AVA Conference Report
Submitted by Carolyn Johnston, IVNNZ Inc. Educator. Originally printed in December 2007 IVNNZ Inc. Newsletter
I attended the 21st Annual Association Vascular Access (AVA) conference held in Phoenix, Arizona 7-10th September 2007. Phoenix is the capital city of Arizona and has a population of 1.2 Million. Arizona is a modern city in the middle of a desert. The temperature ranged from 20° (low) to 40.5° (high) whilst I was there. When I got off the plane, it felt like I was being wrapped in a wool blanket. I can see why they like their crushed iced margaritas! I've never experienced such a dry heat. The conference was held at the Phoenix Convention Centre, 639 delegates in attendance. There was also a large assigned room within the conference centre for the 65 exhibitors and poster presentations. Although I was the only one attending from NZ, there were delegates from all over the world present. It was a multidisciplinary conference, the majority however being nurses. The following are chosen highlights from presentations that I attended over the three and a half days.
Keynote Presentation: Lessons from the Flight Deck Patrick Broune, President of Global Safety Management Harry Sax, Surgeon-in-Chief, Miriam Hospital
Very motivational speakers, who presented on "Crew Resource Management" and described how aviation had developed techniques to optimise team performance, reduce errors and improve the workplace environment. This was a system known as "Crew Resource Management". They discussed different ways to communicate i.e. red talk / green talk, and the development of checklists. Remembering that what you say is not nearly as important as how you say it. They discussed ways to empower staff in hierarchical situations. Most errors are preventable and "Crew Resource Management" has significantly reduced error in aviation. The mission was increase knowledge, change behaviour and reverse bad habits and practices. The introduction of checklists reduced Crew Resource Incidents by 96% in three years.
Topical Antiseptics: Separating Fact from Fiction in Catheter Antisepsis Art Greg, BA MBA, NPDP, Aplicare, Inc., Monument, CO
Raised awareness around the varying discrepancies between current regulatory guidelines and standards, making it difficult to decide which products will help reach the best catheter outcome for the patient. Also discussed, was how the varying products worked and should be used, how they are tested and qualified, and their relative strengths and weaknesses. An underlying message was that it's not always the products fault. That sometimes, it's the lack of knowledge around its correct use and application.
Acquiring IV Skills: It's more than Just Sticks
Rebecca Jensen, RN, MS, CRNI, Indiana University- Purdue University, Fort Wayne
Conducted a survey examining the nursing students perceptions of their own knowledge base and comfort related to IV therapy skills and knowledge. The following conclusions were reached. Students that were taught IV skills through interactive learning techniques (i.e. at a set up clinical station) and then buddied with a nurse in clinic for a clinical practicum of inserting IVs, was the preferred method of learning.
No! I'm not pulling That PICC back...It's At the Caval Atrial Junction: Establishing Consensus for Optimal Catheter Tip Position on the Chest Radiograph Peter Verhey, MD, MS and Jamie Bowen Santolucito, RN, CRNI Oregon Health and Science Hospital.
OHSU campus inserts 230 PICC's per month, estimating around 3000 PICCs insertions per year. A review of professional guidelines for placements of central venous catheters, revealed a lack of research and literature defining the anatomic location of the caval-atrial junction (CAJ) on the chest radiograph. Peter Verhey developed an educational programme in 2003 for their organisation, as there was confusion and inconsistency of placement of the catheter in the distal SVC and CAJ. The education provided, covered PICC insertion and x-ray interpretation and was well received by all staff attending the sessions
Exhibitor Theatre Sessions
These sessions were designed to provide a forum to discuss and disseminate information and knowledge related to devices / products. The speaker has either participated in research, clinical trials, or has actual practice experience with the product.
