Issue link: https://blog.providence.org/i/1541294
Vascular Access Device (VAD) Selection Algorithm (Adult) Non-irritant Osmolarity of Less than 900 mOsm/L Good Vascular Integrity Poor Vascular Integrity Duration greater than or equal to 4 weeks Duration 6 days to 4 weeks Duration less than or equal to 5 days Less than 5 days Greater than 6 days • PIV • US Guided PIV • US Guided PIV • Midline • PICC • PIV • US Guided PIV • PICC Vesicant or Irritant Osmolarity of Greater than 900 mOsm/L • PIV • US Guided PIV • PICC • CVC • IVAD/Port Duration 1 dose Duration greater than 1 dose, greater than 1 day Therapeutic Intervention CRRT / Dialysis / Apheresis Hemodynamic Monitoring • Central venous catheter • Pulmonary artery catheter • Hemodialysis/ Apheresis catheter PIV Midline IVAD/ Port PICC Tunneled Catheter Subclavian Internal Jugular Femoral Lowest Risk Highest Risk Infection Risk Based on Vascular Access Low dose vesicant/irritant peripheral infusion best practices: • Refer to local policy to validate approved practice, medication, and dose • Review vesicant/irritant properties and ensure antidote (if any) and extravasation medications are readily if available • Assess site prior to administration, Use PIV or US guided PIV placed by the VAT (if available) • Avoid sites with impaired circulation and, hand, wrist or AC placement. • Ensure clear visualization of the site throughout the infusion. • Maintain free — flowing IVF to dilute the medication • Ensure good blood return from the line • Use a large vein for PIV administration with an appropriately sized cannula • Insert a new line if more than 24 hours old • Do not infuse via midline catheters Vascular Access Practice Considerations & Key Definitions: • VAD assessment should occur at a minimum q shift • Goal of VAD placement should be vein preservation and the best access device to meet the patient's treatment plan • Avoid lower extremity placement • Place and maintain device(s) with the least number of lumens for prescribed therapy • This is not a comprehensive list; additional factors may need to be considered when selecting a VAD (e.g., future need of hemodialysis) • Placement of an US guided PIV should be completed only by trained individuals • When available, please consult the Vascular Access Team (VAT) or equivalent with questions and refer to local policy • Good vascular integrity — skin is moist, without edema or bruising evident. Good turgor. Veins are visible and/or palpable. Limited comorbidities. • Poor vascular integrity — skin is thin and fragile, without visible and/or palpable veins. Multiple venous access cannulation/device placements. Significant edema, obesity (>35 BMI), comorbidity. History includes comorbidity, IVDU, CKD, lupus. Provider Education Training Manual 11 |