Friday, 4 April 2014

Should Arterial Line Placement be a Part of Vascular Access Services? Chris Naylor, RN, VA-BC


In today’s environment of cost savings and downsizing, it is important to expand your skills and make your Vascular Access (VA) team indispensable. In other words, enable your team to be invaluable by embracing high quality, consistent training and continuing to reach forward with new technologies and procedures that can enhance your worth and ensure better patient outcomes. As a community hospital VA team, we followed and embraced professional standards as they were developed, before they were demanded. Because of this, we had extremely good outcomes.

The team was extremely high functioning in that we demanded the highest quality of work from each other. They were taught to be consistent, to do everything exactly the same way. Everyone set their tray up the same and performed the procedure with the same steps. This made it easier to train new nurses, standardizing how the tray was set up and how the procedure was performed eliminated confusion. It also made it easier to help set up and assist each other. We treated our patients like our family, and if someone on the team made a breach of the sterile field, the procedure was started over. We never risked the patient. As a result, I am proud to say that this team never had an infection from an insertion
in 14 years.

The teams made sure not to focus on delivering quality care with the skills we already had. Instead, we stressed the importance of continued education to expand skill sets. The more you can do, the more valuable you will be. If we don’t continue to advance as nurses, we won’t be doing the best we can for our patients, so I personally felt the next steps were the insertion of Arterial Lines (A-lines) and Central Venous Catheters (CVCs).

Inserting A-lines is a way for nurses to grow in their profession and expand their scope of practice. Using ultrasound guidance for insertion into veins can naturally progress to insertion into arteries. Traditionally, physicians have inserted A-lines. Having a dedicated, consistent team that may be more readily available has lots of advantages. Vascular nurses have applicable skills. They have already been looking at veins with an ultrasound for years, and this skill is transferable to inserting A-lines. Some nurses on the VA team have already inserted A-lines in emergencies when they have been assisting physicians who are not as skilled with ultrasound. This was on an unofficial basis.

Most nurses don’t put in A-lines yet because it is a new skill that requires some special training. We need more avenues for this training. Teams also need champions who will advocate for this training and education. Someone needs to drive the incorporation of A-lines into the VA practice. It is a new avenue for nurses in its infancy stage, just like CVCs. A-lines are a safe progression for these nurses. I personally think we should get away from “PICC teams”, and VA teams should encompass all vasculature. It might take a while, but I think it will eventually happen.

The first step nurses can take to move toward the insertion of A-lines is to know their state regulations and scope of practice. It is also extremely important that VA nurses stay current with their education and become certified in their field. This is accomplished by attending conferences like AVA, and INS, attending local network meetings, staying up to date on current literature and by reaching out to companies like Teleflex that offer training courses.

Nurses are the future of vascular access, and they should be investigating all areas of it so that, where appropriate, they can advance their practice and provide the best care possible to their patients.


Chris Naylor, RN, VA-BC, recently retired after a 44-year career as a nurse with background in Critical Care, Emergency Medicine and Vascular Access. She developed a very successful PICC program in a community hospital in Santa Rosa, California and was the manager of Procedure and Resource Nurses and the PICC team. She was also a Clinical Educator for Bard Access, a member of Association for Vascular Access (AVA) since 2000 and was on the Board of Directors of Bay Area Vascular Access Network (BAVAN) for many years.
Posted by TopicsInVascularAccess at 2:59 PM in /
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