Patient Codes Repeatedly, Needs Access – Nurse Clinicians in Action – 39

Patient Codes Repeatedly, Needs Access describes how a hospital patient who was resuscitated after coding twice was moved to the ICU and needed fluids and vasopressors, but the care team was unable to achieve vascular access.

Patient Codes Repeatedly, Needs Access

– Clinical Case

A Vascular Wellness vascular access clinician had just completed a vascular access procedure in a hospital when she heard that a different patient had coded. This patient was older, had a history of cerebrovascular accidents, and was recovering on a medical floor when he suffered cardiac arrest while eating dinner.

The patient’s care team performed a round of CPR (cardiopulmonary resuscitation), administered epinephrine, and ROSC (return of spontaneous circulation) was achieved. The patient was immediately transported to the ICU where he coded a second time, and ROSC was achieved once more. Fluid resuscitation and vasopressors (medication that constricts blood vessels to raise blood pressure) for stabilization were ordered, but the nursing staff was unable to secure a secondary peripheral IV.

Patient Codes Repeatedly, Needs Access

– Diagnosis and Treatment

While the clinician had not placed a vascular access device in this particular patient, she was concerned that the patient might need additional access, and that it could be difficult to place a line due to the decreased blood pressure. Knowing this hospital partners with and relies on Vascular Wellness regularly for vascular access needs and for assistance in complex cases such as this, she stayed near in case her expertise was needed.

A short time later, the care team identified that additional vascular access was needed. They looked for central access but were unable to attempt it because the patient’s internal jugular had fully collapsed with respiration and was otherwise flat. The physicians began discussing potential options, including IO insertion (the temporary placement of a vascular access device directly into the marrow cavity in a bone).

The clinician introduced herself to the physicians and asked if she could try to obtain PICC access in the patient. The physicians happily agreed, and while the Vascular Wellness clinician was placing the line, the bedside nurse prepared the new medications and lines. The PICC was placed quickly on the first attempt, and because Vascular Wellness uses ECG tip confirmation technology, proper PICC placement was confirmed right away, and the nurse could immediately begin using the line.

The nursing staff was extremely grateful and stated it was a blessing that the Vascular Wellness clinician was there. The doctors stated, “We didn’t realize how useful the [Vascular Wellness] service could be, but we do now!”

The clinician stayed in the ICU to make sure the patient was stable and that nothing else was needed before departing.

Vascular Access Experts

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Key Points

As a trusted client partner, we take the time to understand our client and its patient population, so that we can anticipate potential needs even before the client might.  Our nurse clinicians are salaried professionals not compensated based on lines placed and thus, are encouraged to do what’s optimal using their best judgment whether it is to stay nearby at the client or move on to the next client and procedure.  To do so, the clinician will verify with the Administrator on Call (AOC) to help understand other clients’ needs at the time so all factors are considered.  Our comprehensive and holistic approach is another reason why we believe that we are the Vascular Access Experts.

Further, all Vascular Wellness clinicians undergo extensive training, have a deep skill set and expertise in the placement of vascular access devices, and are specialists in achieving access in DIVA (difficult IV access) patients. As such, they are often called on to gain access when previous attempts are unsuccessful. Our nurse clinicians are regularly called on for the placement of both standard and advanced vascular access lines. Advanced lines are central lines that our competitors do not provide, are typically used in more challenging clinical cases, and include Tunneled Central Lines and Permcaths (Dialysis Catheters), Small and Large Bore Internal Jugulars, Small Bore Mid-Thigh Femorals, Large Bore Femorals, and Small Bore Axillaries.  

We proudly support a greater than 98% success rate and 0% infection rate across both standard and advanced lines, and regularly place more vascular access standard and advanced devices than any other vascular access company in our service areas. Our patient-centric and client-centric approach ensures the right line, as clinically indicated, is placed at the right time – the first time – at the bedside to enable our partner facilities to avoid delay cascades of treatment, improve patient outcomes, and reduce costs.

Additionally, as a client partner, we are a seamless extension of your clinical and administrative teams. We deliver clinical expertise and administrative support, including credentialing, and quality and other reports as needed internally and externally, such as required by The Joint Commission. As a premier vascular access company, we provide services in this essential area of medicine and assist our clients in improving their patient safety, experience, and outcomes.

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, Delaware, Georgia, Mississippi, Pennsylvania, Tennessee, and West Virginia; and
(3) Support vascular access services to Ohio and Kentucky.