Nurse practitioner-led hospital vascular access service: A quality improvement initiative

Internal quantitative assessments demonstrated that existing vascular access services (VASs) for the insertion of peripherally inserted central catheters were associated with delays in therapy initiation and hospital discharge, as well as heterogeneous complication rates.

Evidence suggests that more structured services may improve these outcomes. The aim of this quality improvement initiative was to implement and evaluate a nurse practitioner (NP)-led, hospital-wide VAS to standardise the insertion of peripherally inserted central venous catheters.

After consultation with key stakeholders at a 715-bed urban quaternary hospital, a hospital-wide VAS was designed, incorporating internal feedback and relevant published literature (February 2019). After initiation, data were retrospectively collected for all adult inpatients (aged >16 years) who underwent insertion of a peripherally inserted central catheter during 1 year before and post service initiation. Outcomes included hospital discharge delay due to time spent waiting for catheter insertion, non-intensive care unit (ICU) insertion success, non-ICU insertion complications, and postinsertion complications requiring catheter removal. Descriptive statistics were performed. Resource costs including labour and tip positioning devices were estimated for before and after the service was established.

More catheters were inserted after the VAS was established: 642 vs. 833, respectively (30% increase). Fewer patients experienced hospital discharge delays after the service was established (43 patients [15%] before versus 12 [1%] after). Non-ICU insertion success improved from 96.5% (362/375) to 98.6% (635/643) after implementing the service. The percentage of non-ICU insertion complications reduced from 9 (2.4%) before to 5 (0.8%) after. Postinsertion complications remained similar; catheters inserted by the VAS had the lowest complication rate (n = 63, 15.8%). The estimated cost saving after service establishment was 141,287 Australian dollars per year.

An NP-led VAS improved service capacity, patient outcomes, and resource utilisation while maintaining comparable postinsertion complication rates. These findings support the implementation of standardised, NP-led VASs and warrant further investigation into the specific contribution of the NP scope of practice to vascular access outcomes.