Previous PIVs Fail Repeatedly highlights a patient case involving an elderly man in a Skilled Nursing Home who needed long-term IV antibiotics to treat pneumonia. The facility ordered a peripheral IV (PIV), however, each new PIV failed within a day, delaying therapy and leaving the patient extremely frustrated and dissatisfied.
Previous PIVs Fail Repeatedly
– Clinical Case
This case took place in a Skilled Nursing Facility where an elderly patient with a past medical history of liver and bone cancers was being treated for community-acquired pneumonia. The patient was receiving antibiotics via a PIV, but his IV access was failing daily, and needed new access each day to continue administering the treatment. With the ability to gain new vascular access becoming a challenge, and the patient growing increasingly frustrated, the facility contacted Vascular Wellness and ordered a new PIV to be placed so the antibiotics could continue to be administered for at least 5 more days. The facility assumed that Vascular Wellness, as highly trained specialists, could place the PIV in a manner that enabled it to be used for the entire therapy period without failing.
Previous PIVs Fail Repeatedly
– Diagnosis and Treatment
The Vascular Wellness vascular access clinician arrived at the Skilled Nursing Facility and headed to the patient’s room. When the nurse clinician entered the room, the patient was disheartened to learn that he needed to be stuck again. The clinician acknowledged that repeated sticks are painful and certainly not ideal, and then explained that she would perform a thorough visual patient assessment and medical history review and explain her findings before proceeding.
During the assessment, the clinician noted bruises up and down both arms. The patient stated that he had been stuck at least once a day for several days in a row in order to receive his antibiotics. Given the need for at least 5 more days of antibiotics to be administered intravenously, and the fact that the PIVs were failing daily, the clinician knew that there were limited PIV options, if any, that were available for this patient.
It was important to end this cycle of repeated sticks and failed PIVs, not only to ensure the patient could receive the full round and efficacy of the treatment but also to end the painful sticks and provide some much-needed comfort. Knowing that another PIV would almost certainly fail by the following day, the Vascular Wellness clinician felt a Midline would be a better choice for this patient.
Midlines are flexible catheters (longer than a PIV but shorter than a PICC) that are inserted into the vein in the upper arm, and the tip ends before the armpit, meaning that they are not central lines. Midlines are used to administer medications that are non-irritating to the vein and provide greater flexibility than a PIV. They can be used for either short or longer intervals on patients with difficult vein access and can reduce the number of patient sticks as a substitute for multiple PIVs that do not last the course of treatment.
Learn more about the different types of vascular access devices, including care and maintenance tips HERE
The vascular access nurse clinician immediately reached out to the provider and advocated for a Midline for the patient, explaining the reasoning for the recommendation. The provider agreed and altered the vascular access device order.
The patient was absolutely thrilled with the new plan, and stated, “I like the idea of not being turned into a pin cushion anymore!” The nurse clinician was happy to see the patient in good spirits, and quickly and effortlessly placed the Midline within about 30 minutes so the antibiotic treatment could resume. Both the patient and facility were extremely grateful that the Vascular Wellness clinician advocated for the patient and ensured not only that he could receive and benefit from his treatment, but also that they could end the cycle of repeated, painful sticks.
Vascular Access Specialists
– Key Points
This clinical story demonstrates why it is critical to partner with a vascular access provider who isn’t trained or incentivized to get to the next procedure quickly, but rather who is trained and expected to spend all the time needed with each patient, both in evaluation and explanation. Our Vascular Access Specialists always conduct a thorough review of the patient’s medical history, as well as a complete visual, physical assessment before beginning any procedure. This thorough process, including talking with the patient and family, ensures the most clinically appropriate vascular access device is placed in every case, and the patient and family understand the reasoning and rationale behind it. Partnering with Vascular Wellness augments the patient and family experience and enriches the facility’s brand and reputation.
Taking the time to not just “place the ordered device” but rather to understand each patient and their unique situation is how Vascular Wellness enables our client partners to deliver the best care to their patients, and at a cost savings whenever possible. Because the nurse clinician took the time to do a thorough patient and medical history review, she knew that if she simply placed another PIV, it would fail by the following day and the cycle of painful, repeated sticks, squandered PIV catheter kits, and wasted nurse time would continue. Additionally, they risked the patient not receiving full efficacy of treatment due to the continuous failed intravenous access.
Seeing that this patient still needed at least 5 more days of IV antibiotics, the clinician advocated for a longer-term solution that ultimately would provide a cost savings, make this procedure the last stick needed for this treatment, and ensure the therapy could complete successfully. Partnering with a vascular access provider that places the right line, the first time, not only helps facilities provide the best care for their patients with the best possible outcomes, but it also helps them ensure a patient-centric approach. This includes not only recognizing the patient’s experience and feelings, but also following important guidelines around vein preservation to ensure every vascular access procedure is successful on the first attempt.
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, Georgia, Tennessee, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.
Read more NCIA Patient Cases
Nurse Clinicians in Action stories highlight some of the interesting cases in which Vascular Wellness clinicians have encountered and participated as valuable team members.
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