Recovery, reset, restore, reflect—these are some of the terms that I have heard in the past few weeks to describe the direction of most hospitals as they start to return to whatever the new normal is now going to be in health care. In intravenous (IV) therapy and vascular access practice, the past year has proven to be an opportunity to not only test doing things differently but also to keep what was successful and change what was not.
A great effort has been made to keep vulnerable patients away from hospital sites. Those with long-term vascular access devices are commonly vulnerable due to the nature of their clinical condition and as such have been safer at home shielding. Pre-COVID, they would have attended a hospital-based unit or had a visit from a community nurse, for weekly or monthly device care and maintenance and flushing.
During the pandemic, the risk of these patients being exposed to SARS-CoV-2 while having their vascular access devices flushed or dressings changed was too high a risk, so most teams around the UK adapted their polices for patients with IV devices to remain at home, electing to either teach patients and carers to self-care for the devices and flush them at home or, in the case of implanted ports, pushed recurring appointments for flushing devices back to 3 months.
I have had great feedback from IV teams across the UK who have successfully managed to change their port flushing guidelines from monthly to 3 monthly—and no complications have been noted. Over the past few years studies have been published that support this practice but surprisingly it is only recently that this approach has been highlighted as a good option.
The National Infusion and Vascular Access Society (NIVAS) is planning to produce some standardised practice guidance on extending the period between the flushing of implanted ports, which will complement our recently published guidance on avoiding heparin locks in favour of a 10 ml saline flush.
NIVAS has recently published updated flushing guidance for IV infusion-giving sets: where we had previously outlined multiple options for flushing IV infusions, one of which was to not flush and simply discard the bag, NIVAS has updated the practice with the recommendation that IV infusion-giving sets should be flushed after administration to ensure that all the drug contained in the giving set has been administered.
The UK has recently had to cope with a crisis in relation to the availability of infusion-giving sets. During this time, NIVAS was part of the clinical reference group, which came under the NHS England taskforce that was formed to deal with the crisis. This was a great example of how we all came together to do things differently and changed practice arising from necessity.
As we look at how to reset and recover our IV and vascular access services, I hope the positive adaptations we have made over the past year, such as an increase in IV team numbers, different ways of working and refocusing our attention on infection control measures, will make our practice stronger, with even better outcomes for patients, which will enable us to take some positives from the past year.
Stay safe and continue to do the amazing work you are doing—remember that your hard work in the field of vascular access and IV therapy is making a real difference to patients' safety, experience and clinical outcome.
‘I hope the positive adaptations we have made over the past year, such as an increase in IV team numbers, different ways of working and refocusing attention on infection control measures, will make our practice stronger, with better patient outcomes’