Q&A: IPs, Vascular Access Teams Work Together

The PICC nurse became the PICC team, as Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC, pointed out back in May in an article in Infection Control Today®. Moureau, a member of ICT®’s Editorial Advisory Board, says it’s evolved even more. Now, she prefers to use the terms vascular access specialist or vascular access teams. “What we’re finding is the need for specialists to be able to make those decisions,” says Moureau. “And not only make those informed decisions, but also to make those decisions in a manner that is the most successful and the safest.” When it becomes a vascular access team, Moureau thinks that infection preventionists should definitely be a part of that team. IPs and vascular specialists, after all, are working toward the same lofty goal—the elimination of infection

Infection Control Today®: You wrote an article for us back in May about how the PICC nurse is evolving into the PICC team. Is that still happening?

Nancy Moureau, PhD, RN, CRNI, CPUI, VA-BC: We’re definitely seeing to transition from a focus on PICC lines to a focus more generally across the vascular access devices. Because of the advent of ultrasound and the ability to pick other choices from central venous catheters, PICC lines, peripheral catheters, lung peripheral catheters, midlines: What we’re finding is the need for specialists to be able to make those decisions. And not only make those informed decisions, but also to make those decisions in a manner that is the most successful and the safest. And when we think about success, it’s not only being able to put in the right device at the right time, but also by the right person. And in terms of administration, being successful with vascular access insertion on the first attempt also translates to significant savings. Because you’re not using multiple catheters, you’re not using more supplies. And also we have to factor in, especially for our COVID-19 patients, the savings in terms of time and efficiency.

ICT®: What part would an infection preventionist play in a PICC team?

Moureau: Really, we’re calling it more of a vascular access specialist or vascular access team. And similar to infection preventionists, what we’ve discovered is that having a vascular access specialist available in the hospital—in all hospitals—has been essential for our COVID-19 patients. So, a patient comes into the emergency room and gets emergent access. But yet this patient may be long-term. If the patient continues on to the intensive care area, then in fact they may need a central line placed and have it placed very quickly. We have various recommendations that have been issued by some international groups, specifically Doctor [Michael]Scoppetuolo, providing us with some guidance on which devices are our most efficient for our patients. And it’s determined by where they go for first placement or first admission. Whether they go to an intensive care area, or they go to the regular medical floor. And in the case of the intensive care, we have to consider the different types of central lines. And for those that are not quite as emergent, you still likely need an ultrasound guided lung peripheral catheter that will last for a longer period of time. The transition from the term PICC team to vascular access team or vascular access specialist team is definitely happening. And what we’ve seen throughout hospitals in the United States as they step up in order to manage the COVID-19 emergent situations and an intensity of treatment, is that they’ve been first online in order to place these lines and place them in such a way that they can be used for treatment immediately. And the patient has long-term use.

ICT®: How do the vascular access teams separate the treatment for COVID patients from non-COVID patients? Or do they just assume that everybody could possibly have COVID?

Moureau: You know, that’s kind of a chicken or egg thing, because patients come into the hospital with symptoms, and they’re going to have to determine whether it’s a COVID-19 patient. And so the differentiation has been suspected COVID-19 patients versus confirmed COVID-19 patients. For those patients who are not COVID positive and simply have other types of symptoms, a vascular access specialist provides a level of safety that the generalist nurse doesn’t have. The evidence that we have supporting that is from Doctor [Nicole] Marsh in Australia with the AVATAR team, the Alliance for Vascular Access Teaching and Research and more and more evidence by Doctor Peter Carr and others. And even in a Cochrane Review that looks at these teams as an essential element of all hospitals in order to provide a high quality of service for their patients. And it’s not just quality, its safety, and it’s the fiscal responsibility. So, there are multiple factors involved that don’t just lend itself to the luxury of having a vascular access specialist. It now is more of an essential component of any high-functioning hospital.

ICT®: Who might be working for the vascular access specialist?

Moureau: When I use the term vascular access specialist, I’m thinking more as an individual, whereas a vascular access team may be comprised of multiple specialists, multiple people who have special training. We know from the Centers for Disease Control and Prevention, in their prior recommendations, they show that by having a specially trained person for device insertion, you reduce infections, you reduce complications overall. We’ve also seen this in some of the literature. The PIV5 Right search that was published by Lee Steere out of Connecticut, and others who have shown that by using specialists or using specialist teams to address the issue of peripheral and central access, that they get much better outcomes and a considerable savings for the hospital. The Hartford hospital in Connecticut that I just referenced with the PIV5 Right saw a huge savings as they expanded their vascular access team and allowed them to take over all peripheral access for all patients. And so that’s the kind of evidence that we need to show that the vascular access specialist as an individual or vascular access team in the larger hospitals, is necessary for hospitals in order to provide the level of care that patients deserve, and need.

ICT®: COVID-19 has forced the reallocation of a lot of resources. What’s the argument for hospitals allocating resources to vascular access teams?

Moureau: One of the questions that you asked me earlier that I didn’t fully address was how does the vascular access specialist or team work together with the infection preventionist. And when you talk about where priority should be and where allocations could be: Our priority is to minimize infections or potentially even to eliminate them. We want complications to be history. In order to achieve those goals, I see the vascular access specialist or the vascular access teams as being in a partnership with the infection preventionist. Working with the vascular access specialists in teams in order to implement guidelines, recommendations, provide education to those who are at the bedside to make sure that everyone is following policies and best practices to the level that is necessary in order to achieve our goals. A single infection preventionist or a smaller department is unable to do that. Their focus is not only on central line associated bloodstream infections, but also urinary tract infections that are associated with urinary catheters with ventilator associated pneumonia. And so there are many, many things that are on their list that must be prioritized. Aligning and partnering with these different specialty groups with the different departments that can help to implement the guidelines and make sure that things are followed will help us all to achieve the better outcomes to reduce complications and make things better for patients.

This interview has been edited for clarity and length.