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How to turn a PICC team into a vascular access team

On the second day of BD MACOV@23, a virtual edition of the Multidisciplinary Advanced Course on Vascular Access (MACOVA) held from 5–7 September 2023, Professor Baudolino Mussa from the University of Turin in Italy spoke on, “The journey from a PICC team to VAT: The experience of a centre that places over 7,000 vascular access devices per year.”

Prof Mussa showed step by step how a peripherally inserted central catheter (PICC) team was gradually expanded over time to become a complete multidisciplinary vascular access team (VAT) in his hospital.

More on this topic: Make the case for a vascular access team by convincing with facts

Lack of robust clinical evidence on PICC teams and VATs

During the preliminary work leading to a European survey and publication, a lack of robust clinical evidence on the impact of VATs was identified.1 A Cochrane Collaboration systematic review by Carr et al. published in 2018 didn’t identify any published, randomised, controlled clinical trials (RCTs) comparing the efficacy of vascular care with and without VATs.2

The authors recommended that RCTs be performed to assess the performance of VATs for vascular access device (VAD) insertion and care, as well as prevention of catheter failure.2 Prof Mussa collaborated with vascular access colleagues across Europe on interviews.1 Nine VAT leads or members from six countries (i.e., Denmark, France, Italy, the Netherlands, Spain and the United Kingdom) participated in the interviews in May and June 2020.1

Six observed benefits of VATs reported by the interviewees:1

  1. More VADs inserted per year
  2. Reduced time from referral to insertion
  3. Lower length of stay
  4. Decreased complication rates
  5. Savings on cost of treatment per patient
  6. Increased patient satisfaction

In spite of these positive observations, the interview participants mentioned certain obstacles when trying to implement VATs in their healthcare facilities.1

Five barriers to VAT creation reported by the interviewees:1

  1. Lack of funding
  2. Lack of awareness on VAD selection
  3. Lack of adequate healthcare professional (HCP) training and education
  4. Lack of recognition of vascular access management (VAM) as a specialty
  5. Lack of robust scientific evidence on their efficacy

Prof Mussa explained, “Many hospitals don’t want to spend money on a VAT, because they don’t see what is the money they can get back from VAT activity.” Also in 2020, 1,449 HCPs from seven countries (i.e., France, Germany, Ireland, Italy, Spain, the Netherlands and the United Kingdom) completed a pan-European survey in July and September 2020.3 More respondents in the United Kingdom & Ireland and Italy reported having VATs in their healthcare facilities than those in other countries.3

Healthcare facilities with VATs were more likely to use tools, algorithms or guidelines for the selection of VAD.3 Those with VATs had higher rates of systematic complications monitoring and reporting.3

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

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References

  1. 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
  2. Carr PJ, Higgins NS, Cooke ML, Mihala G, Rickard CM. Vascular access specialist teams for device insertion and prevention of failure. Cochrane Database Syst Rev. 2018;3(3):CD011429. doi:10.1002/14651858.CD011429.pub2
  3. Cortés Rey N, Pinelli F, van Loon FHJ, et al. The state of vascular access teams: Results of a European survey. Int J Clin Pract. 2021;75(12):e14849. doi:10.1111/ijcp.14849
  4. Sandrucci S, Mussa B, eds. Peripherally Inserted Central Venous Catheters. 1st ed. Springer; 2014.

 

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