Making a case for the standardisation of care and maintenance of vascular access devices to reduce infection.
Driving Best Practice in Vascular Access
Overview
In our recent article featured in the Clinical Services Journal (CSJ), Linda Kelly (PhD) Vygon’s International Clinical Educator, explores the national precedence being placed on infection prevention and control, and makes the case for the standardisation of care and maintenance of vascular access devices.
Read an overview of the article below or follow the button below to request a copy of the full article.
According to UK data, one in three patients will have at least one cannula inserted during their hospital stay1, estimating usage among 4.3 million patients in England during 2020-2021 alone. However, despite training on the fundamentals of care and infection prevention being taught as a standard, which all healthcare professionals must undertake in the first year of medical study, the ongoing dedication to the care and maintenance once the device is in situ can sometimes be overlooked.
What are the risks of unstandardised care?
“Although vascular access devices (VAD) have many advantages, the burden of harm associated with them is significant. Complications can occur in all devices and are a significant burden on healthcare.” - Napalkov P. et al2 (2013).
Vascular access devices cover everything from basic catheters, and peripherally inserted central catheters (PICCs) to, midlines and central venous catheters (CVCs). These devices are a vital part of intravascular therapy and can remain in situ throughout a patient’s hospital stay and during outpatient treatment. However, following device insertion it’s important that the device is managed correctly to prevent post-insertion complications, attributed mostly to poor care and maintenance practices. According to Ullman et al3: “many such complications and failures are preventable” (2016).
The European Centre for Disease Control (ECDC) estimates that 4.1 million patients per year develop infections within the European Union (EU) as a result of healthcare and 37,000 deaths result annually due to such infections. The economic burden of Healthcare Associated Infections (HCAIs) is substantial, with annual losses estimated at 7 billion euros and 16 million extra days in hospital for patients4 (WHO, 2011).
Although the above statistics are not exclusive to vascular access devices, we cannot ignore they represent a number within these figures, nor can we ignore the benefit for both patients and healthcare providers to take measures to reduce such incidences.
What is best practice of care for vascular access devices?
The practices of caring for a vascular access device are not revolutionary in their approach but are more about re-establishing the return to the fundamentals of care. At Vygon, we follow six best practices for caring for a vascular access device:
1. Choosing the right line for the patient from the outset:
Selecting the right vascular access device from the outset helps to prevent repeat cannulations, which can increase the risk of infection. In addition to proactively supporting timely clinical intervention, this also reduces vessel damage and preserves vessel integrity.
To find out more about selecting a vascular access device, see our VAD selection matrix
2. Handwashing best practice:
When placing, or interacting with the device, a clinician should always refer to handwashing best practice as well as ensure patients are advised and adequately trained on the correct handwashing technique to prevent complications.
3. ANTT® Aseptic non-touch technique [5]:
Applying ANTT Principles to protect patients from infection during all invasive clinical procedures as well as the maintenance of invasive medical devices.
4. Needle-free devices and active disinfection:
Clinicians should be aware of different devices available and how the design and internal functionality can impact associated risks of infection and the importance of active disinfection – or ‘scrubbing the hub’ as its more often known.
5. Dressing and regular monitoring of vascular access sites:
There are multiple functions of dressings, including providing security for the catheter to prevent dislodgement, creating a barrier impermeable to water and bacteria, protecting the catheter site from extrinsic contamination, and discouraging bacterial production at the insertion site; regular monitoring of vascular access device sites is crucial, permitting the ability to spot the warning signs of any issues.
6. Adequate catheter clearance:
The flushing of catheters is one of the most important preventative measures used to prevent occlusion which should be done at regular intervals to promote and maintain patency and prevent the mixing of incompatible medications and/or solutions.
Standardising training for healthcare professionals in vascular access
Alongside the 2022 National Infection Prevention and Control Manual (NIPCM) for England, additional precedence is being placed on reducing in-hospital infection rates7. The manuals objectives aim to “reduce variation and optimise infection prevention and control practices across care settings in England” as well as “improve the application of knowledge and skills in infection prevention and control”. However, currently, there are no mandatory training requirements for healthcare professionals on the care and maintenance of vascular access devices. Practices rely on initial healthcare training, and departmental or Trust procedures.
As with any skill, without regular practice and reminders vital steps can be forgotten or missed. According to the NIPCM7, a core responsibility of any healthcare professional providing care must “maintain competence, skills and knowledge in infection prevention and control by attending educational events and/or completing training”. With this in mind, we believe, now more than ever, there is a case to introduce such training and standardisation for all clinicians who interact with a vascular access device, which will ultimately reduce the potential for incidents.
Vascular Access Training and Education from Vygon UK
As a leading medical device provider with a wide range of intravascular devices, staff training and education is at the core of our offering. Through the delivery of our vascular access devices, we place an importance on partnership with the Trust to help them with standardisation of training and practice throughout departments, governance, and quality improvement projects.
We recognise the need for regular training, delivered in a way that best suits the departmental and individual needs. Whether this be on-site training within the department or Trust, workshops, or through e-learning. In addition to multiple training options, we also offer mentorship within the clinical areas and support via our intravascular hub and from our team of clinical educators. Our clinical educators hold a current Nursing and Midwifery Council (NMC) PIN number, and their continued study ensures that the knowledge remains current.
To find out more about vascular access training in your department or trust email marketing@vygon.co.uk, or follow the button below to request a full copy of the article.
References
[1] Weston, V. (2019). Assessment for Catheter Function, Dressing Adherence and Device Necessity. In: Moureau, N. (eds) Vessel Health and Preservation: The Right Approach for Vascular Access. Springer, Cham. https://doi.org/10.1007/978-3-030-03149-7_17
[2] Napalkov, P. et al. (2013) ‘Incidence of catheter-related complications in patients with central venous or hemodialysis catheters: a health care claims database analysis.’, BMC cardiovascular disorders. BioMed Central, 13, p. 86. doi: 10.1186/1471-2261-13-86
[3] Ullman, A. J. et al. (2016) ‘Central venous Access device SeCurement and Dressing Effectiveness (CASCADE) in paediatrics: Protocol for pilot randomised controlled trials’, BMJ Open, 6(6), pp. 1–9. doi: 10.1136/bmjopen-2016-011197.
[4] World Health Organization (2011) Report on the burden of endemic health care-associated infection worldwide: clean care is healthy care, Geneva: WHO. Available at: www.who.int/iris/ bitstream/10665/80135/1/9789241501507_ eng.pdf
[5] Aseptic Non-Touch Technique (ANTT) ® Found at: https://www.antt.org/
[6] Infusion Nurses Society, Policies and Practices for Infusion Therapy. (2021) Found at: https://www.ins1.org/policies-and-procedures-for-infusion-therapy/
[7] National Infection Prevention and Control Manual (NIPCM) for England. (2022) Found at: https://www.england.nhs.uk/national-infection-prevention-and-control-manual-nipcm-for-england/