Tunneled, Vascath, IJ, PIV Lines – One Call Does it All – Nurse Clinicians in Action – 50

Tunneled, Vascath, IJ, PIV Lines – One Call Does it All describes a case where an Internal Jugular Central Line and shortly thereafter, a Temporary Dialysis Catheter (Vascath) for hemodialysis were ordered for an LTACH patient who also needed a Tunneled Central Line and Tunneled Permcath to be removed. Both Tunneled Lines were no longer needed, and there was particular concern about infection risk in the Permcath because of its location in the patient’s groin.

Tunneled, Vascath, IJ, PIV Lines – One Call Does it All

– Clinical Case

The care team for a patient in an LTACH with a medical history of cardiac arrest, open heart surgery, and renal failure ordered an Internal Jugular (IJ) Central Line with Vascular Wellness so they could administer two intravenous therapies. The team also requested the two Tunneled Central Lines – one of which was a Tunneled Permcath in the groin – to be removed. Neither of the Tunneled Central Lines were placed by Vascular Wellness, as we typically avoid placing Permcaths and other Large Bore Lines in the groin area unless there is no other alternative.

To help mitigate infection risk, best practices recommend avoiding the groin or bend areas where bacteria tends to reside and can gain entry when placing vascular access devices. Avoiding the groin and bend areas also provides greater comfort for the patient. For these reasons, Vascular Wellness prefers to place Large Bore Lines in the Internal Jugular when possible. In certain cases, the IJ is not available or contraindicated, and some examples include neck cellulitis on both sides, if the patient had a trauma or other condition where they must remain in a cervical collar or neck brace, or upper superior vena cava (SVC) stenosis, to name a few.

Tunneled, Vascath, IJ, PIV Lines – One Call Does it All

– Diagnosis and Treatment

The Vascular Wellness nurse arrived a short while later that same day and performed a detailed patient assessment, reviewed the vascular access order again and the patient’s chart, and then checked in with the provider on duty. After confirming with the provider that the two Tunneled Central Lines were no longer needed and agreeing that the location of the Permcath in the groin posed an infection risk, they moved on to discuss the ordered IJ.

The vascular access nurse confirmed that the patient needed vascular access only for two PRN IV medications – Lasix and Metoprolol. With that verification, the nurse recommended placing two ultrasound guided Peripheral IVs (PIVs) as a clinically appropriate and less invasive option versus the IJ because a central line was not needed to administer these medications. Additionally, the two PIVs together still pose a lower risk of infection than a single Central Line (i.e., CLABSIs or Central Line Associated Blood Stream Infections), and they help preserve the patient’s veins and enable the facility to reduce Central Line days, as well as reduce costs. The provider agreed with the recommendation and also requested and ordered a Temporary Dialysis Catheter (Vascath) to be placed because the patient required hemodialysis.

While a Vascular Wellness clinician who was credentialed in Tunneled Line removal was en route to the facility, the initial clinician quickly and easily placed the two ultrasound-guided PIVs so therapies could begin. When the second advanced vascular access clinician arrived, they successfully placed the new Vascath in the patient’s Internal Jugular vein on the first attempt. Once placement was confirmed with X-ray, the second clinician removed both Tunneled Central Venous Catheters.

The LTACH facility was extremely grateful for the quick response time from Vascular Wellness and the ability of the clinicians to take care of all of the new line placements and the Tunneled Line removals right at the patient’s bedside in the same visit, especially without any need for inner- or interhospital transport. The facility also reached out afterwards to thank Vascular Wellness for their collaboration in advocating for the patient to receive the most clinically appropriate lines for his vascular access needs, and helping prevent infections and reduce Central Line days. Of course, they were also very appreciative of Vascular Wellness lowering their treatment cost, along with improving the patient’s outcome.

Tunneled, Vascath, IJ, PIV Lines – One Call Does it All | Vascular Access Specialists 

– Key Points

Partnering with Vascular Wellness means more than just having skilled Vascular Access Specialists travel to your patient’s bedside to place requested lines when needed. It means you have a vascular access partner that provides the most comprehensive, timely, and highest quality vascular access services you can rely on for:

24/7/365 Access at No Charge: No matter the time of day, our clients have access, at no charge – to our staffed VST (Vascular Support Team Client Call Center) and advanced vascular access clinicians to ask questions, collaborate, troubleshoot, request services, and schedule procedures in advance.

Patient-Centric Vascular Access: Our patient- and client-centered team of Vascular Access Board Certified (VA-BC) specialists work with you to ensure the best, safest, and most anatomically appropriate and comfortable access for your patients right at their bedside when they need it.

Reduce Risk of Infections: Two key ways to reduce the risk of infection include ensuring you successfully achieve vascular access on the first attempt (we support a >98% success rate on both Standard Lines such as PICCs, Midlines, and PIVs, and Advanced Central Lines such as Small and Large Bore Central Lines, including Dialysis Catheters and Tunneled Central Lines), and only placing Central Lines when clinically necessary, as demonstrated in this patient case.

Reduce Central Line Days: Another way to reduce the risk of infection, including preventing clinically relevant CRBSIs and financially relevant CLABSIs – all of which are part of reporting requirements around HOB (Hospital Onset Bacteremia) – is to reduce the number of days a patient has a Central Line that is not needed.

Trained in CVC Removal at the Bedside, including Tunneled Lines: According to a report published with the NIH, approximately 65-70% of CLABSIs may be preventable by limiting the CVC “days present.” Because of the increased risk of infection with extended duration of CVCs, it is recommended to promptly remove unnecessary CVCs.¹ Our highly trained nurses not only can place virtually any vascular access line needed at the bedside, they are also specialists in knowing when a line (including Tunneled Central Lines and Tunneled Permcaths) can be removed, and can do so on that same visit.

With Vascular Wellness, clients know that they get the benefit of the most innovative and up-to-date procedures and best practices that are unmatched in the industry. Vascular Wellness is the smart and safe choice for Vascular Access for all healthcare settings, improving patient outcomes and reducing costs, including those costs not always tracked and connected to poor vascular access. When it comes to Vascular Access at the Bedside – One Call Truly Does it All.

¹  Beville ASM, Heipel D, Vanhoozer G, Bailey P. Reducing Central Line Associated Bloodstream Infections (CLABSIs) by Reducing Central Line Days. Curr Infect Dis Rep. 2021;23(12):23. doi: 10.1007/s11908-021-00767-w. Epub 2021 Nov 2. PMID: 34744517; PMCID: PMC8562022.

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.