References
A vascular access team's journey to central venous catheter and arterial catheter insertion
Abstract
Central venous catheters (CVCs) and arterial catheters (ACs) are indispensable tools in modern healthcare, enabling life-saving therapies. However, they carry risks of complications such as bloodstream infections, thrombosis, and procedural mishaps, which impact patient safety and healthcare costs.1 Nurse-driven central line insertion (NDCLI) programs offer a proactive approach to address these challenges by empowering trained vascular access nurses to perform CVC and AC insertions.2
This 4-year follow-up builds on the initial publication, A Vascular Access Team's Journey to Central Venous Catheter and Arterial Line Placement, highlighting first-attempt success and the low-insertion complication rates of an NDCLI program at a community hospital. The program achieved a 91.25% first-attempt success rate and minimal complications, including a single pneumothorax across 812 insertions. Notably, the addition of midthigh femoral peripherally inserted central catheters (MTFPICCs) addressed critical gaps in vascular access for patients with central vessel occlusions, showcasing the program's adaptability and innovation.
This follow-up underscores the value of NDCLI programs in improving efficiency, reducing delays, and enhancing patient outcomes. It also explores the potential for expanding the scope of practice to include other advanced vascular access devices. As the complexity of patient care evolves, NDCLI programs represent a transformative model for leveraging nursing expertise in vascular access, fostering collaboration, and standardizing best practices.
CVCs are essential in modern healthcare, providing access for the safe delivery of medications, fluids, blood products, and other life-saving infusions.3 However, CVC use is not without risks, as CVC-related complications can lead to higher morbidity, mortality, and healthcare costs. Bloodstream infections are among the most serious of these complications, posing a severe threat to patient safety and the quality of care.4 Additionally, risk of pneumothorax increases when ultrasound guidance is not used to visualize the needle tip during insertion and performing pre- and post-assessment of the sliding lung.5,6
NDCLI programs have emerged as a positive and proactive way to address the challenges of central line insertion delays and management.2 In these programs, nurses use a low-approach insertion technique and carefully direct the catheter down on the chest (see Figure 1). The low approach facilitates greater care and maintenance, serving as a key strategy for maintaining dressing integrity, reducing dressing disruption/changes, and ultimately decreasing central line associated bloodstream infections (CLABSI). Suture-less securement devices replace traditional sutures, minimizing tissue trauma and infection, as well as inserter needle stick injury.2,7’8
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