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The e-news publication of the Association for Vascular Access AUGUST 2019 | VOLUME IX | ISSUE 3



2019 AVA SCIENTIFIC MEETING D-TEAM UPDATE Alana K. Fusco, RN, VA-BC™ | Chair – D-TEAM, AVA Scientific Meeting, 2019

The excitement is building for what is surely going to be the best AVA Scientific Meeting yet! It is difficult to believe that we are just a couple of short months away from the AVA family reunion in fabulous Las Vegas! It is not too late to register for pre-meeting workshops and for the main meeting. Be sure to register by Sept. 13 before prices rise again! Our team is gearing up to get to work again, to ensure a successful event. Don’t forget, the AVA Scientific Poster Committee revised its criteria, created new guidelines and developed new judging


review questions based on those changes. These changes provide a more substantive scientific poster display. The conference app will be available at the end of September. It is highly recommended that you install it prior to attending the conference. You can utilize the app to plan what sessions and events you will attend, keep track of CE credits, view speakers, download slides for presentations you plan to attend before you head to Las Vegas and network with others. See specific opportunities for networking in the table below:



First-Time Attendee Reception & AVA Essentials

Thursday, October 3

5:30-7:00 p.m.

Pediatric Reception

Thursday, October 3

5:30-7:30 p.m.

Friday, October 4

5:30-7:30 p.m.



Exhibitor Block Party

Sunday, October 6

5:45-6:45 p.m.

Industry Partner Showcases

Sunday, October 6

4:45-5:45 p.m.

October 5-6

12:00-1:30 p.m.

Opening Hall Reception Complimentary Coffee Breaks

Complimentary Lunch in Exhibit Hall Other areas you want to be sure you spend time are the Exhibit Hall, scientific poster kiosks and The AVA Foundation booth. As always, follow AVA on social media: LinkedIn, Twitter, Instagram, Facebook and Pinterest for the latest updates, news, events, photos and videos. We also hope to see your contributions to these pages as 2 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

well. Just use the hashtag #AVASM19. Some other key reminders: layer your clothing! Temperatures VARY GREATLY inside and outside of the meeting venue. Wear sensible, comfortable shoes within Caesars Palace and while visiting surrounding attractions, as the walks to those locations can get CONTINUED ON NEXT PAGE


is proud to announce its

Dawn McFadden BSN, RN, CRNI®, CHPN Emily Larsen, RN, BN Kerrie Curtis, RN Catherine Rayburn, RN, MNSc, CPN, CRNI®, VA-BC™ Patrick Evangelista, BSN, VA-BC™ EMPOWER ONE TO IMPACT MANY SCHOLARSHIP RECIPIENT:


Cailin Ford, BSN, RN-BC, VA-BC™

for the

Scientific Meeting


Agi Szekacs, RN, BSN, CCRN, VA-BC™ Jamie Webb, RN, MSN, VA-BC™

D-TEAM UPDATE, CONTINUED FROM PREVIOUS PAGE lengthy. For the budget-minded attendees, and considering you probably aren’t a millionaire (yet!), there is a Walgreens across the street from Caesars Palace where you can purchase the basics if needed. There are also ample areas within the resort to stock up.

AND: Bring a favorite sports jersey! Sunday, October 6, is Jersey Day! Showcase your team spirit! We are so thrilled to welcome you to the adventure of learning and Las Vegas. 

Can’t wait to see you there! AUGUST 2019 | 3

For more information on the PediSIG and how to join:

Special Note From Our PediSIG D-TEAM Reps The content focused on neonatal and pediatric vascular access at the 2019 AVA Scientific Meeting is going to be magical. As is typically the case, this year’s content will appeal to practitioners from novice level to experienced. miniMAGIC and the new VANGUARD Guidelines will help clinicians navigate through difficult vascular access decision making. Contemplate how you would apply these guidelines to complex vascular access scenarios presented in this year’s pediatric grand rounds. Interested in evolving practices such as extended

dwell or midline catheters for your patients? Can you imagine using ultrasound-guided technology with neonatal peel away sheath introducers? Not only will this year’s scientific meeting offer breakout sessions on each of these topics but registering for and attending the PediSIG Pre-Meeting Workshop on October 3 can assist you to lay the groundwork for safe implementation of any new practice. A legal nurse expert will also provide PediSIG Pre-Meeting attendees with insight into unsafe implementation of innovative approaches to vascular access.



