VUMC PIV
Transcript: Evidence Based USGPIV Becoming a Vascular Access Champion Assessment/Selection Introduction VHP Model “Placing PIVCs is both a science and an art, and it needs to be in the hands of clinicians who have a thorough understanding of all aspects of vascular access and how they can affect patient safety,” Lee Steere, RN, CRNI, VA-BC, Unit Leader of IV Therapy Services at Hartford Hospital Objectives Objectives "Reduce liability, lower costs,and decrease length of stay, while promoting vascular preservation, greater patient satisfaction, and better outcomes" (INS, 2016). Clinician is competent in the use of vascular visualization technology for USGPIV insertion. This knowledge includes, but is not limited to, appropriate vessels, size, depth, anatomy and physiology, location, and potential complications (INS,2016). Remove variable practices and create standardized set of steps among all Vanderbilt USGPIV users utilizing ANTT Utilize current Vanderbilt Policy, Vessel Health and Preservation model, INS 2016, AVA, and latest EBP as guiding principles Why Bother? Informs the clinician on status of the targeted vessels, Minimizes tissue trauma Fewer attempts (Lauren, 2020). Enhance patient satisfaction, reduce the amount of nursing time (Kanipe,2018) Decreases the amount of central lines placed due to poor access,(INS,2016) (Khan, 2015) PICC Team/IV Therapy/VAC Superuser PICC team has designated desk personnel to help answer questions and advice regarding latest guidelines Many have obtained their VA-BC (Vascular Access Board Certified) Are to be main resources in seeking to learn fundamental Allows teaching to be centralized and based on latest data Respect the Craft Take this seriously, seriously! Nerve Injury- Minor vs Major Minor injury- Results in Scar tissue formation (Neuroma) at the point of contact. Patient may require up to 12 months of rehab Major Injury- Needle tears nerve fiber causing Complex Regional Pain Syndrome-permanent, progressive, extremely painful, no cure... Narcotic pain control, extensive rehabilitation, nerve blocks, nerve removal, and nerve transplantation, can have nerve cut and surgically implanted into a bone, which results in little or no pain relief. Limited ADL without severe pain, and withdraw from family and social events. What to Look for Actual Nerve Injury Case Settlement "Mrs.V"- 1 million $ 46 Female- 500,000$ 54 Female- 314,000$ 33 male - 1 million$ Patient depositions reveal "electrical shock" down arm as most common Extreme pain "Sudden", "Unexpected" May pull arm away reflexively “Electrical shock” sensation that radiates Tingling or burning sensation Numbness (Masoorli, 2007) Immediate discontinuation of any vascular access procedure when any of these signs and symptoms are stated to occur Basilic Vein- Near Ulnar Nerve Brachial Vein- Near Median Nerve AVA Nerves of the Upper Extremity-*Homework 8min Complications Arterial puncture- User may mistake needle shaft with needle tip giving false reassurance on placement (Moureau, 2019) DVT formation Vein Wall Injury Infiltration and phlebitis are medical emergencies that can lead to infections, loss of limb, infection sepsis, and adversely affect a patient's quality of life (Woody, 2013) Median Nerve Near Antecubital Ultrasound Ultrasound 101 Ultrasound transmission Higher frequency range (MHz), such as linear probe, offers clearer imaging, but limited depth capabilities Gel can be used as conducive medium, air bubbles will distort image Reflects sounds waves from surface of objects like an echo in a cave Reflected Sound waves return to probe creating electrical signals which produce image on screen through calculations (Lauren, 2020) Needle tip is hyperechoic (Bright dot) How to set up your machine Right position- Unobstructed view directly in front, pillow under arm or on bedside table Plug machine in- most US batteries have low battery life Depth- allowable minimum depth is variable per each machine, use lowest depth setting Gain- Each person detects gray scale differently, Set to personal preference (Lauren, 2020) right probe- make sure its the linear vascular probe Ultrasound Position Head and Neck should remain Neutral (Lauren, 2020) Have Ultrasound in close proximity "Place a table or hard surface under the extremity, adjusted to the correct height for comfort, as a location for supplies" (Baston, 2018). Use a stool if available or raise bed to avoid stooping or twisting. Indicator To Screen Orientation Make sure that both probe indicators match up or everything will be inverted Notice "dots" on screen which represent 0.5cm Middle arrow on probe aligns with center line on screen may have to go to machine settings to activate center line (Lauren, 2020) Tissue types "structure can be characterized as hyperechoic (white on the screen), hypoechoic (gray on the screen) and anechoic (black on the screen)" Nerves #1- "Honeycomb" resemblance, nonpulsatile or compressible Adipose Tissue #2- is almost black Muscles #3 are gray with
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