PICC Downgraded to PIVs after VA-BC Nurse Assessment – Nurse Clinicians in Action – 51

PICC Downgraded to PIVs after VA-BC Nurse Assessment describes a patient in a community hospital who was diagnosed with acute cholecystitis (inflammation of the gallbladder) and required vascular access for two days of antibiotics, as well as a cholecystectomy. The patient had two PICC lines that had been removed a few days prior, and the care team ordered a replacement PICC line for the therapy.

PICC Downgraded to PIVs after VA-BC Nurse Assessment

– Clinical Case

An elderly patient in a small hospital in an outlying area had just completed 6 weeks of intravenous (IV) vancomycin for sacral osteomyelitis (an infection of the sacrum, which is a bone at the base of the spine). The patient had a PICC line in the right upper extremity that would have been used for the vancomycin, but it had been removed accidentally so a new PICC line was placed and then removed at the completion of this therapy.

Three days after completing the IV antibiotics and removal of the second PICC line, the patient was diagnosed with acute cholecystitis. The care team prescribed two days of Zosyn (an antibiotic to treat the infection) and scheduled the patient for a cholecystectomy. The facility called Vascular Wellness and ordered a PICC line for the administration of the IV antibiotics.

PICC Downgraded to PIVs after VA-BC Nurse Assessment

– Diagnosis and Treatment

A short while later, the Vascular Wellness VA-BC nurse clinician arrived and began a detailed review of patient’s chart and a thorough physical assessment of the patient and their vasculature, as is always done in accordance with Vascular Wellness’ clinical policies and procedures. Upon reviewing the chart, the clinician noted that the patient had two PICC lines in the previous 15 days, and this order would make it a third PICC line in a very short timeframe.

Drawing upon her extensive training and experience, the vascular access clinician recognized that placing a third PICC line in such a short period of time was contraindicated and would pose a risk to the patient. As such, she reached out to the care team to discuss the reasons for her concern about placing another PICC line, and to recommend an alternative vascular access plan. 

The clinician explained that over accessing vessels via a PICC line or Midline can put patients at an increased risk of catheter associated infections and DVTs (deep vein thrombosis) and recommended placing two peripheral IVs (PIVs) instead of a PICC line to eliminate these risks. She also confirmed that the PIVs were a clinically appropriate vascular access solution based on the prescribed medicines and care plan for the patient.

Our vascular access clinicians regularly collaborate with providers, and our expertise is sought out often to determine the best vascular access options for patients. Because of this trusted relationship, the staff was very receptive and appreciative of the education and agreed with the recommendation to place two PIVs instead of another PICC line, and the provider revised the order.

The Vascular Wellness clinician successfully placed two 20g ultrasound guided PIVs – each on the first attempt – and the short-term antibiotic therapy was initiated immediately. The care team was very grateful for the clinician’s expertise and guidance, and for providing the patient with the safest, least invasive, and most appropriate vascular access in the same visit. With two reliable vascular access devices in place, the patient could complete the antibiotic therapy and then proceed with the cholecystectomy in the coming days.

PICC Downgraded to PIVs after VA-BC Nurse Assessment | Vascular Access Experts

– Key Points

As Vascular Access Experts, our clinicians are more than just “PICC line placers.” They’re VA-BC certified and extensively trained in placing ultrasound guided PIVs, Midlines, PICCs, and Small and Large Bore Central lines, including Dialysis Catheters and Tunneled Central Lines. Our clinicians also serve as a trusted extension of the patient’s care team by drawing on their expertise to help identify during physical examinations and medical history reviews any contraindications, comorbidities, and complications that may arise. With that knowledge, they collaborate with providers to share findings and recommendations to help ensure the safest and most effective vascular access device is placed, which often reduces total care costs. 

Another key factor that makes Vascular Wellness different from other mobile providers is our clinicians are salaried and not paid by procedure with different pay structures based on the procedure attempted or performed. They are not incentivized or faced with a perceived or actual conflict of interest to place the most expensive line with the highest compensation for them or rush to get to the next procedure, but instead, are trained to pivot and recommend the clinically appropriate and safest line for the patient – including if it means the provider downgrading or even eliminating a prescribed line. No matter what type of vascular access device is needed – whether it is a standard line such as a PICC, Midline or PIV, or an advanced line such as a Small Bore or Large Bore central line (for example, Internal Jugular, Mid-Thigh Femoral, and Axillary central lines) – our team of nurse clinicians are trained and have all the catheter supplies and equipment needed to ensure every patient receives prompt care at their bedside and on the same visit.  In other words, the right line, at the right time, the first time.   

All of this plays a critical role in reducing patient complications, avoiding internal and external transportation costs, and allowing your medical team to focus on their field of practice. Our Vascular Access Experts are Vascular Access Board Certified (VA-BC) and skill-verified semiannually to ensure we consistently operate at or above industry standards for patient safety, evidence-based practices, and documentation. Our Director of Research and Development is responsible for ensuring our employees are current on the most recent clinical practice guidelines for vascular access and helps continually improve and advance our vascular access services. We actively participate with AVA, INS, CDC, IDSA, Nursing License Boards, Hospital Boards, and The Joint Commission and are known and recognized as subject matter experts. In summary, Vascular Wellness and our clinicians follow best practices and do not recommend central lines when not clinically indicated despite what misinformation other less-skilled mobile companies who don’t understand or place central lines, may be spreading.  Our new clients are often pleasantly surprised by the decrease in PICCs and other central lines (and increase in PIVs and Midlines) that come from engaging with us, resulting in improved patient outcomes and reduced costs and risks.

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.