Data suggests that ‘Up to 90% of hospital inpatients require IV therapy’[1]. With the number so high and wide-reaching to patients and clinicians alike, improvements to vascular access presents one of the biggest opportunities to improve practice with the goal of improving patient outcomes and experience.
Improvements to vascular access can come even before a line is placed, with a few key considerations added into the initial selection of the most appropriate vascular access device for each patient.
That’s why we’ve put together the 5 steps for Selecting the Right Vascular Access Device. Continue reading to discover more.
Or, to further help with this decision-making process see our: Vascular Access Device Selection Tool. In a PDF printable and easy to use format .
Download: Vascular Access Device Selection Tool
5 Reasons to Select the Right Vascular Access Device for the Right Patient
It is important to use a patient centric approach to choosing the right vascular access device. By selecting the most appropriate device, the patient will benefit from:
- Reduced failure rates / potential venous damage from multiple cannulation attempts
- Preserved vessel health
- Proactive treatment plan
- Streamlined therapy for future therapeutic requirements
- Reduced costs associated with reduced failure rates and additional access requirements
- Patient centric approach
The Importance of Preserving Vessel Health
A proactive approach to vessel preservation helps support safer treatment and better long‑term vascular care, it can also:
- Prevent complications such as:
- Thrombosis
- Stenosis
- Infection
- Maintain patency of vessels for potential future use.
- Minimise patient discomfort
Preserving vessel health as it protects the integrity of a patient’s veins, reduces avoidable harm, and helps ensure that vascular access remains reliable throughout their treatment journey. When vessels are well cared for, patients are less likely to experience complications, and clinicians have more options for safe, effective therapy delivery in the future.
Vascular Access Device Selection: The 5 step Process
- Step 1 – Patient Assessment
- Diagnosis
- Patient history
- Therapy – irritating therapies
- Step 2 – Infusate Criteria
- Peripheral Vascular Access Criteria
- Central Venous Access Criteria
- Step 3 – Duration of Therapy
- Step 4 – Treatment Plan:
- High Infusion Rate
- Patient Lifestyle & Preferences
- Step 5- Device Selection
- Device size
- Lumen numbers
- Impregnated lines
- Insertion sites and placement technique
For a visual aid to support this decision-making process see our: Vascular Access Device Selection Tool.
Available In a PDF printable and easy to use format.
Step 1 – Patient Assessment
When evaluating a patient for any vascular access, clinicians should consider the following patient-centric criteria:
- Diagnosis and proposed therapy
- What condition(s) are we treating for, and what therapies may be required?
- Will frequent or repeat access be needed?
- Patient history
- Does this patient have any comorbidities and / or contraindications that we should be aware of that may affect treatment/therapy?
- Does this patient have a history of difficult intravenous vascular access (DIVA) or any known vascular access abnormalities?
- Available vein health
- What is the existing condition of the vessels/veins that could be used for access (now or in future treatments)
- Vein grade assessment tools are a useful indicator to help clinicians judge vein quality.
Step 2 – Infusate criteria
Once patient assessment is complete, clinicians must then also consider the infusion criteria centre around the two following points:
- Infusate criteria for Peripheral Venous Access
- Solution is non-vesicant
- Solution is non-irritant
- Has osmolarity of less than 600mOsmol/L
- For parenteral nutrition – osmolarity of <800 mOsm/L and pH 5-9
- Infusate criteria for Central Venous Access
- Solution is vesicant
- Solution is an irritant
- Has osmolarity more than 600mOsmol/L
- For parenteral nutrition – osmolarity of >800 mOsm/L and PH >9 or <5
Note: Always be aware of drug suitability for peripheral or central administration.
For UK based clinicians, and for more information in infusion criteria please also refer to:
Step 3 – Expected Dwell Time / Duration of Therapy
At this point, clinicians must also consider the proposed duration of therapy. It is important to consider questions such as:
- What is the anticipated duration of IV therapy?
