Forum topic

I have discovered an advantage to going to bed totally exhausted; you don’t hear the life flight helicopter flying in and out of the hospital all night.

I made it to the breakfast after a quick 3 hours of sleep. Dr. Nifong dusted off his studies in engineering to take us through a mathematical journey. The folks from Arrow brought him in to talk about how vessel flow rates are affected by VADs. It was actually very interesting. Turns out the affect of the catheter on flow could range from negligible to more then 50% reduction depending on where the line lies within the vessel lumen. Given the variable present in the living body, with all of its dynamics, it is likely that the affect of our VADs is considerable. This was one of those “make you think” kind of presentations.

I am also happy to report that Dr. LeDonne and Jamie seem to have gotten that misunderstanding worked out.

The first general session was Accreditation and Standards Improvement: Today and Tomorrow. Mark Schario presented some interesting history about the Joint Commission. He reported that Florence Nightingale was the first person in the medical profession to list or define a set of standards for a hospital in 1858. The medical record, as a necessary part of medical care, was first suggested as a standard by the American College of Surgeons in the 1920’s. That group continued to be a leader in setting standards of care for hospitals until the formation of the Joint Commission in 1951.

After the brief history lesson he talked about how Joint Commission has surveyed in the past and how they do it now. He discussed how change in our profession has influenced the Joint Commission’s process to keep up with those changes and technology to assure the best quality of care possible.

Next we had Oral Abstract presentations. There were a couple of outstanding presentations that could have been a full hour general session instead of the 15-minute snippet we got. They represented what I would consider to be “must know” information that could lead to basic changes in the way we provide care and could prevent thousands of healthcare acquired injuries annually.

First up was Dr. Pittiruti from Italy. He has been coming to AVA for a few years now and his stories of his group’s efforts to improve VAD standards of care in Italy are both fascinating and inspirational. His small group has worked very hard to make significant changes in their country. They have gone from 1,000 PICCs sold in that country annually to over 700 trained PICC nurses placing lines throughout the country. They devised an awesome ultrasound training model using a turkey leg and latex tubing. Hats off to him and his colleagues for their efforts and success.

The next session was presented by Wendy Kaler, a microbiologist. I just can not stress how pivotal I think this work is. I would have loved to have heard this on day one. She designed a controlled prospective study to look into the effectiveness of disinfection of various mechanical valves.

She inoculated 300 valves (4 different brands) with a custom bug solution which contained several common organisms (Staph, Candida and Pseudomonas). All studies were done using just inoculated valves and valves with hyperal within the lumen to facilitate growth of any contaminates. She prepped the valves using 70% alcohol, an alcohol/CHG mix and a control with nothing. She also did both preps using 5 seconds and 15 seconds of friction. All possible configurations were repeated 10 times.

The controls of course passed loads of organisms. The 5 second preps also passed significant loads. Here is the kicker, EVERY SINGLE 15 SECOND PREP HAD ZERO GROWTH. The length of prep was the only variable. Stop and let the implications sink in.

This would seem to indicate that what valve device you use or what you prep it with, is not nearly as important as how long you apply friction in your site preparation before accessing. It sure got my attention.

In the presentation The Effect of an Educational Intervention on RN PICC Knowledge, Confidence and Psychomotor Skill, the authors described how their concern over knowledge retention of annual PICC line care training was being retained led to the development of a new and innovative program. After the course was designed, they presented it with testing of knowledge, skill performance and perceived confidence. After 3 months, testing was repeated and retention was good.

The final presentation from Sophie Harnage, Achieving Zero Catheter Related Blood Stream Infections: 15-Month Success in a Community Based Medical Center was another earth mover for me. Fifteen months with zero infections! Now that is something to shout about, absolutely amazing! This was done by applying a bundle to insertion, care and maintenance.

We heard a lot about bundles at this conference. It seems from all accounts that this is an effective way to address issues in our institutions. I expect to be hearing more bundle success stories next year.

Next Dr Lin, an ER-based clinician, presented Approach to the Difficult Vascular Access Patient. She developed a pneumonic tool to help establish a systematic approach to VAD insertion in the difficult patient. She had a lot of illustrations and was interesting to listen to.

And the grand finale! Trends for the Future of Vascular Access: What Will We Be Doing in 2015? Mary Deschneau took a stab at the crystal ball, perhaps a bit of her hopes and wish list tossed in, and presented one possible direction healthcare and VAD management might be going in the future.

She sees shortages moving the IV team into a multidisciplinary VAD Department. She sees technicians doing some of what RNs do and RNs doing all types of VADs with MD back-up on the most challenging cases. Her vision includes evolving technologies that would simplify and provide novel routes for administration of medications. She sees CMRs for all with benchmarking across all areas. Only time will tell how close her vision is, but change is inevitable and we are all onboard for the ride.

The conference this year was the best ever and I mean that. No one I have spoken to disagrees. As this next year progresses, we will see AVA grow and change to meet the challenges of the evolving VAD profession and market. I intend to be part of the future. I hope all readers will join me by participating on some level, no matter how small, with AVA and join me next year at the conference in Savanna, GA. If everyone will just come to that meeting, I will not have to write this another year, LOL.

I am currently waiting at the airport for my delayed flight. It seems that weather across the country has messed with a lot of schedules. Nancy Trick and her husband are also delayed and were kind enough to invite me to sit with them and enjoy the fine airport cuisine. Cindy from Fort Worth caught me napping. A couple other folks ask me if I had finished my last day’s blog yet as I boarded the plane. If you are reading this, then I made it home, eventually. I love travel. Not!

Be safe, be happy my friends and colleagues, see you next year,

Tony West, RN, CRNI