VASCULAR ACCESS CASES
Mid-Thigh Femoral Vascular Access Cases highlight some of the interesting Nurse Clinicians in Action cases that Vascular Wellness clinicians have encountered and participated in treatment. Having the ability to place Advanced Lines such as Mid-Thigh Femorals enables our nurse clinicians to assess each situation and patient, collaborate with the medical team, and place the most clinically appropriate line. Advanced Lines is just one way that Vascular Wellness provides the most comprehensive Vascular Access solution at the bedside.
Intubated Patient Needs Vascular Access After Failed Attempts | NCIA-11
Mid-Thigh Femoral Vascular Access Cases: A COVID-19 patient with respiratory and renal failure received emergent intubation and a temporary dialysis catheter but needed additional IV access to stabilize his condition. The patient’s peripheral IV (PIV) access failed, and the ICU nurses could not re-establish PIV access. The doctor then attempted a right-sided internal jugular line but could not thread the catheter. The patient continued to decline, requiring vasopressors and further establishing the need for urgent vascular access. Vascular Wellness was consulted to provide a PICC line, however, after the clinician assessed the patient, he realized preservation of the upper arm veins was needed for future hemodialysis, and concluded a PICC was contraindicated. After an ultrasound assessment, the clinician consulted with the doctor to suggest a femoral catheter placement in the mid-thigh. This would give enable the ICU team to deliver lifesaving therapies, the Infection Control team was pleased the greatly reduced risk of infection over a traditional femoral line placement due to its safer placement in the mid-thigh, and the patient’s upper extremity vasculature could be preserved as recommended by the KDOQI. The clinician also arranged for the x-ray technologist to be at the bedside so rapid placement confirmation would allow critical care therapies to start immediately.
Femoral Line for Cavagram | NCIA-09
Mid-Thigh Femoral Vascular Access Cases: While a Vascular Wellness clinician was placing a PICC line in an adjacent room in a long-term acute care (LTACH) hospital, he heard a medical team discussing an emergent situation. The patient’s condition had rapidly deteriorated overnight, and an X-ray revealed a mass causing superior vena cava (SVC) syndrome. The radiologist was urgently requesting a cavagram to identify the obstruction, and the patient also required vasopressors to combat falling blood pressure. The managing physician ordered a PICC STAT, but the Vascular Wellness clinician was concerned that the superior vena cava syndrome was so severe that it would prevent access to the superior vena cava. The clinician recommended a Mid-Thigh Femoral, and the radiologist agreed that would be the best option. The cavagram, administered through the Femoral Line, indicated a rapidly growing aortic aneurysm rather than a mass. The patient was immediately transferred to a local hospital to begin a lifesaving repair of the aneurysm on the same day of the diagnosis. The Vascular Wellness clinician’s ability to recognize a different solution was necessary due to SVC syndrome and was critical to the patient’s successful outcome.
Bilateral Amputation Requires Emergent Vascular Access | NCIA-26
Mid-Thigh Femoral Vascular Access Cases: A teen patient who suffered life-threatening bilateral arm amputation in an accident was admitted to the Trauma unit with massive blood loss. The Trauma physicians made several unsuccessful attempts to place a central line and quickly switched to a Femoral approach. They obtained access, but the line was positional, making it less reliable. Seeing the urgency of the situation, the charge nurse acted quickly and asked the Vascular Wellness Clinician to come to the trauma room. Understanding the dire situation, the Vascular Wellness clinician quickly and successfully inserted a triple lumen catheter using ultrasound guidance into the right jugular vein, which was immediately utilized by the team saving this teenagers life. The Vascular Wellness nurse clinician suggested an additional central line be placed opposite of the positional left-sided femoral vein. The trauma physicians agreed, and this Mid-Thigh Femoral line was placed successfully on the first attempt and the positional line placed by the physician was removed. With two central lines in place, the trauma team was able to stabilize the patient for transport. During the patient’s three-week stay in the Pediatric ICU recovery unit, he was able to keep the stable central line access until it was no longer needed.
Mid-thigh Femoral Vascular Access Cases: Key Points
Our specialized training of advanced lines such as Mid-Thigh Femorals, including bi-annual skill verification, provides our clinicians the skills, knowledge, and confidence to manage even the most challenging cases.
Patient safety and the preservation of the patient’s vascular anatomy are vital to optimal patient outcomes; our clinicians use ultrasound guidance to place advanced lines, including MId-Thigh Femoral Lines, to enable safe and clinically appropriate vascular access options, avoiding multiple sticks and reducing the risk of infection.
Our expertise in advanced line placement, including in emergent situations, enables faster therapy in critical situations and can be life-changing for patients needing multiple access sites.
Our clinicians are Vascular Access Board Certified (VA-BC) and are highly skilled and experienced at inserting both large and small bore lines in the clinically appropriate location, at the bedside. This skillful specialization and expertise distinguish us from other vascular access contractor teams and PICC providers.
Our client partners recognize and respect the value of our expertise and often write orders for “Vascular Access” rather than a specific procedure, deferring to our recommendation for the best possible patient outcomes, knowing we can place more than PICCs, Midlines, and PIVs, when clinically appropriate.
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Mid-Thigh Femoral Vascular Access Services
As Vascular Access Experts, Vascular Wellness is the largest provider in the southeast of comprehensive vascular access services, including standard and advanced line placement, pediatrics, program management, education, training, and infection control and prevention to all healthcare settings such as Tertiary Hospitals, Community Hospitals, Long-Term Acute Care Hospitals, Skilled Nursing Facilities, Hospice, and At-Home. We support a 98+% Success Rate with 0% insertion-related infection rate across all lines, with an average response time of 3 hours. We help our clients improve patient outcomes, enable faster therapy, reduce costs, infections, and readmissions, decrease hospital length of stay, and eliminate transportation.
NURSE CLINICIANS IN ACTION case summaries involve challenging situations or intriguing clinical presentations where Vascular Wellness was able to create clinically appropriate access promptly, minimize sticks, and place the right line at the right time, the first time.
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