‘Pinholes in my arms’: The vicious cycle of vascular access

Background: Vascular access devices (VADs) are essential for delivery of intravenous therapies. There are notable gaps in the literature regarding a focus on patient experience and meaning-making related to living with a VAD, specifically a central venous access device (CVAD). Aims: To explore how patients make sense of living with a CVAD. Methods: This study followed an interpretive phenomenological analysis (IPA) approach. Purposive sampling was used to identify 11 cancer patients who had a CVAD in situ. One-to-one semi-structured interviews were performed. Interviews were digitally recorded, transcribed and analysed by the lead author. Findings: Four superordinate themes were identified: the self under attack; being rescued/being robbed; protection of others/protection of self; bewilderment and dismay at lack of staff competence. Conclusion: Having a CVAD affects the psychological, social, and personal self and impacts on self-esteem and self-image. Despite this, CVADs are accepted by patients and are eventually ‘embodied’ by them.

I-DECIDED® – A decision tool for assessment and management of invasive devices in the hospital setting

Indwelling medical devices, including vascular access and urinary catheters, pose a risk for infection, and therefore daily assessment and consideration of their continued need is a patient safety priority. The I-DECIDED® device assessment and decision tool is an evidence-based checklist, designed to improve the assessment, care, and timely removal of invasive devices in acute hospitalized patients. This paper explains each step of the tool, with rationale for inclusion.

Maximising the opportunity of a self‑administration outpatient parenteral antimicrobial therapy pathway

Background: The University Hospitals of Leicester NHS Trust outpatient parenteral antimicrobial therapy (OPAT) service has expanded rapidly with more nurse-led direction. Aims: A retrospective study between 1 July 2014 and 31 December 2019 was undertaken to assess the impact of OPAT expansion on beds released for further utilisation, clinical outcomes, adverse vascular access device (VAD) outcome, and self- and family-administered parenteral antimicrobial therapy. Method: Data were extracted from the OPAT Patient Management System and from a patient questionnaire survey. Findings: 1084 completed patient episodes were recorded in 958 patients, rising from 39 episodes in 2014 to 265 in 2019. The number of beds released for further utilisation correspondingly rose from 828 in 2014 to 8462 in 2019. The proportion of patients/family members trained to self-administer rose from 25% to 75%, with clinical cure/improvement of infection remaining high at between 84.6% and 92.8% of patients annually. Serious adverse VAD events remained low throughout. The patient response was generally positive. Conclusion: Nurse empowerment within OPAT can lead to significant improvements and patient benefits, while maintaining clinical outcomes.

Innovative approaches to teaching vascular access to nursing students in the COVID-19 era

Purpose: For the student nurse, peripheral venous cannulation is one of the most stressful skills to be learned. Although some healthcare employers/establishments offer courses on vascular access and infusion nursing as part of their onboarding programs, ultimately educational institutions should share the responsibility to ensure that graduating nurses can provide safe infusion therapies. Methods: An innovative vascular access and infusion nursing (VAIN) curriculum was created and mapped onto the entry-to-practice undergraduate nursing program at McGill University in Montréal, Québec, Canada. This presented an opportunity to implement new teaching approaches. Results: Students experienced multiple new teaching approaches including multimedia and experiential learning and live simulation to ensure acquisition of knowledge and psychomotor skills. The teaching approaches had to be rapidly modified with the advent of the COVID-19 pandemic. Conclusions: The VAIN curriculum emphasizes simulation and directed practice, seeking to increase competence, confidence, and knowledge. The pandemic underscored the need for flexibility and creativity in content delivery.