AVASM19 PEDIATRIC SESSIONS Pre-Meeting Workshop – Being a Pioneer in Vascular Access: Leading the Way to Safe Clinical Change While Protecting and Expanding Your Practice Thursday, October 3, 1:30-5 p.m. | LEARN MORE

Oh, the Places You’ll Go! How to Develop a PICC Program Through Multidisciplinary Collaboration

The Journal to Zero in the NICU: The Legacy of a Mentor Saturday, October 5, 5:45-6:15 p.m. | LEARN MORE

General Session – Informing Our Pediatric Practices With miniMAGIC: Ready for the MAGIC! Sunday, October 6, 9:15-10:15 a.m. | LEARN MORE

Friday, October 4, 2-3 p.m. | LEARN MORE

General Session – VANGUARD Guidelines for Preservation of Venous Access: An Overview

5th Annual PediSIG Neonatal and Pediatric International Grand Rounds

Sunday, October 6, 10:15-11:15 a.m. | LEARN MORE

Friday, October 4, 3:15-4:15 p.m. | LEARN MORE

Making Your First Stick Count: Identification and Management of Children with Difficult Peripheral Venous Access Friday, October 4, 4:30-5:30 p.m. | LEARN MORE

Proving the Value of Vascular Access Teams Through Collaborative Quality Improvement Efforts: An Exercise in CLABSI Reduction in a Pediatric Hospital Saturday, October 5, 2:30-3:30 p.m. | LEARN MORE

“Stuck in the Middle” – More Than a PIVC, But Not Quite a PICC; Function and Outcomes of Midlines Saturday, October 5, 3:45-4:45 p.m. | LEARN MORE

Learning the Curve: Assessing Competency in Ultrasound-Guided Vascular Access Procedures in Pediatric Patients Saturday, October 5, 5-5:30 p.m. | LEARN MORE

A Retrospective Look at Ultrasound-Guided Peripheral IV Insertion at a Tertiary Pediatric Hospital Saturday, October 5, 5:45-6:15 p.m. | LEARN MORE

Three Strikes and You’re Out: A Patient’s Lifelong Experience with Multiple Medical Complexities, Chronic Access Needs, and Depleted Veins Sunday, October 6, 2:15-3:15 p.m. | LEARN MORE

Pettit Scholar Breakout Session – It’s a Numbers Game Monday, October 7, 7:30-8:30 a.m. | LEARN MORE

Better Together: Collaborative Efforts Between A Vascular Access Team and Dedicated Wound Care Team to Effectively Manage, Treat, and Prevent Serious Harm PIVs Monday, October 7, 8:45 a.m.-9:45 a.m. | LEARN MORE

Bridging the Gap: Implementation and Evaluation of a Midline Program at Two Large Pediatric Institutions Monday, October 7, 10-11 a.m | LEARN MORE

Ultrasound-Guided Peripherally Inserted Central Cather Insertion with Peel Away Introducer in Neonates Monday, October 7, 11:15 a.m.-12:15 p.m. | LEARN MORE

AUGUST 2019 | 5


If you are making the trip to Las Vegas for your first AVA national meeting, we encourage you to join us at the reception for a drink. The reception is a great place to receive valuable information about what you can expect from the conference. Members of the AVA Board of Directors will join us to welcome you and answer your questions about the conference and AVA in general. Please join us on Thursday at this great networking opportunity to get your questions answered, your welcome gift and maybe win a door prize!

The Membership Engagement Committee (MEC) has been busy these last few months. A heartfelt thank you to the volunteers on the committee who have put countless hours into making our projects a success, including the work to promote Vascular Access Specialty Day, October 5. This date specifically honors AVA founder, Suzanne Herbst, on her birthday, and we plan to celebrate it in style at the 2019 AVA Scientific Meeting in Las Vegas. The MEC held a contest to select this year’s slogan for Vascular Access Specialty Day and received more than 100 entries! Thank you so much to all for your creative ideas – it made for a difficult decision to choose the winning slogan. This year’s slogan is “Improving Patient Outcomes, One Vessel at a Time,” submitted by Teresa Ortiz, MSN, RN, of Philadelphia. Teresa received a one year AVA membership for winning the contest.

The MEC is also managing the First Time Attendee Ambassador program again this year, matching up AVA Ambassadors (those volunteers who have attended more than two past AVA Scientific Meetings) with first-time attendees who request one. This program aims to provide a one-on-one relationship to ease the stress of attending for the first time. Ambassadors will reach out to the first-time attendees before and during the meeting to answer questions and provide guidance, camaraderie and friendship. This program has sparked some friendships that long outlast the annual meeting.

We also researched the process of instituting a proclamation and shared the steps and a sample proclamation with AVA network leaders and membership. We hope you follow the channels necessary to request a proclamation to name October 5 Vascular Access Specialty Day in your city, county or state. The MEC looks forward to celebrating Vascular Access Specialty Day with everyone in Las Vegas and hearing what you have done to celebrate in your workplaces and networks.

The MEC works all year round, not just before our annual meeting. The committee always looks for new ideas and suggestions from you to keep members engaged and active in AVA. What can we do to facilitate your involvement all year long? How can we encourage local network members to join AVA nationally? We would love to hear from you! Please send feedback to Chris Cavanaugh at ccavrn@att. net. See you in Las Vegas!

We have also been working hard to organize the First Time Attendees Reception at the scientific meeting on Thursday, October 3, from 5:30-7 p.m.

