V.E.I.N.S.S. series, part two. Evaluation and assessment: what is your call to action?

June 17, 2020 Karen Laforet

Evaluate and assess peripheral venous access devices (PVADs)

Part one of the V.E.I.N.S.S. series discussed the three elements that are important for vessel health, namely a healthcare professional’s competency at device insertion; their knowledge of vein anatomy and physiology; and a comprehensive patient-centric vascular access plan that guides device selection.1 

As advocates for proper patient care, it is our responsibility to reframe our thinking about the use of vascular access devices (VAD), especially peripheral venous access devices (PVADs). Are these devices “just” IVs, or can they put your patient at risk?2

Inserting a VAD is an invasive process that increases the potential for complications. Therefore, it is necessary that we as healthcare providers ask this question: “Is this VAD really necessary?”

Four steps to ensure VAD patency and function, and to identify possible complications.

Your effort to keep “the IV in place” must be evaluated daily at the very least.1-3 An “idle catheter”4 can increase a patient’s risk of complications such as cellulitis, infiltration, extravasation, bacterial phlebitis, thrombophlebitis, nerve damage, or peripheral or central line associated blood stream infections (PLABSI).4-6

Once it is established that the vascular access device is required, a complete assessment of its patency, the condition of the insertion site, the integrity of the skin and dressings, and observation for signs of infection or complications must be completed prior to each access. Next, ask the patient for any untoward symptoms to confirm VAD patency and function, as well as to identify any early signs of complications.

These four stages can be summarised up as follows:

  1. Assess:
    • VAD patency and integrity, following your organization’s protocol.
    • The PICC’s external length, and then compare it to the previous measurement.
  2. Observe:
    • The dressing and the securement or stabilisation method. Is the dressing intact? Are the edges of the dressing secure? Is the cannula stabilised under the dressing to avoid twisting or pistoning? 
    • The insertion site and surrounding skin for signs of inflammation or infection. Next, check for leakage or drainage at the insertion site, blanching, or skin discolouration.
    • Look for signs of phlebitis, namely erythema around the insertion site, red streaks along the vein pathway, or any discolouration or skin changes under the dressing.
  3. Palpate:
    • Around the insertion site and surrounding area for swelling, tenderness, or firmness along the vein pathway. 
    • For signs of infiltration. Is the skin cool to touch? Is there any skin tightness? Is there any extravasation? Examine the skin for temperature changes, tenderness, or burning pain during this examination.
  4. Ask:
    • The patient for symptoms of pain, burning, tenderness, tingling, or numbness. Patients feel what we cannot see.

How often should the VAD be assessed?

Most current guidelines and standards recommend:1,7

  • Every 4 hours for alert and oriented patients in acute care settings with continuous non-vesicant infusion via PVAD.
  • Every 1-2 hours for sedated patients, who are cognitively or sensory impaired or critically ill. Neonates and paediatric patients will require more frequent observation.
  • Once a shift or at each visit in alternate care settings (e.g. community). Patients and caregivers must be instructed on how to assess the PVAD every 4 hours and to report any changes immediately.
  • Every 5-10 minutes for vesicant medications or any solution or medication with increased clinical risk.6
  • Every 30 minutes or more for patients receiving non-chemotherapy vesicants via the peripheral vascular access device (PVAD).
  • Every 2-5 mL confirming blood return for IV push chemotherapy agents.

Our call to action is to reduce the risk of complications and provide positive outcomes for patients. Evaluating the need for vascular access devices each day and completing regular and consistent assessments can help improve our patients’ experiences and reduce their risk of complications.

Part 3 and 4 of our series will delve deeper into ways that we can help reduce a patient’s risk of infection at every touchpoint of the vascular access device journey. 

For more information on evaluation and assessment of PVADs, contact a representative by filling out the form below.

 

References.

  1. Canadian Vascular Access Association (CVAA). 2019. Canadian Vascular Access and Infusion Therapy Guidelines. Pembroke, ON: Pappin Communications.
  2. Cooke, M. et al. 2018. “Not ‘just’ an intravenous line: consumer perspective on peripheral intravenous cannulation (PIVC). An international cross-sectional survey of 25 countries,” in PLoS ONE 13(2): e0193436. Available at: https://doi.org/10.1371/journal.pone.019343
  3. Moureau, N.L. 2019). “The VHP Model,” in Moureau, N.L. (ed.) Vessel Health and Preservation: The Right Approach for Vascular Access: pp.3-8. Cham, Switzerland: Springer.
  4. Becerra, M.B., Shirley, D., and Safdar, N. 2016. “Prevalence, risk factors, and outcomes of idle catheters: an integrative review,” in Am J Inf Control 44: e167-e172.
  5. Bolton, D. 2010. “Improving peripheral cannulation practice at an NHS Trust,” in British Journal of Nursing 19(21): 1346, 8±50. https://doi.org/10.12968/bjon.2010.19.21.79998 PMID: 2135535
  6. Sims, A. 2018. “Infusion therapy using peripheral veins” in Hadaway, L. (ed.) Infusion therapy made incredibly easy (5th ed.): pp. 53-118. Philadelphia: Wolters Kluwer.
  7. Gorski, L. et al. 2016. “Infusion therapy: standards of practice. (supplement 1),” in J Infus Nurs. 39(1S): S1–S159.

Disclaimer: Karen Laforet is a 3M-sponsored blogger. The opinions expressed in this article are those of the individual.

About the Author

Karen Laforet

[enBio=Karen is an accomplished nurse leader with over 30 years of healthcare experience in critical care, community care, industry, and academia. Having received her Master’s in Clinical Science from Western University, Karen is recognised globally as an expert in infusion therapy and skin and wound care management. She is Canadian Certified in Community Health Nursing (CHNC (C)), certified in Canadian Vascular Access (CVAA (C)), and internationally certified in vascular access (VA-BC™). ],[enJob=Registered Nurse],[frBio=Karen est une infirmière chef de file accomplie comptant plus de 30 ans d’expérience en soins de santé dans les soins critiques, les soins communautaires et les milieux industriels et universitaires. Titulaire d’une maîtrise en sciences cliniques de l’Université Western, Karen est reconnue à l’échelle mondiale en tant qu’experte en traitement par intraveineuse et en gestion des soins de la peau et du traitement des plaies. Elle détient une certification en soins de santé communautaires (IISCC [C]) et en accès vasculaire (CVAA[c]) au Canada et une certification en accès vasculaire (VA-BCMC) à l’échelle internationale.],[frJob=Infirmière autorisée]

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