Pediatric Patient with Trisomy 18 – Nurse Clinicians in Action 31

Pediatric Patient with Trisomy 18 describes how a young pediatric patient with Trisomy 18 (a rare genetic disorder) needed vascular access for antibiotics and due to painful, multiple failed attempts, she developed procedure-induced anxiety. 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.

Pediatric Patient with Trisomy 18

– Clinical Case

This case took place in the Pediatric Department of a hospital, where a five-year-old patient with Trisomy 18 was admitted due to a suspected infection.  The patient, who was not expected to live past the age of two, needed critical vascular access in order to begin antibiotic therapy.  Although the unit nurses had been trained on ultrasound-guided PIVs, they were unable to obtain PIV access, despite multiple attempts, and the patient became upset and started crying.  At the request of the patient’s father, who understood that his daughter was a DIVA (Difficult IV Access) patient, the nurses called the Vascular Access Team – Vascular Wellness – for help.

Pediatric Patient with Trisomy 18

– Diagnosis and Treatment

The Vascular Wellness expert clinician arrived.  She spoke with the nurses and the patient’s father, reviewed the patient’s medical history, and then took out her ultrasound equipment and got to work.  Within 10  minutes of her arrival, the clinician obtained PIV access and the unit nurses commenced the antibiotics therapy.  The patient’s father expressed his thanks and gratitude for the work of the vascular access expert clinician.  The clinician took the extra time to explain to the father the advantages of the ultrasound and her advanced training in vascular access and told him not to hesitate to ask the medical team to request the Vascular Access Team if any further access was needed for his daughter. Unfortunately, that conversation turned out to be prophetic.  The patient’s stay became an extended one and the unit nurses continued to have difficulty with vascular access.  Vascular Wellness was called three additional times and each time, the clinician quickly and painlessly obtained access. 

Vascular Access Experts

– Key Points

As Vascular Access Experts, we provide our nurse clinicians with advanced training on the use of ultrasound, including needle positioning and vein visualization, to obtain vascular access.  Additionally, once the clinician’s preceptor signs off on their competency, the clinician uses these skills regularly in the field, and as such, avoids skills degradation.  The skills are verified semiannually to ensure that they remain top-notch.  This case demonstrates why Vascular Wellness invests in and employs this approach.  The unit nurses were trained on how to use the ultrasound, but most likely, did not use these skills regularly in challenging cases.  These skills, like many other healthcare skills, are wasted assets if not regularly practiced on standard, as well as challenging, patient cases.  Ultrasound-guided vascular access is not like “riding a bike” where muscle memory simply can be recalled, even if not used for a long time.

There are many reasons why a person might be a DIVA patient, including age, gender, height, weight, health conditions such as cancer, drug abuse, and diabetes, vein visibility, and vein palpability.  Regardless of the reason, best practice should be to consult the Vascular Access Team to help avoid the risk of multiple and painful sticks, leading to patient stress and anxiety.  Consulting Vascular Access Experts such as Vascular Wellness improves patient outcomes, especially in DIVA patients.

Furthermore, responsive Vascular Access mitigates risks associated with the “Delay Cascade,” the concept that describes how delays in initial diagnosis and treatment can cause increased length of stay, worsening patient condition, antibiotic resistance, decreased patient satisfaction, and wasting of clinical resources (see References below).  In this case, the Vascular Wellness clinician arrived promptly, and quickly created vascular access to help avoid any additional treatment delay of vital antibiotics to treat the infection.

References regarding “Delay Cascade”

1. Heart & Lung. Volume 49, Issue3, Page 273-286, May-June 2020
2. Journal of Infusion Nursing. 43(4): p222-228, July-August 2020
3. Journal of the American College of Emergency Physicians Open.  2020 Dec; 1(6): 1660–1668

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.