The Challenges of Vascular Access
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The Challenges of Vascular Access Peripheral intravenous catheters (PIVCs) are used for:1 Intravenous therapy Vascular access device insertion is one of the most frequently performed invasive procedures1 Central vascular access devices (CVADs) are used for:2 Poor peripheral venous access of catheters require replacement before the completion of therapy1 PIVCs are sold in the U.S. each year3 Administration of irritant or vesicant drugs More than 400 million Extended and repeated access Intravenous therapy of central lines need to be removed prior to completion of therapy in pediatric patients4 More than 4 million CVADs are sold in the U.S. each year3 of hospitalized patients receive a PIVC1 who acquire a central line-associated blood stream infection (CLABSI) will die7 healthcare-associated S. aureus catheter-related bloodstream infections (CRBSIs) are due to PIVCs5 resulted in a breach in aseptic technique8 of CLABSIs are antimicrobialresistant in acute care settings6 Occlusions occur in of long-term central venous catheters9 experience monthly blood exposure during IV catheter insertion and Contributing factors to complications... Variation in policy, practice and training13 occur more than 5 days after insertion11 Inappropriate device selection, placement, care and maintenance13,24 Variation in patients (>50% may be difficult intravenous access)14 Vascular access complications cause substantial burdens... Economic outcomes Patient experience Clinical outcomes • Unnecessary PIV restarts can cost a 200-bed hospital more than $980,000 annually.1 • Treatment of CRBSIs can extend a patient’s length of stay.16 • CLABSIs are estimated to cost the U.S. healthcare system $45,814 per occurrence or ~$1.9 billion every year.16 • Multiple insertion attempts increase pain to the patient.18 • CLABSI patients have been associated with 2.27x greater risk of mortality than non-CLABSI patients.20 • Bloodstream infections (BSIs) not associated with a central line captured as hospital onset bacteremia (HOBs) cost $23,998 per occurrence.15 • Needlesticks are a fear in 1 of 4 adults and 1 of 3 children.17 Quality assurance and performance improvement plans should include multidisciplinary functions and an integrated multimodal approach such as: • Education and training of healthcare workers23 • Products that support and align to industry best practices23 • Surveillance and feedback24 • In the ICU setting HOBs represent up to 17x the occurrence rate of CLABSIs alone.22 Care and maintenance of catheters should be the focus of performance improvement and quality assurance24 • The overall median rate of HOB is up to 0.124 per 100 admissions.19 • In a systematic review of disinfection practices, 33% to 45% of needleless connectors were contaminated with a 10% compliance r

References 1. Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2019;42(3):151-164. 2. Cheung E, Baerlocher MO, Asch M, Myers A. Venous access: a practical review for 2009. Can Fam Physician. 2009;55(5):494-496. 3. Tian M. Millenium Research Group, Inc. Vascular Access Devices: US Market Analysis. Toronto, Canada: Decision Resources Group, 2019. (BD Internal Data on File). 4. Ullman AJ, Marsh N, Mihala G, Cooke M, Rickard CM. Complications of central venous access devices: a systematic review. Pediatrics....