DR. Vineet Chopra
Assistant Professor of Medicine and Research Scientist,
The Patient Safety Enhancement Program and Center for Clinical Management Research;
Ann Arbor VA Medical Center and the University of Michigan Health System, Ann Arbor, Michigan
Friday 2:00 – 3:00pm
CHOOSING THE RIGHT VASCULAR ACCESS DEVICE: DOES SCIENCE MEET PRACTICE.
Use of the most appropriate vascular access device is the foundation of safe and reliable venous access. Ideally, device selection is informed by numerous factors including clinical context, provider training and availability of specific devices or technologies. Such decisions should also be guided by available evidence and data regarding the safety, efficacy and durability of one particular approach vs. another.
In this keynote address, Dr. Chopra will review key evidence that informs decision-making in vascular access. In discussing these data, he will show how existing evidence-based guidelines are inherently limited in the ability to inform clinical decisions at the bedside. He will also discuss key randomized controlled trials, highlighting how these have advanced the field but have also led to more questions. With growing technology and availability of various devices, the mental arithmetic of choosing the right device has only become more challenging as a result.
Consequently, substantial variation in use and outcomes associated with vascular access devices exists. Sharing data from over 10,000 patients enrolled in the Michigan Hospital Medicine Safety Consortium, Dr. Chopra will highlight such variation in use and outcomes associated with placement of PICCs as an example of just such an instance. He will discuss how these shortcomings were among the key drivers for the development of the Michigan Appropriateness Guide to Intravenous Catheters (or MAGIC) and show early application of this process to improving the use of vascular devices in hospital settings
Dr. Chopra is an Asst Prof of Medicine and Research Scientist at the University of Michigan School of Medicine and the Ann Arbor VA Medical Center. A career hospitalist, Dr. Chopra’s research is dedicated to improving the safety of hospitalized patients through prevention of hospital-acquired complications. His recent work focuses on identifying and preventing complications such as infection and thrombosis associated with peripherally inserted central catheter. Dr. Chopra is funded by a Career Development Award from the Agency of Healthcare Research and Quality and has received grant support from the National Institute of Aging, the Blue Cross/Blue Shield Foundation of Michigan and the American Heart Association. He is the recipient of numerous awards including the 2014 McDevitt Award for Research Excellence and the 2014 Society of Hospital Medicine Young Investigator Award, given to a single investigator whose work stands to most impact the field of hospital medicine in the nation. He has published over 80 peer-reviewed papers and is Associate Editor at the American Journal of Medicine and the Journal of Hospital Medicine.
BSN, CRNI, CPUI, VA-BC
Friday 3:30 – 4:30pm
VESSEL HEALTH AND PRESERVATION: APPLYING EVIDENCE FOR THE BEST OUTCOMES
Vascular access today is a high volume, high impact clinical process with much risk to the patient. Insertion of an intravenous device is the most common invasive procedure performed by clinicians with hospitalized patients. Unfortunately, little has been done to develop an intentional process for vascular access selection and management for this common invasive procedure. Traditional vascular access is reactive, painful and ineffective, often resulting in the exhaustion of all peripheral veins prior to consideration of other access options.
Evidence suggests application of methods to improve outcomes and reduce variation in care:
- The use of specialized vascular access teams demonstrates increased safety for patients
- Education of staff and patients is vital to any vascular access insertion and infection prevention program
- Positive results are maximized through systematic application of current guidelines and recommendations
- Incorporation of evidence based bundles provides the greatest impact on increasing positive outcomes including the reduction of catheter associated bloodstream infections
- Application of intentional processes mitigates risk and reduces liability
More than 7 million central venous catheters (CVCs), 3 million PICCs and 330 million peripheral IVs are sold annually in the United States alone and 10 million CVCs worldwide (iData Research, 2014). According to the CDC, selection of the right device inserted into the right location is paramount to reducing complications, specifically infection (O’Grady, et al., 2011). Fast, well-directed treatment following diagnosis is the hallmark of an efficiently managed hospital system. Clinical pathway protocols, systems of care, multi-disciplinary teams, training and organized standards lead to vascular access care that yields consistently positive results. Application of best evidence-based decision process for vascular access at admission with placement by trained specialists, followed by care and daily assessment for dressing management, health of veins, as well as continued necessity of the device are the basis of Vessel Health and Preservation.
