By Emily Levy and Matt Gibson, RN, CRNI®, VA-BC™ – President, Vascular Access Consulting
In the world of healthcare, particularly for patients requiring vascular access, there are crucial guidelines that must be followed to ensure safety, efficacy, and respect. This blog was inspired by an AVA 2018 presentation titled Empowering Vascular Access Specialists: How to Better Inform Patients of Their Options When It Comes to Their Long-Term Care. In the presentations, patient advocate and co-founder of Mighty Well, Emily Levy, and vascular access nurse and CEO of Vascular Access Consulting, Matt Gibson, presented the “Ten Demandments” as a way to portray ten important steps and considerations in safe and respectable vascular access care.
Just as the Ten Commandments provide moral guidance, the following “Ten Demandments” outline essential guidelines and are beneficial for:
- Patients who are about to get a vascular access device and want to understand how they can advocate for themselves in this process.
- Caregivers who would like to support vascular access patients in this process, especially if their loved ones may be feeling overwhelmed.
- Clinicians who place and/or help maintain vascular access devices and want an easy way to remember best practices.
Let’s delve into each demandment and understand its significance in the context of vascular access care:
The 10 Demandments of Vascular Access:
- Thou shall clean your hands before you touch my device: Hand hygiene is paramount in preventing infections. Clean hands reduce the risk of introducing harmful pathogens into the bloodstream through vascular access devices, such as PICCs, Midlines, implanted Ports, and other devices.
- Thou shall put gloves on your hands before touching my device: Gloves act as a barrier, further reducing the risk of contamination. They protect both the patient and the healthcare provider from potential infections.
- Thou shall not touch my skin after you cleaned when starting my IV: Once the skin is cleaned, it should remain untouched to maintain sterility. Any contact post-cleaning can introduce bacteria, jeopardizing the integrity of the vascular access site.
- Thou shall not pull the fingertip out of your glove, so you can feel the vein better: Maintaining glove integrity is crucial. Pulling the fingertip out compromises the barrier and increases the risk of contamination.
- Thou shall not place my peripheral IV in my wrist or bend of the elbow: Optimal placement of vascular access devices is essential for patient comfort and safety. Improper placement in areas prone to movement or compression can lead to complications. Just say “NO” if a nurse wants to place your IV there!
- Thou shall clean my catheter before you connect the syringe or tubing: Prior to any connection, the IV catheter must be meticulously cleaned to prevent contamination and reduce the risk of bloodstream infections.
- Thou shall watch for complications and know how to treat them– (this applies to patients and their families too!): Vigilance is key in monitoring for any signs of complications associated with vascular access. Healthcare providers should be well-equipped to recognize and manage these complications promptly and educate patients and their families for enhanced awareness.
- Thou shall place the best IV catheter for the medicine I am getting–If you, the patient or caregiver don’t think the right one is prescribed, then bring it up to the right clinician. Selecting the appropriate catheter size and type is vital to accommodate the specific medication and treatment plan. Advocating for the right device ensures optimal therapy delivery and patient comfort.
- Thou shall treat me with respect when I question what you are doing: Patient autonomy and involvement in your care are paramount. Healthcare providers should welcome and respect patient inquiries, fostering a collaborative and trusting relationship.
- Thou shall not keep an IV in my body that doesn’t work “just in case”: The presence of a non-functioning vascular access device poses risks without benefits. Prompt removal and consideration of alternative options ensure patient safety and comfort.
Additionally, it’s crucial to inform patients of their options, especially regarding longer-term vascular access care. Tailoring options to meet individual needs and preferences enhances patient satisfaction and overall quality of care. For example, Emily had multiple PICCs and with the help of clinicians from the Association for Vascular Access, Emily advocated for an implanted chest port, which was the best device for her lifestyle and medical needs.
In conclusion, let us remember and uphold the “Ten Demandments” of patients and their families when it comes to vascular access care. By adhering to these principles, we ensure a standard of care that is safe, respectful, and patient-centered.