Chapter 17: Vascular access devices: insertion and management
Skip chapter table of contents and go to main content
Clinical governance
Nurses who wish to undertake this role must be competent in cannulation, and they must receive additional training in theory and practical hands‐on instruction at the bedside (Bullock‐Corkhill [56], NMC [356], RCN [381]). Moureau et al. ([335]) developed evidence‐based guidelines for training in CVAD insertion and insertion itself, and highlighted the need for standardized education, simulation practice and supervised insertions in order for nurses to achieve clinical competency.
Competencies include:
- knowledge and skills in anatomy and physiology of the veins of the upper arm and central veins
- selection of the vein and equipment
- use of ultrasound and local anaesthetic
- prevention and management of complications.
A number of hospitals and organizations now provide PICC training days and programmes that combine theory and practice and that may also include the use of ultrasound and ECG technology. Dedicated PICC or vascular access teams are developing globally in most healthcare settings as they successfully contribute to the implementation of best practices and the achievement of improved outcomes for patients while reducing cost and complications (Alexandrou et al. [7], Johnson et al. [233], Kokotis [245]).
Consent
The benefits (the ability to withdraw blood and infuse medications over the long term), risks (bleeding, thrombosis, infection and malposition) and possible alternatives must be explained to patients prior to insertion. Patients must be given sufficient information, in a way that they can understand, in order to enable them to make an informed decision (Celli [67]). Written consent must be obtained. An example of a PICC consent form is shown in Figure 17.29.
Figure 17.29 Example peripherally inserted central catheter (PICC) consent form.
