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How to build CVAM care bundles

It is estimated that up to 90 percent of people treated within a hospital in-patient setting receive an intravascular (IV) catheter.1 While intravascular access is vital for the delivery of fluid and medications, complications from a failed IV catheter impact not only the patient, but the healthcare system as a whole. 1,2 In particular, catheter related bloodstream infections (CRBSIs) are a significant cause of morbidity and mortality within healthcare settings.3

So, how can you improve central vascular access management (CVAM) and CVAM care bundles within your own healthcare setting? Read on for tips from an Infectious Disease expert.

Vascular access teams

Whether vascular access is through a central line, a peripherally inserted central catheter (PICC) line, a port or a peripherally inserted catheter, a dedicated vascular access team (VAT) can improve outcomes arising from vascular access devices.4 Generally, a well-functioning VAT is drawn from a range of disciplines such as infection control, nursing and medicine, and is entirely supported by hospital management.4,5

CVAM care bundles: clarity and inspiration

To help a VAT work effectively and efficiently, evidence-based guidance is readily available. The good news is that you can devise a robust care bundle, which can be tailored to the needs of your own healthcare population, using existing recommendations. However, with the plethora of guidelines from a variety of reputable sources, how do you avoid being blinded by information overload?  How do you identify which guidelines are best suited for your team and your patients?

Advice from the field

Professor Doctor Ilker Devrim, who works in the Department of Paediatric Infectious Diseases and is Chair of the Infection Control Committee, Dr. Behcet Uz Childrens Hospital İzmir, Turkey, has some advice. Speaking at the BD MACOV@23 congress, Prof Dr Devrim outlined the various ways their VAT and CVAM care bundles made significant improvement to the outcomes of hospitalised children and to their healthcare system in general.

The purpose of this short blog is to give you a starting point from which to develop your own CVAM care bundles. To this end we can turn to Prof Dr Devrim’s two over-arching rules:

  1. Always use the ‘all or nothing’ approach. So, if you are planning to emulate other care bundles, but even a single element contained within that bundle does not work for your healthcare facility, exclude that entire bundle from your options.
  2. In your care bundle, it is vital to specify guidance not just for the insertion of a vascular access device, but also for its maintenance.

What follows is what worked for Prof Dr Devrim’s team when devising their CVAM care bundles. While not all these points may apply to your healthcare facility, they represent a good jumping-off point for your consideration.

More on this topic: Danish vascular access team facilitates shift to home care

Register to read the full article and watch Prof Dr Devrim’s presentation

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References

  1. Helm RE, Klausner JD, Klemperer JD, Flint L, Huang E. Accepted but unacceptable. J Infus Nurs. 2015; 38:(3)189-203.
  2. Marsh N, Larsen EN, Takashima M. et al. Peripheral intravenous catheter failure: A secondary analysis of risks from 11,830 catheters. Int J Nurs Stud. 2021; 124.
  3. Olaechea PM, Palomar M, Alvarez-Lerma F. et al. Morbidity and mortality associated with primary and catheter-related bloodstream infections in critically ill patients. Rev Esp Quimioter.2013; 26:(1)21-29.
  4. National Infusion and Vascular Access Society (NIVAS). The Benefits of a Nursing Led Vascular Access Service Team. Published June 27, 2022. Accessed April 16, 2024 at https://nivas.org.uk/contentimages/main/NIVAS-White-paper-for-standardisation-of-vascular-access-teams-within-the-NHS_FINAL-27.06.22.pdf
  5. Mussa B, Pinelli F, Cortés Rey N, et al. Qualitative interviews and supporting evidence to identify the positive impacts of multidisciplinary vascular access teams. Hosp Pract. 2021;49(3):141-150. doi:10.1080/21548331.2021.1909897
  6. Devrim İ, Yaşar N, İşgüder R, et al. Clinical impact and cost-effectiveness of a central line bundle including split-septum and single-use prefilled flushing devices on central line-associated bloodstream infection rates in a pediatric intensive care unit. Am J Infect Control. 2016;44(8):e125-8. doi: 10.1016/j.ajic.2016.01.038
  7. Loveday HP, Wilson JA, Pratt RJ, et al. Epic3: National Evidence-based Guidelines for Preventing Healthcare-Associated Infections in NHS hospitals in England. J Hosp In infection prevention. 2014;86(suppl 1):S1-S70.
  8. Saliba P, Cuervo G, Hornero A, et al. The impact of flushing with pre-filled saline syringes on the incidence of peripheral venous catheter failure: A quasi-experimental study. J Vasc Access. 2019;21(4):490-496. doi:10.1177/1129729819888423

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