The vast majority of children at The Hospital for Sick Children require intravenous or vascular access devices that are able to deliver fluids and medications as part of the treatment plan for their health condition or for diagnostic tests. Indeed many children require devices for longer term treatment lasting a few weeks to years. The high degree of patient acuity, coupled with the fact that SickKids patients are children of all ages, can make even the seemingly simplest of peripheral intravenous line (PIV) insertions a challenge.
Recognizing the need for the re-emergence of a specialty team dedicated to initiating PIV and managing other types of vascular access devices (PICCS, ports, CVL), the Vascular Access Service was redeveloped and found a new home within the Diagnostic Imaging Department in June 2007. Starting with two full-time (Francine Faubert, Susan Kirkos) and three part-time staff (Roze Kovalakovska, Susanne Bush, Ray Lam), the Vascular Access Team focused on hiring staff and building on their expertise in PIV insertion. By December 2008, the team was completed with an additional nine RNs for a total of 7.1 FTE. During this time, the Vascular Access Resource Nurses (Mari Acebes-Carcao, Alona Abramovich) were integrated in the Vascular Access Service while still maintaining a very close working relationship with IGT and reporting to the manager for Vascular Access Service. We have also increased the number of nurses in the Vascular Access Resource role from 1.0 to 1.5 full-time equivalents.
Another priority for the Vascular Access Service has been to increase the overall capacity at SickKids for performing PIV insertions by developing core groups of in-patient nursing staff and medical residents. To facilitate this process and to establish a consistent, structure approach that adheres to safe occupation health and safety practices—to keep our staff safe—and adheres to good infection control practices and practice standards—to keep our children safe—a Clinical Instructor role was initiated in September 2008. The role was open to all Vascular Access Team members and Kim Newcombe was the first Vascular Access Team member to hold this one-year term position. Her pursuit of specialty certification with Infusion Nurses Society and the Canadian Vascular Access Association has helped her expand a comprehensive training program for paediatric PIV insertion that provides intensive one-on-one support for people new to the skill along with on-going follow-up.
As we continue to build the Vascular Access Service, we will move toward expanding the PIV insertion education program to first-year medical residents, more nurses and medical radiation technologists. We will build on the role of the Vascular Access Team by developing each team member’s knowledge and expertise in managing complications from central vascular access devices (CVAD), work on quality improvement projects aimed at reducing the number of CVADs requiring repair, and explore technologies that will assist in visualizing peripheral veins for those difficult PIV insertions in children. We will also improve our ability to deliver excellent procedural pain management strategies for PIV insertions by collaborating with the various in-patient units and supporting organization-wide initiatives. Other key projects will be the renewal of the policy and procedures associated with vascular access and the development of clinical practice guidelines to support health-care teams in selecting the most appropriate vascular access device for their patients. The Vascular Access Service is looking foward to another full and exciting year.
Advanced Nursing Practice Educator
Vascular Access Resource Nurses
Mari Acebes-Carcao, Deborah Kern, Alona Abramovich
Vascular Access Team
Paul Dupuy, Francine Faubert, Susan Kirkos, Shelly Philip Laforest, Alla Raitsin, Josephine Lazaro-Caetano, Nicole Anstey, Roze Kovalakovska, Susanne Bush, Sheri Backman, Ray Lam, Eileen McGuchan, Pam Sattz