Vascath Exchanged to Tunneled Permcath describes a case where a patient in an LTACH who had suffered many serious injuries in a motor vehicle accident needed emergent dialysis and Vascular Wellness promptly placed a Vascath; then ten days later, a Tunneled Permcath was ordered after determining the patient would need long-term dialysis, and Vascular Wellness was able to promptly exchange Vascath for a Tunneled Permcath at the patient’s bedside.
Vascath Exchanged to Tunneled Permcath
– Clinical Case
A middle-aged patient with a past medical history of hypertension, colon cancer, and DVT (deep vein thrombosis) was being treated in an LTACH for several serious injuries after a traumatic high-speed motor vehicle collision two months prior. As a result of the accident, the patient suffered from multiple fractures and injuries, including diaphragmatic and chest wall injury with herniation of the stomach and large bowel, left lumbar herniation, splenic injury, acute traumatic mesenteric injury, displaced fractures of the C2 and C3 vertebrae, fractures of L1 and T8 vertebrae, and concern for traumatic dissection of the left vertebral artery.
The patient had a tracheotomy and PEG (percutaneous endoscopic gastrostomy, also known as a feeding tube), and was receiving electrolyte replacement, LASIX, and Eliquis. The patient’s medical course was also complicated by sepsis, which was recently resolved.
Due to the injuries and comorbidities, the patient experienced a worsening acute kidney injury and was confused, and it was determined that she would need to be emergently dialyzed. The LTACH facility called Vascular Wellness to have a Vascath temporary dialysis catheter urgently placed at the patient’s bedside, and then later after the Vascath placement, determined that a permanent dialysis catheter would be needed.
Vascath Exchanged to Tunneled Permcath
– Diagnosis and Treatment
The large bore trained nurse clinician arrived at the facility and began a thorough assessment of the patient and medical history. Due to the cervical spine fractures, the patient was on strict orders to remain in a neck brace at all times. Typically, Vascaths are placed in the internal jugular (IJ), but that was not possible due to the neck brace. As such, the clinician determined that a femoral dialysis catheter – or Vascath – would be the best insertion point option for this patient. The Vascath was placed at the patient’s bedside without incident and the patient was able to begin dialysis immediately following a bedside abdominal X-ray to confirm proper placement of the device.
Ten days later, the care team determined that the patient, who remained confused and was still on strict orders to remain in a neck brace at all times, required long-term hemodialysis. The LTACH facility again called Vascular Wellness and requested placement of a Tunneled Permcath. Our two-nurse team of advanced vascular access clinicians, which is required for our large bore tunneled permcath procedures, arrived a short while later and once again began a thorough assessment of the patient and medical history.
During the review, the clinicians noted that the patient did not show any signs or symptoms of infection around the Vascath temporary dialysis catheter that was placed ten days prior. Because the patient was still in the neck brace and the current temporary dialysis site was clean and free from signs of infection (typical for Vascular Wellness placed lines), the vascular access nurse clinicians determined that a catheter exchange to the left femoral site was appropriate. The clinicians completed an exchange of the large bore Vascath temporary hemodialysis catheter to a large bore Tunneled Permcath at the patient’s bedside without issue. Another portable abdominal X-ray was arranged in advance and obtained to verify placement, and the patient continued to receive hemodialysis without any delay or interruption to her regular schedule.
Vascular Access Experts
– Key Points
Having a specialized vascular access partner whose advanced nurse clinicians are credentialed and skilled in the placement of innovative small bore and large bore advanced central lines, including Vascath and Tunneled Permcath dialysis catheters, greatly enhances our clients’ ability to successfully treat patients quickly, eliminate the need for transportation to another facility and the coordination and costs associated with it, and help improve patient outcomes and satisfaction. As added benefit, our clients can then utilize their newly available medical resources to deliver more and higher-impactful healthcare services to their community.
This case clearly demonstrates how partnering with vascular access specialists and experts who are deeply skilled, particularly in advanced procedures, and available for emergent and delicate cases such as this one at the bedside 7 days a week, including after-hours, weekends, and holidays, makes a tremendous difference in a facility’s ability to care for their patients.
Teaming with Vascular Wellness means clients can rely on a dedicated professional team of vascular access experts who are trained, precepted, and certified in the placement of standard and advanced central lines. Our clinicians are Vascular Access Board Certified (VA-BC), insured, and skill-verified, which means we deliver consistent, reliable, and quality services to the patient. And with no upfront cost or commitment, partnering with Vascular Wellness to have vascular access specialists available on-demand and on-site is generally an “easy” decision for most healthcare facilities, especially given that we promote teamwork internally and externally by either becoming an extension of a client’s in-house team or operating as their outsourced provider.
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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