Multidisciplinary Advanced Practice Nursing-Led Vascular Access Care Pathway in Patients with Cystic Fibrosis: A...

Background: Patients with cystic fibrosis frequently require repeated courses of intravenous antibiotic therapy, resulting in cumulative vascular injury, progressive depletion of peripheral venous access, and increasing complexity in long-term vascular access management. Integrating structured vascular access planning into multidisciplinary care pathways has become increasingly important for preserving venous capital, optimising vascular access decision-making, and ensuring continuity of care. Objective: To describe the development and implementation of an Advanced Practice Nursing-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. Methods: A practice-based descriptive analysis of a multidisciplinary vascular access pathway was conducted, incorporating ultrasound vascular assessment, structured clinical decision-making, and coordinated care across the Emergency Department, Cystic Fibrosis Unit, Vascular Access and Infusion Team, Hospital Pharmacy Service, and Hospital-at-Home Programme. An illustrative patient example was used to demonstrate pathway implementation in routine clinical practice. Results: Pathway implementation illustrated the feasibility of integrating ultrasound-guided vascular assessment, evidence-informed selection of vascular access devices, and coordinated home-based intravenous therapy within a multidisciplinary care model. Ultrasound-guided vascular assessment identified a suitable upper-arm basilic vein despite severe peripheral venous depletion. An Advanced Practice Nurse successfully performed ultrasound-guided midline catheter insertion, achieving first-attempt cannulation and no immediate complications. The illustrative patient completed four weeks of home-based intravenous antibiotic therapy without observed catheter-related infection, thrombosis, occlusion, catheter dysfunction, or unplanned hospital readmissions. The patient reported satisfaction with the treatment experience and the ability to maintain daily activities throughout treatment. Conclusions: This study describes and clinically contextualises an APN-led multidisciplinary vascular access care pathway for patients with cystic fibrosis requiring prolonged intravenous therapy. The illustrative patient demonstrated the feasibility of applying the pathway in routine clinical practice. Further prospective multicentre studies are required to evaluate its effectiveness, safety, reproducibility, and broader applicability.