The Introduction of a
Specialist Paediatric
Vascular Access
team
Sara Melville, Lead Nurse
Vascular Access, Alder Hey
The team
Most important factor being the team members are permanent
within vascular access.
• Lead Nurse Vascular Access and Intravenous Therapy
• Nurse Specialist Vascular access and Intravenous Therapy
• Associate Nurse Specialist Vascular Access and Intravenous
Therapy
What are the Issues?
• Improving patient safety and reducing
risk to patients
• Improving patient experience
• Education and training provision
• Appropriate use of staff and resources
• Evidence based and standards of
practice
• Equipment/medical devices
Addressing Central line infection
(CLABSI) rates
Implementation of Aseptic Non touch Technique and
High Impact Intervention bundles of care
2010
Know a baseline starting figure to enable monitoring
to assess impact.
PASTA
Plan
Action
Standardise
Training
Audit
What is the impact on
CLABSI infection rates?
Has it reduced risk to
patients and improved
patient safety in relation to
vascular access?
CLABSI rates per 100,000 bed days
What next?
CLABSI rates are significantly lower, but what else can we do to continue
this downward trend?
Continue to monitor compliance with ANTT and High Impact Interventions
with regular feedback to ward staff
Implement the washing of patients preoperatively as part of cardiac and
neurosurgery prevention of SSI pre-operative bundle.
Consider/implement the use of chlorhexidine impregnated dressing in high
risk patients
Line insertion service
A logical progression from tackling CLABSI was to initiate a specialist
line insertion team.
Aims were:
•
•
•
•
To improve training and education to rotating medical staff
Improve the patient experience in relation to vascular access
To facilitate the use of human resources and skills appropriately.
To reduce the numbers of patients being referred to theatres for short
to medium term vascular access.
• To improve duration of line patency
The role
• Not to deskill medical staff to enhance and improve service provision
through training and education.
• To provide experienced clinical support during a procedure to junior
staff facilitating learning, whilst maintaining patient safety.
• Supportive to the medical team and is for difficult procedures were
unsuccessful attempts have all ready been undertaken.
• Theory and practical training and education for all MDT
• Peripheral cannulations and midline (long line) insertions
What makes us unique?
• The team undertake line insertions on all patients groups, all conditions, all
ages, all areas.
• Provide a post insertion care and maintenance support bundle for ward
staff.
• Vascular access nurses responsible for addressing CLABSI rates, not
infection control.
• Vascular access nurses responsible for all guidelines and policies in relation
to vascular access, intravenous drug preparation and administration and
equipment
Where are we now?
On average per month the team are referred to for:
35-40 long lines
35-40 peripheral cannulations
15-20 venepunctures
The current average for successful insertions is 86% with over 90% of
those successfully inserted being done on a 1st attempt.
Long line duration of patency increased from an average of 5 days, up
to an average of 10 days.
Safer Sharps legislation
• Safety Gripper needles implemented
• Safety cannula implemented
• Needle free devices for vascular
access devices implemented
• Safety lancets implemented
• Blunt filter needles implemented
• Review of butterfly needles underway
What next?
Paediatric OPAT service launching in 2014
Improve the assessment processes for paediatric patients for
vascular access
Collaboration with anaesthetics, surgery and general paediatrics to
establish what is needed and how we get there.