Vascular access expertise after hours describes how a Vascular Wellness nurse on her way home returns to the hospital to immediately help a patient experiencing Ventricular Tachycardia, a type of dangerous heart rhythm, and is the focus of this Nurse Clinicians in Action case story. 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 Expertise After Hours
– Clinical Case
This case took place in a hospital with a patient who was a young, healthy expectant mother who was experiencing Hyperemesis Gravidarum, the condition described when a pregnant woman has excessive and continual nausea and vomiting which can lead to malnutrition, weight loss, and dehydration. Hyperemesis Gravidarum is not the typical morning sickness that may cause mild nausea and vomiting early in the pregnancy, and must be addressed. Hyperemesis Gravidarum is treated by Total Parenteral Nutrition (TPN) to enable the correct nutrition for both the mother and baby. TPN 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. The cavo-atrial junction is the area where the superior vena cava, the large vein in the chest, meets with the heart. If a PICC is placed too deeply or a patient has unique heart anatomy, the distal tip can irritate the heart’s electrical system, causing Ventricular Tachycardia, a type of abnormal heart rhythm. In this case, the Vascular Wellness clinician placed the PICC line and perfect placement was confirmed by using ECG placement technology.
Several hours after the PICC was placed, and during the night shift, the patient started to experience Ventricular Tachycardia, and the staff nurse summoned the physician. The PICC was not suspected as the placement was confirmed correct, and the physician had to determine the best course of action.
Vascular Access Expertise After Hours
– Diagnosis and Treatment
While the physician was evaluating the situation, the charge RN called Vascular Wellness and the Vascular Wellness Vascular Access Support team was immediately able to connect via phone the charge RN with a Vascular Wellness nurse familiar with the situation. The Vascular Wellness nurse had already left the hospital and was heading home, but immediately turned her car around and headed to the patient’s room having a sense of what may have happened. The patient was still in distress when the Vascular Wellness nurse arrived, 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 Wellness nurse concluded that since the patient had no history of arrhythmia and the patient was pregnant, the change or shift of the organ location was the most likely cause of the issue, which proved to be the case.
Vascular Access Experts
– Key Points
As Vascular Access Experts, Vascular Wellness prides itself on bringing to every clinical case, the experience and skills learned over many years and hundreds of thousands of lines throughout diverse healthcare settings. We are able to diagnose and address an uncertain situation promptly as there is a strong chance, we have seen a similar situation before, as was the case here. We track these atypical situations and incorporate them into our education and training so every clinician can learn from every type of clinical case. This approach has earned the trust of many Licensed Independent Practitioners who are comfortable ordering a Vascular Access Consult, and not just a device placement, and allowing our clinicians to place the right line at the right time, the first time.
In addition, we care. 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, even after hours, when necessary, beneficial to both our clients and patients. We care deeply about each other, each patient, each client, and our relationship with the healthcare and local community. We are experts in our field who help people and make a difference in all lives we touch.
If you require Vascular Access or want to learn more, speak to the team at Vascular Wellness today. For the latest articles and insights, follow us on LinkedIn, Facebook, Twitter, YouTube, and Instagram.