Device Product Trials Gregory J Schears, MD Mayo Clinic
Inadequate catheter securement is an unrecognised patient safety issue that contributes significantly to catheter related complications, including dislodgement, occlusion, infiltration and infection. Research was gathered from 83 Hospitals performing product trials on a catheter stabilisation device. 10,164 patients either got tape or stabilisation device. The results showed that 67% reduction in complications was seen in the stabilisation device group compared to tape. No surprises there.
Round Table Session - "Save That Line Program".
Janet Pettit, MSN, RNC, NP, CNS Doctors Medical Centre, Modesto, CA
This was a clinical round table session and 17 clinical topics were being offered and I had to choose just one to attend. I chose the save that line program session to get a better understanding of how they implemented the program, as it appeared well known across the State. My mission was to find out how they distributed the information at a national level.
This program was designed by AVA in conjunction with the Oley foundation and INS. Initially it was called the "keep me safe programme' which employed simple techniques to decrease the incidence of catheter associated bloodstream infection. Back to basic's approach. Through education / posters on hand washing, skin antisepsis and catheter hub cleansing they believe that the SAVE that line is unique in that it not only provides information related to best practices inserting and accessing vascular devices but offers a critical component that highlights methods to motivate colleagues to adopt these practices. The idea is to provide a consistent tool, which can complement other national programmes that hospitals may have already implemented such as the Health Care Improvement save 100,000 lives campaign.
For further information about this programme head to the AVA website.
Approach to the Difficult Vascular Access Patient Michelle Lin MD, San Francisco
Dr Lin talked about the trials and tribulations of the Emergency Department patient with failing venous access and coming up with a new approach for vascular access in the adult populations. The use of ultrasound guided approach for CVC placement as opposed to the blind approach was adopted. The discussion focussed around the challenges faced with getting colleagues on board with this new approach, with the outcome being optimal catheter tip placement.
Non-Vascular Application for Vascular Devices Salomao Faintuch M.D., Interventional Radiology, Boston.
Alternative routes for treatment using traditional vascular access devices has been utilised by Dr Faintuch. The access devices have been adopted for Intra peritoneal administration of fluids for those with limited vascular access and also antineoplastic drug delivery (i.e. ovarian cancer trial). Included in this experimental phase was Intrathecal catheter for analgesia and peritoneal accesses for ascites drainage, which has shown a low complication rate with very successful outcomes. Dr Faintuch is hoping to publish the findings later in the year.
SVC Syndrome Jacqueline M Fritz, RN, MSN, CNS
Defining SVC syndrome and the complications associated with the obstruction of the SVC. I will write an article about SVC syndrome for the next IVNNZ newsletter.
Achieving Zero Catheter Related Blood Stream Infections (CRBSI) Sophie Harnage, RN, BSN, Clinical Manager Infusion Therapy Services Sutter Roseville medical Centre
The goal was to develop a bundle (pathway) that would reduce CRBSI within their medical facility. The presenter outlines the process they went through, outlining the key components as:
- Maximal barrier precautions
- All PICCs placed by ultra sound guidance / upper arm basilic vein of choice
- Biopatch and chloroprep swab stick and statlock device
- Daily monitoring by PICC team
- Saline flush 8hrly
We are yet to introduce dedicated PICC teams here in New Zealand that provides a complete service from insertion, and management of until removal of the PICC. America appears to be strides ahead of us, in this field of thought and practice. From the studies completed in America, with the zero CRBSI rates, literature will soon be available to support this statement.
My overall impression of the conference, was that it was well organised and the calibre of speakers was of a high standard. A large proportion of the presentations were focussed on education, placement and management of PICCs. However this focus was deemed relevant when comparing the amount of PICCs inserted annually in the States. The conference gave me the chance to learn and expand on my own knowledge base. The networking opportunity was great. America has well organised dedicated PICC teams. However I believe New Zealand does extremely well for a small country. We already have established protocols and guidelines for vascular access within our own organisations and a willingness to share that information across the industry.
I would like to thank all those who supported me financially to attend this conference, it was an amazing opportunity.