Vascular Access for Sepsis Protocol – Nurse Clinicians in Action – 28

Vascular Access for Sepsis Protocol describes how a Skilled Nursing Facility resident with a fever of unknown origin was transported to the Emergency Department where she was put on the sepsis protocol for early diagnosis and treatment, and needed difficult-to-obtain vascular access.  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.

Vascular Access for Sepsis Protocol

– Clinical Case

This case took place in the Hospital Emergency Department where the patient needed vascular access to commence the sepsis protocol of treatment.  Unfortunately, the patient was not only dehydrated, but also severely contracted in the bilateral upper extremities, making vascular access very difficult.  Multiple Emergency Department nurses and physicians attempted traditional and ultrasound guided IV access without success.  A Vascular Wellness clinician was already on site for another patient, and was approached to assist in this difficult situation.

Vascular Access for Sepsis Protocol

– Diagnosis and Treatment

After assessment by the Vascular Wellness clinician, the clinician recommended a midline, which was approved by the treating physician.  The clinician carefully and quickly placed the midline on the first attempt.  During the insertion, the clinician was able to obtain blood samples for laboratory analysis and a set of blood cultures in furtherance of the treating protocol, and initial therapies could be delivered without any further delays.  The Vascular Wellness clinician used excellent judgment in a patient-centric approach by not recommending or escalating to a more invasive and potentially unnecessary central line until more information could be obtained.  And if a central venous catheter (CVC) was to become necessary and clinically appropriate – whether a PICC, Internal Jugular, Mid-Thigh Femoral or other central line – the skilled Vascular Wellness clinician was present with all necessary supplies and could place such line promptly.

Vascular Access Experts

– Key Points

As Vascular Access Experts, we understand and appreciate the significance of the “Delay Cascade,” the concept that describes how delays in initial diagnosis and treatment can cause increased length of stay, worsening patient condition, antibiotic resistance, decreased patient satisfaction, and wasting of clinical resources (see References below), and we partner with our clients to mitigate these risks.  The midline placed in this scenario allowed for the start of treatment and the end of the Delay Cascade.  With the limited amount of clinical information available on the patient at the time (due to delay in obtaining blood samples), a midline was the least invasive, clinically appropriate device at the time of placement.  It provided the ability to obtain lab samples and deliver therapies until more information could be learned.  Perhaps an oral antibiotic could be given, and no further access would be required, or perhaps the lab results would return a result requiring IV antibiotics and the patient would become unstable, possibly requiring a central venous catheter. In that case, a Vascular Wellness clinician proficient in performing this clinical procedure was available and could place the applicable line upon request.

Unlike many of our competitors, our nurse clinicians are Hospital-Credentialed, Skill-Verified, Board-Certified, Insured, and Salaried W2 employees, and they are trained to perform a comprehensive medical history review to ensure the clinically appropriate line before sticking, as well as to answer all questions about the procedure and care and maintenance. It is not unusual for us to work with the medical team and offer recommendations based on the medical history review and treatment plan, and such recommendations are often accepted by the treating doctors, such as in this case with our recommendation for a midline.  Through this comprehensive and thorough training, as well as access to a clinical administrator on-call and all other clinicians via a HIPAA-compliant app, our clients and patients get superior quality at the bedside derived from the hundreds of thousands lines placed since inception.

Partnering with Vascular Wellness stops the “Delay Cascade” and removes a major barrier to initiation of medical treatment.

References

1. Heart & Lung. Volume 49, Issue3, Page 273-286, May-June 2020
2. Journal of Infusion Nursing. 43(4): p222-228, July-August 2020
3. Journal of the American College of Emergency Physicians Open.  2020 Dec; 1(6): 1660–1668

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.

Vascular Wellness provides:
(1) Comprehensive vascular access services to North Carolina, South Carolina, and Virginia;
(2) Customized vascular access services to Tennessee, Georgia, and West Virginia; and
(3) Support vascular access services to Pennsylvania, Ohio, and Kentucky.