- Less than 1 week
- Between 1-4 weeks
- Between 1-3 months
- 3 months plus
- Will this patient be looking at short- or longer-term IV therapy and access?
- Will there be repeated vascular access requirements?
Although it is not always possible to anticipate the therapeutic routes, clinicians can still be proactive in their decision making for better patient experience and improved outcomes.
Step 4 – Treatment Plan
High Infusion Rates Needed
For some immediate and acute therapies, devices with high-infusion rates are needed for rapid delivery of fluids and treatment. Specific indications include patients experiencing imminent blood loss associated with accident, major surgery or for those in intensive care with multiple injuries or sepsis. For these situations, acute central venous catheters or long-term CVC’s are the appropriate choice.
In cardiac surgery, it is commonplace for Anaesthetists to place a sheath introducer, or pulmonary artery catheter, when high volume access is required, along with a standard 4-lumen/quad central venous catheter (CVC) for multi-drug delivery and haemodynamic management.
However, another alternative is to consider the use of a less invasive, an all-in-one solution such as a 5-lumen catheter with a high-flow distal lumen for high-volume infusion, coupled with four other access points for multi-drug delivery, and haemodynamic management. These high-flow catheters enable the administration of up to 1.2 litres of fluid in three minutes, which is a critical function where rapid volume resuscitation is essential to patient outcomes.
For more information on CVC selection for high-risk patients see our latest blog: Central Venous Access in Cardiac Surgery: “Why use two, when one will do?”
High Infusion Rates Not Needed in Treatment Plan: Consider Patient Lifestyle and Preferences
For non-urgent vascular therapies that do not require high-flow access, clinicians can also consider how and where on-going treatment will take place. This is especially important for longer-term IV access, where patients may not remain in a hospital environment.
To get the best patient experience and understanding their own personal preferences, clinicians can ask patients about:
- Their normal activities
- Exposure to moisture (are baths and/or swimming a consideration?)
- Is their independence a factor
- What are their abilities/resources to care for a device that is in situ
- Comfort level
- Experience of catheter options
- Personal preference
Patient lifestyle and preference examples:
Patient A) Is a more active patient who wishes to continue swimming regularly may prefer a port placement for longer term IV therapy.
Patient B) Alternatively, patient B may be needle-phobic and therefore having repeated access with a Huber needle may cause them discomfort.
Both above scenarios are valid patient preferences that should come into consideration for their treatment. Clinicians can discuss these on a case-by-case basis and decide the best device for the patient’s therapy whilst improving the patient experience.
Step 5- Device Selection and Insertion
According to the well-known guidance of Moureau et al. from their 2012 paper of vessel health and preservation, they state ‘Prevention starts at insertion’ [1].
Therefore, for best outcomes and reduced infection rates, the insertion choices for the device are just as important as the initial device selection. Clinicians will also need to consider:
- Placement technique to use to place the catheter – Seldinger or tunnelling?
- Device size – select the smallest catheter possible
- Lumen Numbers – select the fewest number of lumens possile
- Impregnated lines
- Could this patient benefit from additional protections, such as impregnated lines?
- Vessel selection
- Select the largest vessel possible
- Maximise dilution
- Promote blood flow
- Site selection
- Insertion at the healthiest site
- Placement Technique
- could this be done by ultrasound guided vascular access for better outcomes?
Conclusion
Upon reading the above list, you’ll most likely find that many of these considerations are already in place within your practice and local protocols. However, it’s important to note that with creating best outcomes for device selection it never can be a one-size-fits-all for every patient.
However, by implementing even one or two of the additional considerations could see some improvements to outcomes or patient experience.
To further help with this decision-making process see our: Vascular Access Device Selection Tool. In an easy-to-use PDF for download or print.
References
- Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure. J Infus Nurs. 2015;38(3):189-203
- Moreau et Al. ‘Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management’ (2012)
