every day while she was at the hospital and, over time, brought him a plant, balloons, Pepsi, and Toaster Strudel from the oven.  The hospital team appreciated how much the Vascular Wellness clinician cared for her patient and was very impressed by this extra effort.  As a final measure of achievement, the patient now looked at the clinician as his ally in his medical treatment.

Key Points

Vascular Wellness clinicians care about their patients and this caring approach goes beyond the Vascular Access medical procedure.  Our clinicians try to do everything possible to help ensure that a patient is comfortable with the clinicians and the procedure.  Anxious patients are part of any nursing career and our clinicians do not take negative comments personally.  Instead, we understand that the comments come from a place of fear and uncertainty and we do our best to help alleviate the concerns.  We believe that being a good clinician is more than the quantity of procedures or other numerical measurements; it is about being a kind, empathetic, good listener, as well as a nurturing human being.

Vascular Wellness clinicians have placed many thousands of central venous catheters and this experience enables us to assess a situation properly and if a line is not performing, diagnose and address the issues.  Further, by having the tools of US Guided PIVs, Midlines, PICCs, Small Bore lines such as Internal Jugular lines (IJs) and Femoral lines (Fems), and Large Bore lines including Vas Caths and Quad Lumens, Vascular Wellness is able to create clinically appropriate access in virtually all patients even in situations such as above when a line loops or is not performing for any number of reasons.  These factors, along with a consultative approach with the treating physician, are just a few reasons why Vascular Wellness improves patient outcomes, reduces costs, and strengthens infection control.