Marcia A. Ryder, PhD MS RN FNAP: BD: Consultant (Ongoing); Eloquest Healthcare: Consultant (Ongoing), Grant/Research Support (Ongoing), Speaker's Bureau (Ongoing); HAI: Consultant (Ongoing), Grant/Research Support (Ongoing); ICU Medical: Consultant (Ongoing), Grant/Research Support (Ongoing)
The major shift to the use of peripheral vascular access devices (PVADs) in the U.S. to avoid CLABSI has created a major patient safety challenge. Administration of inappropriate drugs/solutions for peripheral administration, disregard for catheter:vein ratio, and repeated replacement of failed catheters is tolerated as a trade-off to avoid CLABSI penalty. Subsequently harmful thrombotic events increase with loss of peripheral vasculature. Can we reduce the risk of these harmful outcomes? The "midclavicular" catheter tip position was abandoned in the mid 1990’s due to a perceived increase in catheter related venous thrombosis. More recently, global experience with catheter tip position in the distal and proximal axillary vein, and the proximal subclavian vein has demonstrated improved outcomes compared to other PVADs. Practitioners in the United States continue to reject the potential benefit without consideration of current evidence. Why? In this session we will examine the current data and practice recommendations to expand our options to prevent patient harm.
Learning Objectives:
Understand the anatomical and flow dynamic differences between basilic or brachial vein and properly positioned axillary or subclavian catheter tip positions.
Examine the current evidence evaluating adverse events and outcomes of the various midline tip positions.
3. Incorporate appropriate use into the device selection process.
