PICC Vascular Access Cases highlight some of the interesting Nurse Clinicians in Action cases that Vascular Wellness clinicians have encountered and participated in treatment. Our hospital-credentialed, board-certified clinicians provide hospital-quality PICCs at the bedside when PICCs are the least invasive, clinically appropriate option. PICCs (Peripherally Inserted Central Catheters) are generally the next best option when Midlines or PIVs, which we both fully embrace as patient-centric vascular access devices, are not effective treatment options such as for extended access needs or medications with irritative or vesicant properties.
Vascular Access and Patient Collaboration | NCIA-14
PICC Vascular Access Cases: A patient battling cancer had a suspected infection in an implanted port catheter in her right chest wall, and a right arm access restriction due to previous right mastectomy with lymph node removal. She also had an edematous left arm from multiple failed Peripheral IVs and infiltrations, and an ongoing need for pain control and total parenteral nutrition (TPN). The patient and her family were nervous about the removal of the suspected infected port, which would be another painful procedure given her difficult IV access (a DIVA patient), as her left arm was swollen due to multiple infiltrated IVs. The Vascular Wellness clinician was consulted and reviewed the patient’s medical history, and listened to the patient’s goal to leave the hospital with the ability to receive pain medication and TPN at home. The clinician shared that even though a PICC is typically not needed in the presence of an implanted port, a benefit of the PICC was that it would not infiltrate like the PIVs, and it would be inserted only after the administration of a local anesthetic for comfort. The patient and her family were pleased with the consult, they understood the benefits of a PICC line in this scenario and felt comfortable proceeding despite their initial hesitation. The clinician performed an ultrasound assessment of the left arm, confirmed appropriate vessels for access even in the presence of the edema from the infiltrated IV sites, and successfully placed the PICC. The procedure went smoothly, and the family was so grateful that they had the benefit of a Vascular Access Specialist who would take the time to advise and advocate for the best solution to their unique scenario. After placement and the ensuing treatment initiated, the patient was discharged home to be with her family with her PICC in place.
Vascular Access Expertise After Hours | NCIA-15
PICC Vascular Access Cases: A young, healthy expectant mother was experiencing Hyperemesis Gravidarum, a condition when a pregnant woman has excessive, continual nausea and vomiting which can lead to malnutrition, weight loss, and dehydration. Hyperemesis Gravidarum is treated by total parenteral nutrition (TPN) to enable the correct nutrition for both the mother and baby, and can be delivered through a small-bore feeding tube that bypasses the patient’s stomach, or if that fails, a PICC line. A PICC line functions best in most scenarios with its distal tip in the cavo-atrial junction, where the superior vena cava meets with the heart. The Vascular Wellness clinician placed the ordered PICC line, and perfect placement was confirmed using ECG placement technology. However, several hours into the evening after the PICC was placed, the patient started to experience Ventricular Tachycardia. The PICC was not suspected as the placement was confirmed correct, and the while the physician was evaluating the situation, the charge RN called the Vascular Wellness Vascular Support Team (VST). The charge RN was immediately connected via phone with a clinician familiar with the situation. The Vascular Wellness nurse had a sense of what may have happened and immediately headed to the patient’s room. The patient was still in distress upon arrival, and she calmly took the PICC dressing down and retracted the PICC by about 2 centimeters. Immediately, the patient felt better and the heart rhythm returned to normal. Based on her expertise and experience, the vascular access expert clinician concluded that since the patient had no history of arrhythmia, and was pregnant, the change or shift of organ location was the most likely cause of the issue, which proved to be the case.
Vascular Access for Cardiac Rehabilitation Patient | NCIA-22
PICC Vascular Access Cases: While an elderly man was recovering at a Short-Term Acute Care Hospital after a successful quadruple bypass with a valve replacement procedure, he developed pneumonia, post-operative swelling, and atrial fibrillation. The patient became frustrated with these setbacks, and it grew as his condition didn’t improve, which resulted in repeated labs and numerous painful blood draws. Although his cough persisted, it was eventually decided to remove his IVs and transfer him to an inpatient Cardiac Rehabilitation Hospital. While in the Cardiac Rehabilitation Hospital, an X-ray confirmed that the patient’s pneumonia was still present, and he would need new vascular access to treat the infection. The facility contacted Vascular Wellness and requested a nurse clinician to place a PICC line. A short while later, the clinician arrived and reviewed his medical history. The clinician learned from a conversation with the patient that he had several concerns, ranging from the level of procedural pain to the depth and breadth of the clinician’s experience. The patient had experienced numerous painful blood draws due to swelling in his hands, and was apprehensive about another procedure. The clinician answered each question with patience and kindness, ensuring the patient was comfortable with how the vascular access would be performed, why it was necessary, and that his comfort level with her and the procedure was an integral part of his treatment. Once the patient was comfortable, the Vascular Wellness clinician began the process. Vascular Wellness clinicians use ultrasound guidance and other advanced technology and best practices, and because of this, in addition to the deep skill level of the clinician, she noticed an episode of atrial fibrillation during the procedure. The PICC was placed without incident, and the Vascular Wellness clinician immediately notified the patient’s physician and care team of the Atrial Fibrillation. The medical team quickly ordered additional antibiotic therapy. The patient’s condition quickly improved, and he was discharged the following week.
PICC Vascular Access Cases: Key Points
Our large footprint of specialists are available 7 days a week, including after-hours, holidays, and weekends, have a 3-hour average response time, and 95% of our calls are serviced the same day and within 6 hours.
Our clinicians are salaried rather than paid per procedure, and are encouraged to spend all time necessary to perform a comprehensive medical history review to ensure the clinically appropriate line before sticking, and to answer all questions about the procedure and care and maintenance.
Our clinician’s expertise often gets utilized successfully after failed attempts by other clinicians. We have a 98+% success rate with 0% insertion-related infection rate across all lines.
In states where nurses are permitted, as Vascular Access Specialists, our clinicians can provide immediate X-ray clearance of lines when tip confirmation is not available or appropriate and X-ray confirmation must be used. This saves money, time, and coordination with a Radiologist or other doctor and enables the lines to be used immediately to avoid treatment delays.
Our clinicians are VA-BC certified, skill tested, and skill verified semi-annually and can rely on the breadth of their intensive training to achieve successful access, including in complex cases and difficult intravenous access (DIVA) patients.
Not only do we use the latest technology such as ultrasound machines with ECG technology for vein visualization and tip confirmation, but our clinicians are experts in many vascular access devices to not only evaluate the situation and recommend the right line but be able to place such line the first time and on the same visit.
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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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