Clinical Significance of a Nurse-Driven Vascular Access Protocol

A lack of standardized practice in IV placement and inconsistent availability of advanced-skilled vascular access nurses was identified at an approximately 275-bed hospital. To address the gap in practice, a performance improvement project was piloted on four medical/surgical units using the standard plan-do-check-act method of quality improvement and Donabedian’s theory of quality assurance in healthcare. The aim of the project was to determine if, in an adult population with difficult venous access (DVA), would the use of an evidence-based vascular access protocol and development of a specialized nurse team affect first-time success rates, cost, catheter dwell times, and complications of peripheral vascular access placement. Several of the Infusion Nurses Society 2016 Infusion Therapy Standards of Practice were incorporated into a nurse-driven protocol and workflow for the identification of DVA patients and combined with an evidence-based practice vascular access device (VAD) selection algorithm to guide nursing actions and improve clinical outcomes.

Clinically significant findings included decreased time from the call for assistance to successful placement of difficult IVs, as well as higher first-time attempt success rates and longer catheter dwell times when guide wire assisted peripheral IV catheters were inserted by specialty vascular access nurses. Opportunities for cost savings were identified by decreasing the number of attempts required to place an IV, fewer IV restarts, and prevention of advancement to more invasive lines. The cost analysis provides preliminary support that can be used when considering hiring additional staff to provide VAD placement after-hours and on weekends.

The results demonstrate the value of translating evidence in VAD placement into practice and the leveraging technology to improve patient outcomes through the use of EBP in vascular access. Recommendations for further study include expanding the project hospital-wide and repeating PDCA cycles. The nurse-driven protocol can implemented at other similar organizations where nurses are primarily responsible for placing peripheral vascular access devices.