Vascular access and patient collaboration describes how a patient with a long battle with cancer and various complications collaborates with the Vascular Wellness clinician on her vascular access treatment plan to help accomplish clinical and non-clinical personal goals and is the focus of this Nurse Clinicians in Action. 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 generally 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-compliant communication app. 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.
Vascular Access and Patient Collaboration
– Clinical Case
This case took place in a hospital with a middle-aged female patient battling cancer. Her clinical scenario included an implanted port catheter in her right chest wall with a currently suspected infection, a restriction on right arm access due to previous right mastectomy with lymph node removal, a current edematous left arm from multiple failed Peripheral IVs and infiltrations, and an ongoing need for effective pain control as well as requested total parenteral nutrition (TPN) for comfort purposes. The patient did not want to go through yet another procedure to have the suspected infected port removed. Further, due to the patient’s difficult IV access and short-lived PIV access sites, the patient and her family were very concerned about the number of needle sticks for glucose checks, labs, and PIVs as her left arm was swollen due to multiple infiltrated IVs. The patient’s main goal was to leave the hospital and return home with the ability to receive pain medication and TPN.
Vascular Access and Patient Collaboration
– Diagnosis and Treatment
The Vascular Wellness clinician was consulted and personally spoke at length with both the patient and her family about their needs, wishes, and their primary goal to return home. Ultimately, in order for the patient to leave the hospital, they needed a plan to stabilize the patient from the suspected port infection with antibiotics and enable the continuation of pain medication and TPN.
The Vascular Wellness clinician reviewed the patient’s medical history and discussed the benefits of a PICC line, even though a PICC is typically not needed in the presence of an implanted port. The clinician explained that the PICC 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 and now understood the benefits of a PICC line in this scenario and felt comfortable proceeding despite their initial hesitation. Risks and benefits were explained, and informed consent was obtained to proceed with the PICC insertion.
The clinician performed a thorough ultrasound assessment of the available left arm which revealed 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 with no complications 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. By taking the time to explain the options, the family was able to participate in a successful treatment plan and for this patient to meet her goals of end-of-life care. After placement and the ensuing treatment initiated, the patient was discharged home to be with her family with her PICC in place.
Vascular Access Specialist
– Key Points
As a Vascular Access Specialist, Vascular Wellness prides itself on having earned the trust of many Licensed Independent Practitioners who are comfortable ordering a Vascular Access Consult and not just a device placement. Earning this trust means that many of our partner Medical Doctors, Physician Assistants, and Nurse Practitioners who order Vascular Access Consults know that not only does Vascular Wellness do a thorough consult for the right line at the right time, the first time, but in almost all cases can place that line rather than refer to another specialty which would cause more treatment delay for the patient. We are Vascular Access Specialists in both knowledge and skill sets and our Vascular Access Clinicians place both large and small-bore lines in the clinically appropriate location, whether that is the arm, neck, chest, or lower extremity. This skillful specialization sets us apart from other vascular access contractor teams.
In addition, we use the latest technology such as Ultrasound machines for vein visualization, especially when the vein can’t be easily identified, and our employee training which includes creative out-of-the-box thinking, bedside manner, and identifying and addressing common fears. In general, our employee model (W2 Employees) as compared to an independent contractor model (1099 Contractors) allows for a more holistic, patient-centered approach to vascular access, beneficial to both our clients and patients. This clinical story required therapeutic conversation taking into account many clinical and non-clinical factors to achieve the best outcome, which takes time and sensitivity and is included in the Vascular Wellness service. When we say we provide holistic care, we mean every part of the care, including understanding the patient and family’s desires, explaining the procedural options to the patient, and placing the right line, at the right time, the first time, to best address all clinical needs and personal goals and wishes.
For a similar clinical story about bedside manner, see
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