Anxious Patient Needs Hemodialysis describes how Vascular Wellness helped an anxious patient, who needed extra time and assistance, to become calm enough for the nurse clinician to place a Vascath at the patient’s bedside so she could receive urgently needed hemodialysis.
Anxious Patient Needs Hemodialysis
– Clinical Case
An elderly patient who was newly diagnosed with ERSD (end-stage renal disease) was hospitalized and in need of emergent dialysis to address an acute kidney injury superimposed on chronic kidney disease (meaning additional injury to the kidney beyond the chronic kidney disease). The hospital contacted Vascular Wellness that evening and requested a Vascath – a large bore central venous catheter (CVC) or central line that is used for dialysis (e.g. hemodialysis) – to be placed the following day.
The next morning, the Vascular Wellness advanced vascular access clinician arrived at the facility to place the Vascath. Upon arrival, the clinician noted that the patient was experiencing confusion and seemed nervous, so she gently performed a visual assessment and reviewed the patient’s medical history. In addition to the ERSD, the patient’s medical history included congestive heart failure, COPD (chronic obstructive pulmonary disease), anxiety, GERD (gastroesophageal reflux disease), coronary artery disease, seizures, hypertension, hyperlipidemia, T2DM (type 2 diabetes mellitus), and osteoarthritis.
The vascular access nurse clinician scanned the patient to determine the best viable vessel for the procedure and determined that the right internal jugular (IJ) approach was ideal. At this point, the patient was in a confused state and very nervous, and the clinician decided it was unsafe to continue with the procedure to place the Vascath without first attending to the anxious patient’s obvious stress.
Anxious Patient Needs Hemodialysis
– Diagnosis and Treatment
Knowing the importance of taking time to ensure patients are comfortable and relaxed before beginning any vascular access procedure, especially when placing a large bore line, the clinician notified the care team that the patient was particularly anxious. The provider gave the patient some anxiety medication, and then the vascular access clinician returned a short while later after confirming the medication had begun to take effect.
The vascular access clinician also called in some co-workers to help keep the patient calm and safe during the procedure. The additional team members arrived, chatted with the patient, and helped her stay comfortable and calm while the Vascular Wellness clinician inserted the Vascath safely, quickly, and without any difficulty.
With the much-needed Vascath in place, the previously anxious patient was able to receive hemodialysis almost immediately after the insertion was complete and X-ray confirmation of the correct placement of the vascular access device was received.
The following day, the Vascular Wellness clinician followed up with the patient and saw that she was beginning to feel more like herself again. The patient was very grateful for the team’s cohesive approach in helping her feel calm and for helping her get the care she needed.
By the Numbers:
1730 – Facility contacted Vascular Wellness to schedule in advance a Vascath for the following day.
0946 – Vascular Wellness clinician arrived at facility the next morning to place the large bore Vascath. After noting the patient was very anxious, facility administered medication to help and for clinician to return after patient was relaxed.
1148 – Vascular Wellness clinician returned to patient’s room once receiving confirmation that anxiety medication had taken effect and patient was ready.
1233 – Vascath placement was complete, and X-ray was notified to confirm placement.
1325 – X-ray confirmation of correct placement received.
1848 – Hemodialysis session for this patient was complete.
A typical hemodialysis session takes approximately 4 hours. Even with the delays the facility experienced in ensuring the patient was ready for the procedure, only 7 hours passed from the time the Vascular Wellness clinician arrived in the room to begin the procedure until completion of a full session of hemodialysis.
Vascular Access Experts
– Key Points
As Vascular Access Experts, Vascular Wellness pioneered nurse-placed Vascaths. Vascular Wellness’ nurse-placed Vascaths – and Permcaths – at the bedside have many advantages over the primary alternative of physician-placed devices in an Operating Room (OR) or Interventional Radiology (IR) Suite, including lower costs, faster hemodialysis treatment, and greater facility, physician, and patient satisfaction.
As physician-placed Vascaths and Permcaths are dependent on OR or IR room and medical personnel availability, they are typically not able to be performed the same day due to already scheduled procedures. Transportation within a facility or to another facility to get to the OR or IR room is costly and requires significant coordination of resources. Furthermore, unlike nurse-placed procedures at the bedside where only local sedation is needed, physician-placed dialysis catheters require patients to fast prior to their procedure because of the need for anesthesia, which can cause additional delays in treatment. The use of anesthesia for surgical procedures in an OR adds significant resources and costs for the facility, as well. All of these moving parts can cause Delay Cascades for the patient, which are unnecessary delays in receiving critical care therapies that can result in medical complications, increased length of stay, worsening patient condition, waste of clinical resources, and more (see References below).
In addition, Vascular Wellness provides our client partners with a dedicated professional team of vascular access experts and specialists who are trained, precepted, and certified in the placement of standard and advanced lines at the patient’s bedside. We arrive onsite, generally within three hours, with all the necessary equipment and supplies to perform vascular access procedures, whether it’s placing a standard or advanced line. Our value-added vascular access services support your facility by enabling you to avoid unnecessary transportation costs, utilize your medical resources efficiently, and deliver faster, safer therapy to your patient’s bedside. In addition, we promote teamwork internally and externally by either becoming an extension of your in-house team or operating as your outsourced provider, and all of our services are customized to meet our client’s needs. Superior client services are an essential component of our partnerships, and our expert clinicians function as a bridge among all stakeholders, the patient, their family members, and the medical team, as in this instance.
References regarding “Delay Cascade”
- Heart & Lung. Volume 49, Issue3, Page 273-286, May-June 2020
- Journal of Infusion Nursing. 43(4): p222-228, July-August 2020
- Journal of the American College of Emergency Physicians Open. 2020 Dec; 1(6): 1660–1668
Nurse Clinicians in Action is a spotlight series highlighting some of the interesting cases that Vascular Wellness clinicians have encountered and participated in treatment. These cases involve challenging situations or intriguing clinical presentations and may involve more than one Vascular Wellness clinician, as our clinicians have the ability to consult each other while in the field, as well as an on-call Clinical Administrator via a HIPAA (Health Insurance Portability and Accountability) compliant communication app. In addition, our extensive training program and diverse client base, including Level 1 Trauma Centers, Short Term Acute Care Hospitals, Long Term Acute Care Hospitals, and Skilled Nursing Facilities, provide our clinicians with a wide array of clinical experience and why we believe our clinicians, as a group, are the most experienced and best trained and supported vascular access clinicians.
If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today.
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Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, Oklahoma, South Carolina, and Virginia; and
(2) Customized vascular access services to Arkansas, Georgia, Tennessee, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.
Read more NCIA Patient Cases
Nurse Clinicians in Action stories highlight some of the interesting cases in which Vascular Wellness clinicians have encountered and participated as valuable team members.
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