Fracture and Extravasation Complicates Vascular Access involves a case where a patient’s need for vascular access for a blood transfusion was complicated by a fracture and a Vancomycin extravasation, which the facility thought was a tape allergy, and multiple failed attempts at vascular access. 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.
Fracture and Extravasation Complicates Vascular Access
– Clinical Case
This case took place in a hospital where a patient was recovering from a fall at home that resulted in a fracture, requiring surgical intervention and antibiotics to address a concomitant infection. The patient was receiving Vancomycin, a powerful IV antibiotic that is not only acidic but also has cytotoxic properties. The patient needed additional vascular access for a blood transfusion, but because of the broken upper extremity, as well as a series of wounds from previously failed IV sticks, most likely due to the harsh effects of the therapeutic drugs being administered, the staff nurses were having difficulty inserting the Peripheral IV. Additionally, due to the fractured limb, only one arm was available for IV access. At that point, Vascular Wellness was called to assist in obtaining IV access. The Vascular Wellness clinician arrived shortly after the call, and upon closer assessment, he discovered additional complications that required immediate attention.
Fracture and Extravasation Complicates Vascular Access
– Diagnosis and Treatment
After a thorough assessment of the patient’s medical history, including labs, the Vascular Wellness nurse clinician entered the patient’s room and introduced himself to the patient and family. Immediately, he noticed several areas where IVs were unsuccessfully attempted. In addition, he also noticed an area of irritation, redness, and darkened skin around a slightly larger dressing at the patient’s arm bend. Upon closer inspection, he observed fluid-filled blisters in the area and immediately suspected a Vancomycin Extravasation. The facility believed the blisters were from a reaction to tape adhesive, but the patient denied ever having a problem with the tape, and there was no tape in this area of concern. Medications that can cause blistering or necrotic injuries are called vesicants, and Vancomycin is a known vesicant.
Vancomycin is very effective against many pathogenic bacteria, but due to its infusion properties, it needs to be carefully administered. When Vancomycin is administered intravenously, it is given slowly through a catheter. If Vancomycin leaks into the surrounding tissue, it can cause swelling, pain, and even necrosis, which is referred to as Vancomycin Extravasation. Extravasation can occur when the catheter used for the intravenous injection dislodges or punctures the vein, and the medication leaks out onto the surrounding tissue. Prompt recognition and management of Vancomycin Extravasation is necessary to minimize tissue damage.
The Vascular Wellness nurse clinician knew the IV Standards of Practice and stated no new IV should be started through an area of extravasation, so after conferring with the facility RN, he spoke with the physician caring for the patient. The clinician conveyed his concerns about the IV injury, and a wound nurse consult was ordered by the patient’s care team to confirm the extravasation and monitor the site. With the Vancomycin Extravasation addressed, the Vascular Wellness clinician then focused on the additional IV access needed for the transfusion. Utilizing ultrasound guidance, he assessed the patient’s vasculature to find a viable vein to start the IV just above the fracture. The Vancomycin was discontinued, the transfusion IV access was tested and cleared for use, and the patient was able to receive proper treatment while avoiding further injury. The staff nurses were thankful for the opportunity to observe a specialized vascular access procedure, and more importantly, they were appreciative that this complex vascular access problem was identified and resolved.
Vascular Access Experts
– Key Points
This case demonstrates how a Vascular Wellness clinician, a Vascular Access Expert, was able to skillfully assess the patient’s complex situation to provide safe access for the necessary blood transfusion while identifying and addressing other misdiagnosed complications. His expert assessment revealed a combination of conditions that complicated vascular access – the fracture, Vancomycin extravasation, and the wounds from multiple sticks. Even if a vascular access order seems straightforward, our protocol is to independently review the medical history and the patient’s current condition to confirm the correct device is ordered and to determine the best place to obtain vascular access, in addition to identifying any other conditions that may need attention outside of vascular access as part of our comprehensive services. In this instance, the expert clinician needed to convey additional information to the nurses and the medical doctor to address the wounds and the Vancomycin Extravasation. The complications posed risks to the patient and needed to be monitored, as sometimes extravasations take days to fully develop.
Vascular Wellness maintains a 24/7 call center with a skill-verified vascular access expert clinician on-call who is credentialed in the placement of standard and innovative advanced lines, including temporary dialysis catheters, should a consultation be needed. Consults can be used to help assess a potential patient not currently being seen by Vascular Wellness, or a current patient with an existing line that may need some care and maintenance. Having a specialized vascular access partner who is skilled in handling complex and emergent procedures at the bedside 7 days a week, including after-hours, weekends, and holidays, greatly enhances our clients’ ability to successfully treat patients quickly, eliminates the need for transportation to another facility and the costs associated with it, and helps improve patient outcomes, satisfaction, and Press Ganey scores, especially when hospital length of stay is reduced as a result.
If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today. For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.
Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia;
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.