Development of a Vascular Access Team
Shonda W. Morrow, JD, MS, RN, CENP, Samantha Aranda, MSN, APN, ACCNS-AG, CCRN, Guadalupe Ordaz-Nielsen, BSN, VA-BC, Leo DeGuzman, BSN, VA-BC, CPUI, Mark Serain, MBA
In 2018, Rush leadership recognized increased patient length of stay (LOS) related to wait time for placement of peripherally inserted central catheters (PICC) and midlines in Interventional Radiology (IR).
There were 70 LOS avoidable days from July 2018 through October 2018.
In May 2019, nursing leadership collaborated with the nursing finance team to form a task force and create the nurse-driven Rush Vascular Access Team (R-VAT). The goals of the R-VAT are to improve patient safety, decrease the CLABSI rate and decrease LOS.
After a thorough patient assessment and review of evidenced-based practice in the literature such as INS standards (2016), R-VAT decided to use ultrasound and electrocardiogram (ECG) PICC tip confirmation for bedside PICC placement to improve patient safety and decrease radiation exposure.
The R-VAT team began placing lines on July 1, 2019. The R-VAT nurses round daily on all R-VAT placed central lines to monitor for breaks in the CLABSI bundle, while providing just-in-time coaching to bedside nurses to decrease CLABSIs and increase central line maintenance. R-VAT daily rounding compliance is 98.7% and aligns with “Eyes on Lines” observation criteria.
From July 1, 2019 to Jan. 31, 2020, the CLABSI SIR was 0.36 with CLABSI SIR goal of 0.68. Avoidable increased LOS days attributed to R-VAT were zero as patient discharges were prioritized. A total of 89% of R-VAT patient consults were assessed on the same day that orders were placed.
Furthermore, R-VAT avoided 13 inpatient admissions by assessing, troubleshooting, or replacing malfunctioning PICCs or midlines in the emergency department or observation units. R-VAT has placed 398 PICCs and 295 midlines with a success rate of 96.3%. Lastly, R-VAT has decreased patient radiation exposure by 89.2% by utilizing the ECG PICC tip confirmation system.
R-VAT provides ongoing education on line selection and additional CLABSI reduction strategies to bedside nurses and providers.
Using evidence-based practice, innovative technology, and collaboration, the R-VAT team has superseded goals of decreasing LOS and the CLABSI rate while increasing patient safety.