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A Protocol to Set Up Needle-Free Connector with Positive Displacement on Central Venous Catheter in Intensive Care Unit
Published on: July 13, 2019
A dedicated consultant-led vascular access team significantly reduces out-of-hours and emergency permanent central
John M Wells1, Wajid B Jawaid, Peter Bromley
1Department of Pediatric Surgery, Birmingham Children's Hospital, Steelhouse Lane, B4 6NH Birmingham, UK.
Insights
A dedicated vascular access team (VAT) significantly reduced emergency and out-of-hours permanent central venous access device (PCVAD) insertions. This initiative also decreased procedure times, improving overall vascular access efficiency.
Area of Science:
- Vascular Surgery
- Medical Device Insertion
- Healthcare Management
Background:
- Permanent central venous access devices (PCVADs) are often inserted as emergencies, impacting efficiency.
- Establishing a specialized vascular access team (VAT) can optimize PCVAD insertion processes.
Purpose of the Study:
- To evaluate the impact of a vascular access team (VAT) on the frequency of emergency and out-of-hours permanent central venous access device (PCVAD) insertions.
- To assess changes in operative times and overall efficiency following VAT implementation.
Main Methods:
- Retrospective analysis of PCVAD insertions before (2002-2003) and after (2005-2006) VAT establishment.
- Data collected included procedure type, list allocation, surgeon grade, and operative duration.
Main Results:
- PCVAD insertions increased by 22% post-VAT implementation.
- Emergency PCVAD insertions decreased from 24% to 13%, and out-of-hours insertions fell from 6% to 3% (P < .05).
- Median operative time for elective PCVAD insertions was significantly shorter (67 minutes) compared to emergency insertions (85 minutes; P < .05).
Conclusions:
- The introduction of a VAT significantly reduced emergency and out-of-hours PCVAD insertions.
- VAT implementation improved the efficiency of vascular access provision by decreasing procedure times for elective insertions.
Purpose:
The insertion of a permanent central venous access device (PCVAD i.e. Broviac or Hickman lines and vascuports) is often considered a low priority and performed as an emergency. In 2004, a vascular access team (VAT), responsible for all PCVAD insertions, was established in our institution to address this.
Methods:
Data were collected retrospectively on all PCVAD insertions in 2 periods (January 2002-December 2003 and January 2005-December 2006). This included procedure, list type, surgeon grade, and operative time.
Results:
During 2002 to 2003 and 2005 to 2006, 465 and 569 PCVADs were inserted, respectively (22% increase). After introduction of the VAT, the percentage of lines inserted during emergency lists fell from 24% (n = 112) to 13% (n = 72), and out-of-hours fell from 6% (n = 29) to 3% (n = 17; P < .05), respectively. Median time taken for PCVAD insertion in 2005 to 2006 was significantly less if using an elective list compared with insertions performed on an emergency list (elective, 67 [56-82] minutes vs emergency, 85 (65-110) minutes; P < .05).
Discussion:
Introduction of a VAT has led to a significant decrease in emergency and out-of-hours PCVAD insertions, despite an increase in overall activity for the period. The median time taken for elective insertions is significantly less than emergency insertions, which has increased the efficiency of vascular access provision at our institution.
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