Good morning all!
I have been approached by my director to see what the general comments and feedback are in the vascular access community about VAMPs. In particular, this one:
http://www.edwards.com/products/pressuremonitoring/pages/vampsystem.aspx
My director is the director of infection prevention at our facility, so I would assume she is interested in particular, if there is any information about infection risks when using these products. She wants the good, the bad...any evidence on their benefit/risks...etc.
It is my understanding that some of our ICU staff are pushing for their adoption for use...at least on their unit(s). Given our lack of experience in their use...thought it was best to see what others know about them (good, bad and indifferent) before moving any further.
Tx in advance!
Brian Gackenbach
I have not used these in clinical practice, but did include them in my chapter on Infusion Therapy Equipment in the INS textbook, page 410-11. I am sure there are studies out there about these systems, although they may be old, maybe from the 1990. I think they make a good alternative to our traditional methods for drawing blood samples from catheters. They prevent the wasting of blood and reduce manipulation of the catheter hub. I would also like to hear from someone with clinical experience using them.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
We use the Edwards VAMP where I work, I can't imagine working in an ICU without one. Iatrogenic blood loss is affects every patient even though it may not reach the level of clinical significance, except for ICU patients where it often has the potential to significantly impact patients.
I don't think there are any studies to confirm the assumed benefits of VAMPS related to infection risk, primarily because the main selling point is blood conservation. The theory is that VAMPS can decrease infection risk because you significantly decrease the amount of times a connection point is accessed. When drawing off a central line, you need one syringe to flush/draw your waste, attach another syringe (or vaccutainer adapter) to get your sample, and then attach another syringe to flush (actually another 2 syringes where I work as we flush with 20cc after a blood draw). So that's at least 3 connection manipulations for a single sample. With the Vamp, you only access the sample port once.
There are some disadvantages to a VAMP which are fairly minor. The shape of the vamp can cause it to snag on objects. There is a sharp cornered square plastic piece on the bottom that used as a handle and can be trouble if the VAMP ends up underneath a patient, although it's easily removed. If you forget to turn the stopcock when filling your tube then you'll get the diluted waste blood in your tubes. No major problems that can't be easily addressed, I would at least recommend trialing the product, or at least using them on specific patient populations such as severe anemia or lab draws more than once or twice a day.
We use the Edwards product on a-lines that are used for Flo-Tracs. For the majority of a-lines,however,we use the "Safeset":
http://www.icumed.com/criticalcare/Documents/M1-1227_SafeSet_Tip_Sheet.pdf
Both have their plusess and minuses. I find that the Safeset style is a little easier to manipulate than the Edwards. The Edwards' aspiration port is much easier to cleanse--the latex dome cleans easily. The Safeset's aspiration port is impossible to properly clean. There is a gap between the housing and the dome and you can't get at the blood that seeps under that gap. Perhaps an infection risk,perhaps not.
I have tried the Safeset on a PICC line for patient getting Q2H labs,hoping to minimize the blood loss. It worked,but there was no way to use the pressure bag to flush the line afterwards and make sure 10ml had run through. You have to improvise to do a proper flush. I have the IFU's for the Safeset somewhere if you need them.
Whichever device you end up going with,you will be decreasing your infection risk,decreasing iatrogenic blood loss and saving on nursing staff time and labor.