Vascular Access with Bilateral Fistulas – Nurse Clinicians in Action – 27

Vascular Access with Bilateral Fistulas describes how a PICC line for antibiotics was prescribed for a patient, but during the pre-procedure patient assessment, the Vascular Wellness clinician discovered the patient had bilateral fistulas, making access in the upper extremities contraindicated. 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 with Bilateral Fistulas

– Clinical Case

This case took place in a Skilled Nursing Facility where the patient needed a vascular access device placed for IV antibiotic therapy. The facility contacted Vascular Wellness to place a PICC line. However, during a thorough examination of the patient and the medical records prior to the procedure, the vascular access expert discovered that the patient had bilateral fistulas for hemodialysis, making the prescribed PICC line contraindicated.

Hemodialysis is a medical procedure used to manage a patient’s kidney failure or severe kidney disease. The creation of a Fistula is often performed to allow for a high blood flow rate, which is necessary for effective Hemodialysis treatment. Bilateral Fistulas are less common than unilateral Fistulas, but sometimes are necessary for certain medical purposes and individual needs.

The nephrologist was consulted, and agreed and requested that no vascular access devices be placed in the upper arms of this patient.

Vascular Access with Bilateral Fistulas

– Diagnosis and Treatment

Because the Vascular Wellness RN was highly skilled, trained, and certified as a Vascular Access Board Certified specialist, the clinician was familiar with the national guidelines regarding renal patients needing hemodialysis. As such, this clinician knew that a Small Bore Internal Jugular line was the clinically appropriate option for this patient for the intravenous antibiotics. The Director of Nursing and the attending physician at the Skilled Nursing Facility were impressed that not only could the clinically appropriate line be inserted, and its placement confirmed, but that the clinician having all supplies could perform the procedure immediately. The procedure went smoothly, and the patient was able to continue with the ordered therapy without any delays, or unnecessary transportation or procedural costs. 

Vascular Access Experts

– Key Points

As Vascular Access Experts, Vascular Wellness delivers hospital-quality vascular access to patients and their Skilled Nursing Facilities because, unlike many of our competitors, our nurse clinicians are Hospital-Credentialed, Skill-Verified, Board-Certified, Insured, and Salaried W2 employees. This employee vs. 1099 contractor model allows for a more holistic, patient-centered approach to vascular access, even after hours, when necessary, and is beneficial to both our clients and patients. Ensuring exceptional client service is a fundamental aspect of our partnerships, and our highly skilled clinicians act as a bridge among all stakeholders, including the patient, their family members, and the medical team.

Our clinicians are encouraged to spend all time necessary 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. With our greater than 98% success rate and 0% infection rate, across standard and advanced lines (advanced lines are central lines that our competitors do not provide and are typically used in more challenging clinical cases such as difficult intravenous access (DIVA) patients), we offer superior quality at the bedside without delay, unnecessary trips to the hospital, bad sticks, or inability to obtain access, and why we are the true Vascular Access Experts.

Because medical procedures and therapies are often prescribed or performed in a linear fashion, a delay of one can trigger more delays, which can add up quickly and impact patient outcomes. When a series of delays occur in medical care, the impact to the patient can be significant. Vascular Wellness is different from virtually all other mobile PICC or vascular access companies because not only do our clinicians come to the patient’s bedside – not matter where it is – to place vascular access lines, but more importantly, our clinicians’ level of skill and expertise enables us to not only verify if an ordered vascular access device is clinically appropriate, but we can also pivot and insert advanced lines such as Internal Jugulars, Mid-Thigh Femorals, Axillaries, Quad Lumens, and Tunneled Central Lines at the bedside.  We are equipped with the supplies as well to enable a change at the bedside.  This differentiator prevents delays and enables therapy to begin right away, directly impacting patient outcomes, and patient satisfaction with the facilities where they are receiving care and treatment.  Pivoting from a PICC line to an Internal Jugular line as in this Vascular Access with Bilateral Fistulas case is the value-added service that we uniquely provide.

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.