Patient emergently intubated with Covid-19 respiratory failure and renal complications needed proper vascular access after failed attempts describes how the Vascular Access clinician was able to place the proper vascular access device after expert assessment of the patient’s needs and is the focus of this Nurse Clinicians in Action.
Intubated Patient Needs Vascular Access After Failed Attempts
– Clinical Case
A male in his 40’s was admitted to the hospital and transferred to the Intensive Care Unit (ICU) with respiratory failure and kidney failure which can be a complication of Covid illness. After emergent intubation, a temporary dialysis catheter was placed to provide hemodialysis access due to renal failure. The patient’s condition continued to decline, and additional intravenous (IV) therapies were needed to return the patient to a stable condition. The patient’s peripheral IV (PIV) access failed, and the ICU nurses were unable to re-establish PIV access. The doctor then attempted a right-sided internal jugular line but was unable to thread the catheter into the correct placement, probably due to the presence of the left-sided internal jugular dialysis catheter. At this point, the patient required vasopressors to maintain blood pressure further establishing the need for urgent vascular access.
Intubated Patient Needs Vascular Access After Failed Attempts
– Diagnosis and Treatment
Vascular Wellness was consulted to provide vascular access for this patient through the placement of a PICC line. The Vascular Wellness clinician assessed the patient and realized that the patient needed upper arm vein preservation for possible future hemodialysis treatment, making a PICC line not the ideal vascular access device. After a careful ultrasound assessment of the patient’s vasculature and an understanding of the emergent need for critical care medicines, the Vascular Wellness clinician consulted with the doctor to suggest a femoral catheter placement in the mid-thigh. This would provide a win-win-win scenario: the ICU team would have the access they needed to deliver lifesaving therapies; the Infection Control team was pleased as the risk of infection was greatly reduced over a traditional femoral line placement due to its safer placement location in the mid-thigh; and the patient’s upper extremity vasculature could be preserved as recommended by the KDOQI guidelines (a national set of clinical guidelines addressing patients with acute and chronic kidney disease). Additionally, the Vascular Wellness clinician arranged for the x-ray technologist to be at the bedside at the completion of the procedure so rapid confirmation of proper placement would allow critical care therapies to start immediately. After obtaining consent from the patient’s wife, who expressed gratitude for the teamwork exhibited by all involved, the Vascular Wellness clinician placed the femoral line successfully.
Vascular Access Expert
– Key Points
Vascular Wellness clinicians have placed hundreds of thousands of lines and this experience enables each clinician to be a Vascular Access Expert and to assess a situation and patient properly. Vascular Wellness prides itself on training its clinicians to have the skill sets needed for difficult vascular access scenarios like this. The ability to place the right line, at the right time, the first time, for the patient requires a Vascular Access Expert for the best outcomes. Combining the latest technology with intensive training often allows our clinicians to achieve access in complex patients or challenging situations. In this case, the patient had difficult vasculature which was further complicated by the existing large-bore dialysis catheter in the patient’s neck. Readily having the skills of a Vascular Access Specialist will not only improve patient outcomes, reduce costs, and strengthen infection control, but it will also increase the satisfaction of the care team as well as the patient and family members.
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. 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.
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