Vascular device considerations
Intravascular devices are an essential component of any OPAT service but they are not without risk.
Complications include phlebitis, thrombosis, localised infection, blood stream related infection and (rarely) embolisation. In order to minimise risk and optimise patient care a number of steps should be considered when embarking on a course of parenteral therapy via an OPAT service:
Is IV therapy definitely indicated?
Patients should not receive IV antimicrobial therapy when there is an appropriate oral alternative.
Is there any risk of misuse of the vascular device?
As was discussed in week one some patient groups may be at increased risk of tampering with or misusing the device. In these circumstances alternative models of care should be considered e.g. supervised therapy as an inpatient or in a supervised outpatient setting with cannulation on the day of therapy only.
Is the drug appropriate for peripheral administration, or should it be delivered centrally?
The majority of antimicrobials used in OPAT practice can be administered via a peripheral vein. There are a variety of peripherally inserted catheters including short, mid and and central lines. Check with the antimicrobial product literature and also any local guidance/ device availability in your organisation.
What is the health of the patient’s veins?
Vein quality can be assessed by the number of palpable (non-thrombosed) peripheral veins. A score between 1 (excellent) and 5 (poor) is allocated. See the accompanying “Right vein” guideline for further information.
What is the proposed treatment duration?
Proposed length of therapy will be an important determinant of choice of line. Central catheters (usually peripherally inserted) in general are preferred for longer term (>1 month) IV therapy. It is important to check what devices are available in your organisation.
Intra-vascular devices should be placed aseptically and using locally agreed protocols and care bundles for follow up assessment and monitoring to minimise complications and particularly device-related infection. Vascular devices should be removed as soon as they are no longer required to reduce risk of infection.
Read about preventing vascular device-related infections in the Epic 3 UK National evidence-based guidelines (see pages S8-S10 of PDF for summary). These guidelines provide comprehensive recommendations for preventing HCAI in hospital and other acute care settings based on the best currently available evidence. National evidence-based guidelines are broad principles of best practice that need to be integrated into local practice guidelines and audited to reduce variation in practice and maintain patient safety.
How do you think you could overcome all these potential barriers?
Taking all these factors into consideration, what do you think the best way of managing vascular devices?