International Nurses Day: empowering nurses in vascular access

Happy International Nurses Day to all nurses out there!

Nursing can sometimes be undervalued by healthcare leaders, policy makers and society at large.¹ The International Council of Nurses chose the economic power of care as the theme for this year’s International Nurses Day.¹

The aim is to create a paradigm shift by “demonstrating how strategic investment in nursing can bring considerable economic and societal benefits.”¹ On a day that honours nurses around the world, we ask the question: Can nurse-led intravenous (IV) teams empower nurses?

Nurse empowerment relies, in part, on mobilisation of resources.² For Mudallal et al., “…power is the ability to attain, organise, and control resources, information and support to achieve organisational goals”³ in a work environment. Leader empowering behaviours can have an impact on worker performance and workplace empowerment.³

Five potential benefits of leader empowering behaviours:³

1. Enhanced work meaningfulness
2. Increased participation in the decision-making process
3. Recognition for high-performance
4. Improved attainment of organisational goals
5. Autonomy and freedom from bureaucratic barriers

When nurses take ownership of vascular access management (VAM) with their holistic view of the patient, time from vascular access device (VAD) referral to placement is reduced with nurse-led central venous catheter (CVC) teams,⁴ while patient satisfaction increases during nurse-led peripherally inserted central catheter (PICC) insertion when compared with radiologists.⁵

Nurse-led VATs may help increase the economic power of healthcare facilities by reducing IV complications.⁶ They may also have a positive impact on patient safety and satisfaction, while increasing organisational efficiencies.⁷

In healthcare facilities where VATs haven’t been implemented yet, the following stories may inspire those with the goal of creating a specialised IV team of their own.

More on this topic: Invisible to invaluable: Honouring International Nurses Day

International Nurses Day: Empowering nurses with a midline team in Poland

Multiple insertion attempts in small veins can lead to significant distress in patients and can be time-consuming for healthcare professionals (HCPs) who place VADs.⁵

It may be difficult to place an implantable port in patients with certain kinds of neck cancer because of tumour location.⁸ Midline catheters and PICCs may be suitable alternatives to centrally inserted central catheters (CICCs) in certain clinical situations.⁸

Let’s head to Poland to meet Maciej Latos, a nurse practitioner in the intensive care unit (ICU) at the Medical University of Warsaw (MUW) Hospital. During the COVID-19 pandemic, Mr Latos was caring for patients with respiratory failure who didn’t always require a CVC, but still needed reliable vascular access.⁹

ICU colleagues suggested he place midline catheters as an alternative to CVCs.⁹ Midline catheters are indicated for IV therapy lasting up to 4 weeks.⁸ Mr Latos and his colleagues developed a protocol and nursing staff were trained on midline echo-guided insertion.⁹

At first, midlines were only placed in patients with difficult venous access (DIVA).⁹ But they soon expanded midline insertion to patients without DIVA as well.⁹

A team of nurses at the MUW Hospital was then trained to place peripheral intravenous catheters (PIVCs) using ultrasound guidance.⁹ Their IV team is made up of 10 nurses and 3 physicians.⁹ It has inspired other hospitals in Poland to develop their own teams.⁹

International Nurses Day: Empowering nurses with a PICC team in Czechia

Now, let’s discover how the first PICC team in Czechia was implemented. Six nurses at the Faculty Hospital Prague Motol in Prague attended a 3-month training programme to learn PICC and midline catheter placement using ultrasound, electrocardiogramme (ECG) and fluoroscopic navigation.⁸

Ultrasound guidance was used by two of the six members of the team to place these catheters.⁸ Lisova et al. conducted a study on this PICC team.⁸ During the study period, they placed a total of 167 PICCs and 162 midline catheters.⁸

PICC complication rates tend to be higher in healthcare facilities without a dedicated PICC team.⁵ Complication rates for PICCs placed in this hospital were comparable to rates reported in the literature, as well as complication rates for PICCs placed by Czech physicians.⁸

Andrew Barton, Chair of the National Infusion and Vascular Access Society (NIVAS) recommends a PICC team made up of two specially trained nurses and a clinical assistant as a starting place for a specialised IV team.⁷

Beyond midline and PICC teams on International Nurses Day

Once a midline or PICC team is established, nurses may be empowered to expand the service to a full VAT. This expanded team would include an assessment process, tool and an algorithm, as well as HCPs from different medical fields.^7,10

Nurses on VATs reported:^10,11

• A sense of autonomy¹¹
• Confidence in speaking up¹¹
• A collaborative role in the VAD selection process¹¹
• Improved satisfaction¹⁰
• Support from management¹¹

VATs can contribute to nurses’ sense of empowerment,^10,11 while increasing the economic power of care.^6,11 If you don’t already have a specialised IV team in your healthcare facility, why not start one today, on International Nurses Day?

More on this topic: How to turn a PICC team into a vascular access team

References