Vascular access devices (VADs) are the most common therapeutic medical device used in modern medicine. The success of most acute and chronic life-sustaining therapies across all ages and patient populations is dependent on reliable vascular access. While a critical part of medical treatment, VADs are high volume, high risk medical devices with substantial potential for costly adverse events. Patients may suffer a multitude of sequelae from vascular access failures, including the need for repeat invasive procedures, venous depletion from repeated catheterization, escalation to more invasive central venous access devices with associated higher risk profiles, extravasation with skin necrosis, catheter line associated bloodstream infections (CLABSI, BSI), interruption of medical therapies, longer hospital stays, and unwarranted cost. Despite the potential harm, VADs are often simply considered a means to an end.
Continued advancements in VAD and ultrasound technology has broadened our capacity to provide more complex intravenous therapies with an expanded selection of peripheral and central catheters. Currently, vascular access is implemented by virtually every discipline. Any one patient interacts with numerous clinicians during their hospitalization journey. The patient is at the mercy of, for the most part, clinicians with only general knowledge of evidence-based vascular access practices and expertise resulting in a piecemeal approach to patients’ needs. The same predicament exists in many long-term acute care facilities, outpatient infusion centers, homecare, and nursing homes. The field of vascular access is under-recognized and unappreciated as a specialty practice. The result is little oversight, accountability, or ownership for the (mostly preventable) morbidity and mortality associated with VAD use across the continuum of care.
The national success of CLABSI reduction due to the application of best practice insertion/care and maintenance bundles demonstrates the power of using research, surveillance, and broad-based collaboration/education to improve patient safety. But this has not been applied to the reduction of the excessive occurrence of adverse events and harm related to peripheral access devices. The financial pressures of CLABSI penalties inappropriately shifted the use of central venous access devices to peripheral devices with utter disregard to near equivalent infection rates, excessive catheter failure rates, and precarious depletion of the upper extremity vasculature.
Significant ambiguities remain regarding device selection, device insertion, care and maintenance, and adverse event reporting in all care settings that threatens patient safety and inadequate surveillance that neglects recognition of patient harm. We need a long-term effort of dedicated multidisciplinary, multiorganizational alliance to solve these issues if we are to improve outcomes and reduce patient harm related to vascular access devices.
