The 11th National Infusion and Vascular Access (NIVAS) conference, held last month in London, was designed with a focus on vessel health and preservation (VHP).
Andrew Barton, Chair of NIVAS, began by stressing the importance of VHP, challenging our view on ‘how many attempts (at cannulation) is too many?’ and why it matters to vessel health. In line with this, Andrew gave an update about NIVAS campaigns and initiatives, including collaborative work with NHS Resolution's Safety and Learning Team on infiltration and extravasation; national antimicrobial intravenous-to-oral-switch (IVOS) criteria for early switch (UK Health Security Agency, 2023); Device Related Infection Prevention Practice (DRIPP) (Infection Prevention Society, 2023), and VHP (Moreau, 2019; Hallam et al, 2020).
It is noteworthy that, with this year's theme on VHP, the appropriate training and use of ultrasound and its value for successful cannulation – getting it right at the first attempt – was widely covered. There was an impressive talk by Emily Smith, vascular access lead, about her evaluation of ultrasound-guided long peripheral IV catheters (PIVCs) in patients with difficult intravenous access (DIVA), and Sean Warburton, anaesthetic registrar, shared his story about the transition of ultrasound-guided cannulation from best practice to becoming normal practice in his trust.
Paul Lee, clinical scientist, gave an interesting and thought-provoking talk about ultrasound in vascular access, exploring why we use it and governance issues for clinical users. Colin Fairhurst, advanced clinical practitioner, spoke about using ultrasound for confirming placement of central venous catheters (CVCs) to exclude complications.
There's no denying that insertion of any type of vascular access device (VAD) comes with risks of complications. In addition, it is widely documented that treating DIVA patients comes with further risks of complications associated with the number of attempts to obtain, secure, and maintain a reliable IV access.
Research has shown that ultrasound-guided cannulation proved to have a higher first-attempt success rate, at more than 90% in comparison to 25-30% with conventional methods (Blanco, 2019). It is the gold standard as the first approach to DIVA patients for IV cannulation (Chakraborty et al, 2022; Rickard et al, 2023). A research project in Australia is under way called Difficult Access Requires Thought, Training and Technology (DART3), which entails considerations for sustainable implementation of ultrasound-guided procedures for difficult PIVC insertion, with emphasis on the use of ultrasound-guided cannulation on DIVA patients requiring thorough assessment, training and tools (Rickard et al, 2023).
It is evident that a thorough assessment, by using the right tool, is imperative to identify the right device at the right time for the right needs of the patient the first time. In effect, reducing VAD-related complications, improving patient outcomes and thereby promoting vessel health and preservation.
Identifying patients with non-palpable, non-visible venous access is a skill that can be integrated into clinical practice with training and experience. We are in the 21st century: blind, multiple attempts at cannulation should not be the norm anymore – ultrasound-guided cannulation should be the norm.
Members of NIVAS can access the conference presentations on the website (https://nivas.org.uk/conference/11th-nivas-conference-2023).