Nancy Moureau is an internationally recognized speaker and expert in the field of PICCs and vascular access practice. She began her nursing practice in 1981, has been certified as an Intravenous Specialist since 1987 and is currently a Professional Registered Nurse staff member of the PICC/IV team at Greenville Memorial Hospital in Greenville, SC. As the owner and CEO of PICC Excellence, Ms. Moureau functions as an educational consultant, working with program development, project management, advisory boards and speakers’ bureaus to share information about vascular access.
As a well-published author, Ms. Moureau is constantly involved with research and literature analysis, providing information and interpretation for individuals, manufacturers, hospitals and groups. She is a speaker and expert throughout the US and abroad on subjects specific to PICCs, ultrasound, central lines and general vascular access. She began her PICC insertion training at MD Anderson Cancer Hospital in Houston, TX. She later studied at Gemelli Catholic Hospital in Rome, Italy, the Royal Berkshire Trust Hospital in Reading, England, and the Gartnaval Royal Hospital – National Health Trust in Glasgow, Scotland for Central Venous Catheter insertion training. Her training at these facilities included PICC, Internal Jugular, Tunneled Catheter, Axillary and Port insertions.
Most recently, Ms. Moureau chaired the International Consensus Forum for the World Congress of Vascular Access (WoCoVA) Standard Minimal Requirements for Central Venous Access Devices. Ms Moureau is also an adjunct associate professor at Griffith University in Brisbane, Australia, Nancy is involved with research through the One Million Global (OMG) Prevalence study and a member of the Alliance for Vascular Access Teaching and Research (AVATAR).
Saturday 9:30 – 10:00am
GUIDING GUIDELINES TO GREATNESS IN VASCULAR ACCESS
Clinicians worldwide rely on published Clinical Practice Guidelines to synthesise the large number of journal articles and research about best practice. Such guidelines are published by respected professional and government organisations, and are typically then used to develop local hospital or healthcare policies. So they are important documents, and we want them to be great.
But; the number of guidelines is growing and their advice is not always consistent. How can this be? Which one/s should we follow?
Guideline development often goes wrong when:
- development committees do not follow a process consistent with the AGREE II Instrument (Appraisal of Guidelines for Research and Evaluation), and/or,
- the quality and/or quantity of research available to develop the guidelines is low.
Vascular access expert clinicians can guide guidelines to greatness by addressing these weaknesses. When judging whether to use a guideline, ask ‘does it meet AGREE II requirements for good guidelines?’ When on a guideline development committee, use AGREE II. And finally, always advocate for the need for more, high-quality, adequately large, randomised controlled trials, and facilitate the undertaking of these in the clinical setting.
Professor Claire Rickard RN PhD, is the founder and Head of the Alliance for Vascular Access Teaching and Research (AVATAR Group). She is Chief Investigator B of the NHMRC Centre for Research Excellence in Nursing Interventions at Griffith University in Brisbane, Australia. She is an Honorary Fellow at the Royal Brisbane and Women’s, Prince Charles, and Princess Alexandra Hospitals, and an Honorary Professor with the University of Manchester in the UK.
Prof Rickard believes a randomized controlled trial is a thing of beauty and its joys last forever. She attempts to apply that beauty and joy to improve the care of almost all hospital patients, and many community patients who need intravascular access for treatment.
With over 100 publications, including a 1st authored paper in The Lancet, her work has significantly advanced global recommendations such as the safety of removing peripheral intravenous catheters based on clinical rather than time-based criteria.
The Mum of two, Prof Rickard was inducted into the prestigious STTI International Nurse Researcher Hall of Fame in 2012.