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Recognizing the seriousness of vascular access, a most concise description of this therapy was stated by Marcia Ryder PhD MS RN, Research, Consulting and Education in Vascular Access, and Nancy Donaldson PhD RN, Director, Center for Research and Patient Care Innovation at UCSF/Stanford. Their joint statement reads as follows:
Consider the following:
- Vascular access is a high volume, high risk, high cost therapy
- Vascular access spans across the continuum... preemie to elderly and virtually all patient populations in all healthcare settings (hospital to outpatient clinic to long-term care facilities to home)
- Complications of Vascular Access Devices (VADs) result in substantial morbidity, increased length of stay, increased costs, and increased liability, therefore effective VAD care is critical to patient care quality, outcomes and costs
- Evidence does not exist to support all VAD related practice(s)
- As a result, practice policies, procedures and guidelines are an integration of evidence, expert opinion, rational extrapolation, and conservative good sense
- Hence clinical oversight and perpetual quality and outcomes monitoring is vital!
Traditional IV teams as historically structured are probably no longer the most effective method to meet the current demand. Given the above, the most prudent approach at this time seems to be to manage vascular access as a formally structured, multidisciplinary continuous quality improvement effort including a VAD CQI committee and a clinical vascular access team. This requires rethinking, reengineering and refocusing of efforts.