Appropriateness of Vascular Access Device Selection

Central venous access devices (CVADs) are associated with serious complications, including central line associated bloodstream infection (CLABSI), that place patients at risk for poor outcomes and are costly for hospital systems. Research suggests great variability of CVAD use in hospitals including overuse and inappropriate use of these devices which places patients at unnecessary risk for complications. Each unique patient situation involves multiple characteristics that adds complexity to their hospitalization. Clinicians make decisions regarding line selection often during emergent situations without the appropriate level of evidence to support this decision, which results in inconsistencies and variations in the use of CVADs. Vascular access nurses, specialized clinicians who place and maintain vascular access devices (VADs) in hospitalized patients, are often involved in decision making regarding VAD use. Providing these specialized clinicians with the latest evidence-based decision support tools and the knowledge needed to interpret this information to determine the most appropriate VAD for an individual patient may impact VAD utilization. Empowering vascular access nurses to appropriately evaluate and decide if a patient meets the criteria for CVAD insertion prior to placement could prevent unnecessary exposure to potentially dangerous and costly complications. The proposed project objectives include introducing an evidence-based guideline for use by the vascular access team to support VAD selection for hospitalized adult patients at a large academic medical center. Decision support guidelines are composed of evidence-based recommendations from Michigan Appropriateness Guide for Intravenous Catheters (MAGIC) resources. The algorithms to be implemented address various complex patient scenarios that challenge clinicians when choosing the most appropriate VAD. Project goals include improving appropriateness of VAD selection through recommendations from vascular access nurses using MAGIC resources as evidence-based guidelines in clinical decision making. Achieving these goals may result in a decrease in inpatient CVAD use and a reduction in serious complications associated with CVADs. Objectives are aimed at improving the quality of patient care by using the latest evidence for vascular access recommendations. Improved quality of care can reduce health care costs by preventing serious and life-threatening complications that prolong the hospital length of stay and require additional unnecessary therapies and hospital readmissions.