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Alternative IV Access Options • Use of dorsum of both hands • Central venous catheter Via internal jugular site Triple lumen catheter (short term) Tunneled cuffed catheter (long term) (Hohn © , Pro-line © , Groshong © , Broviac © ) Avoid subclavian site due to high risk of stenosis • PICC line may be appropriate for critically ill or terminal patients for whom hemodialysis is not an option. • PICC Avoidance Tool Kit: The Renal Network 4, 9, 10 www.therenalnetwork.org/home/form1.php Damage Caused by PICC Lines • Endothelial denudation • Vein wall thickening • Increased number of smooth muscle cells • Focal catheter attachments to the vein wall with thrombus and collagen formation • Higher risk of central venous stenosis, when compared to a tunneled cuffed central catheter. Forauer & Theoharis, 2003. J Vasc Interv Radiol 14:1: 1163-1168. Nursing Input • Comprehensive and multidisciplinary vascular access plan should be implemented once patient is identified as having CKD. • Education Patient, family, healthcare staff • Minimize vascular damage No IV’s, BP’s, phlebotomy in protected arm once eGFR 2.0 Use dorsum of hands instead Any surgical procedures to avoid access arm damage Restrict PICC lines or subclavian catheter placement Nursing Input • Identifying CKD patients early on Automatic calculation of eGFR with labs Use of EMR to identify and stage patients • Vascular preservation tools Use of “Save the Vein” wristbands Post signs in prominent patient specific places Arm veins suitable for placement of vascular access should be preserved regardless of arm dominance. - KDOQI UNC Model for CKD • Need for a multidisciplinary approach to effectively care for today’s CKD patient. • Timely placement of vascular access is a consistent problem. • Education of patients and other healthcare staff is essential. • Collaborative communication between all points of care has lead to improvement in CKD outcomes. Neyhart, C.D. et al. (2010). A New Nursing Model for the Care of Patients with Chronic Kidney Disease: The UNC Kidney Center Nephrology Nursing Initiative. Nephrology Nursing Journal; March-April; Vol 37 (2), 121-130. UNC Model for CKD Reprinted from Nephrology Nursing Journal , 2010, Volume 37, Number 2, pp 121-130. Reprinted with permission of the publisher, the American Nephrology Nurses' Association (ANNA), East Holly Avenue, Box 56, Pitman, NJ 08071-0056; 856-256-2320; FAX 856-589-7463; E-mail: nephrologynursing@ajj.com ; Web site: www.annanurse.org
Educating the Patient Information to be presented: CKD stages At what point would they get an AVF placed Options for when they need to have blood drawn or an IV Brief overview of vascular anatomy Benefits of vein preservation and AVF Use of the Save the Vein (STV) wristband Encouraging Self Care • FFBI (Change Concept 13) promotes patient self-management throughout CKD stages, including vascular access. • Improvement in survival and quality of life for patients that actively participate Take responsibility Active participation Dedicate the time and effort required Vigilantly follow the procedures and guidelines Work collaboratively with their healthcare team Self care - practice of activities that an individual initiates and performs on their own behalf in maintaining life, health, and well being. - Dorothea Orem’s Self-Care Theory Getting the Word Out about Save the Vein Educating and discussing with: Nephrologists Nephrology nurses APN/PAs Primary care practitioners Vascular Surgeons Interventional radiologist/nephrologist Hospital staff: ER, phlebotomy, nurses, MD Community phlebotomy labs ANNA Support • Vascular Access Position Statement: Vein preservation should be incorporated into patient teaching and care. Use dorsum of hands for all blood work/IV’s. Avoid use of subclavian catheters or PICC lines. • Enthusiastic support from Board of Directors for the Save the Vein project. • APN SIG group support and work on moving this project forward. • ANNA website: www.annanurse.org Resources Fact sheetsVascular access ResourcesSave the Vein Save the Vein Wristbands • Many nephrology/vascular organizations emphasize use of a “medic alert bracelet” or wristband to identify CKD patient and need to preserve arm veins, including Fistula First (Change Concept 2) and VAI. • Our Save the Vein (STV) wristbands were developed and successfully used in Tennessee by a CMS organization. • STV wristbands are at the heart of our project; to be given out by nephrology nurses to CKD patients that have been educated about vein preservation. Ordering Wristbands Note - wristbands are not produced by ANNA. To order online: 1. Go to: www.annanurse.org/savethevein Click “wristband order form” 2. List in box #8: "Layout #3816” 3. Special instructions box: State "Individually wrapped” 4. Leave all other boxes blank/unchanged To order by phone: 1. Call 1-800-778-1580 2. Provide Layout #3816
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