Care and Maintenance to Reduce Vascular Access Complications

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Care and Maintenance to Reduce Vascular Access ComplicationsRecommendation 20.0Nursing best practice guidelines can be successfully implemented only where there are adequateplanning, resources, organizational and administrative support, as well as appropriate facilitation.Organizations may wish to develop a plan for implementation that includes:■ An assessment of organizational readiness and barriers to education.■ Involvement of all members (whether in a direct or indirect supportive function) who willcontribute to the implementation process.■ Dedication of a qualified individual to provide the support needed for the education andimplementation process.■ Ongoing opportunities for discussion and education to reinforce the importance of best practices.■ Opportunities for reflection on personal and organizational experience in implementing guidelines.In this regard, RNAO (through a panel of nurses, researchers and administrators) has developed theToolkit: Implementation of Clinical Practice Guidelines based on available evidence, theoreticalperspectives and consensus. The Toolkit is recommended for guiding the implementation of theRNAO guideline Care and Maintenance to Reduce Vascular Access Complications. Level IVDiscussion of EvidenceGraham et al. (2002) indicate that in order for guidelines to be implemented successfully, a critical stepmust be the formal adoption of the guidelines by the organization. One way this can be accomplished is byincorporating recommendations into policy and procedures with respect to care and maintenance of vascularaccess devices. This key step helps to provide direction regarding the expectation of the organization andfacilitates integration of the guideline into such systems as the quality management process.New initiatives such as the implementation of best practice guidelines require strong leadership fromnurses who are able to transform the evidence-based recommendations into useful tools that will assist indirecting practice. It is suggested that the RNAO Toolkit (2002) be considered to assist organizations todevelop the leadership required for successful implementation. Refer to Appendix M for a description ofthe RNAO Toolkit: Implementation of Clinical Practice Guidelines.44
Nursing Best Practice GuidelineResearch Gaps & Future ImplicationsThere is limited Canadian clinical research in terms of randomized controlled trials and/or cohort studiesto support current practices regarding vascular access care and maintenance. Information is notconsolidated in one area or guideline and the development panel were challenged in gathering currentrelevant information for the development of this guideline.The development panel, in reviewing the evidence, has identified several gaps in the research literaturerelated to VAD care and maintenance. In considering these gaps, the following research priorities wereidentified that would benefit client outcomes:Interventions■ Effectiveness of various cleansing solutions for reducing VAD complications.■■■■■■●●Which solutions are most effective for which VAD?Which solutions are most effective for clients with factors that predispose them to VADcomplications?Effectiveness of various types of dressings on reducing VAD complications.Effectiveness of various securement methods for preventing VAD migration.Effectiveness of scheduled thrombolysis treatments to reduce CVAD thrombolytic occlusions in clientswith hypercoagulation.Effectiveness of various flushing techniques and solutions and their impact on VAD complications.Effectiveness of heparin versus 0.9% normal saline for locking.Effectiveness of changing IV administration sets every 96 hours versus every 72 hours.Education■ Effectiveness of targeted client education on reducing VAD complications.■■Effectiveness of various nursing education techniques in academic and clinical settings to fostercritical thinking around care and maintenance of vascular access devices.Effectiveness of increasing nursing knowledge of patient types and disease process on improvingclient outcomes.Monitoring/EvaluationDevelopment and validation testing of audit and surveillance tools for complications of VAD.AdvocacyDevelopment of Ontario legislation mandating the use of safety engineered devices.45
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