October 3, 2019 5:30 -7:00 pm Milano Ballroom III-IV



In my home state of Wisconsin, cows are a pretty big deal. While researching evidence-based practice (EBP) models in school I came across an article that drew an analogy between tipping sleeping cows in a pasture to ridding sacred cows in our daily practice. Needless to say, I was intrigued. The introduction of Sacred Cow Gone to Pasture: A Systematic Evaluation and Integration of EvidenceBased Practice (Hanrahan et al. 2015) began by describing the urban legend that cows could be tipped over with a quick push because they sleep standing up. However, I can attest that this is not the case. Even if the animal was sleeping upright, the law of physics suggests that it would likely take six people of average strength to topple an upright cow, that is if the animal would even allow you to get that close (Collins 2013, Sep 06). This analogy is certainly relatable to any area of nursing practice and unquestionably applicable in vascular access. In 2014, I attended my first AVA national scientific meeting and a speaker suggested that to minimize bleeding and risk of infection during the placement of a peripherally inserted central catheter (PICC), Vascular Access Specialists (VAS) should attempt to dilate first, dilate up if needed, and only as a last resort use a skin nick (dermatotomy). I immediately texted my colleagues back home urging them to give this a try. We had been taught only one way to insert a PICC and never wavered with our use of a scalpel for every line insertion. Albeit a seemingly small change in practice, putting down our scalpels and inserting the PICC without nicking the skin was

putting a sacred cow out to pasture. We only placed PICCs one way and never considered an alternative approach. When a patient experienced site oozing related to the dermatotomy, the solution was to apply hemostatic agents rather than consider why the complication occurred. And because our team was not tracking outcomes, we did not understand how often this complication happened, how frequently we used hemostatic products, or how many unscheduled dressing changes occurred as a result of the oozing. I didn’t need a lot of evidence to support this change in practice but in retrospect wish that I had done a better job assessing the impact of this change. I didn’t have baseline data to compare to. Did our infection rate change? Did we reduce the use of hemostatic agents to control post-insertion bleeding? How did avoiding dermatotomy impact patient satisfaction or translate to cost savings? This moment flipped a switch for me. I began to scrutinize everything I was doing as a VAS, discussing and debating ideas with colleagues and encouraging them to do them same. I began reading and researching with earnest to better understand vascular access practices. Many routines become entrenched and we resist change. There is the we’ve always done it that way attitude or fear that questioning a practice may be received negatively. There is also fear of change and having to learn something new and yet others who simply don’t appreciate someone rocking their boat. We need to put our sacred cows out to pasture, but how do we do that? Certainly, randomized controlled trials (RCTs) would provide CONTINUED ON NEXT PAGE AUGUST 2019 | 7

ELIMINATE SACRED COWS, CONTINUED FROM PREVIOUS PAGE the best evidence to guide all components of our practice. While evidence gained through RCTs is vital, it also expensive and time consuming. And, let’s face it, we’re all not equipped (education, financial, time, or manpower) to carry them out. In reality, only between 10 and 40 percent of what clinicians do is covered by RCT evidence and it is often true that the best evidence is our own observed aggregate data (Haughom 2015). I looked at the information our team was collecting and realized we were only recording a log of tasks we accomplished every day. What we did had value, but there were no outcomes tied to the procedures we did. This was another sacred cow: like many teams, we were taught to maintain a procedure log but never considered expanding our data collection. I tried to use the electronic medical record (EMR) to assess our outcomes but soon realized the information retrieved was not as reliable or meaningful as I thought. For example, the EMR may allow nurses to copy and paste the same information from shift to shift. This explained the pattern of sluggish PICC lines that finally became occluded with no accurate documentation reflecting when the change in line performance occurred. Central line and PICC dressing changes often did not clearly state why the dressing change was needed. Sadly, some EMRs still lack an accurate and consistent place for clinicians to document missed attempts for intravenous (IV) line insertion. I now travel to consult and educate vascular access clinicians across the country and though it may not be related to the purpose of my visit, I will always ask how or what data the team is tracking. There is wide disparity in the answers I receive. While some have started an organized data collection in an electronic spreadsheet, many still struggle to get started in the process or expect that


the EMR is doing the task. Those using spreadsheets admit that the data is not graphed or assessed regularly. For data collection to be done well, it must become part of the workflow rather than distract from it. Data collection should be an ongoing process, not an episodic one. Too often clinicians want to implement a change or try a new product but have no baseline data to measure to compare or measure the impact of the change (Haughom 2015). This is a call to action. In order to eliminate the sacred cows from your practice it’s imperative that you track your practice outcomes on an ongoing basis. More important though is the data you collect will allow you to make better decisions for your patient based on their needs and preferences. Of course, if you prefer to go the route of trying to tip the cow in the pasture by yourself, please do. Evidence already supports strength in numbers, so I highly recommend going the route of gathering data instead.

REFERENCES Collins, N. (2013, Sep 06). Cow tipping myth dispelled. The Telegraph. Retrieved from news/science/science-news/10289862/Cow-tipping-mythdispelled.html Hanrahan, K., Wagner, M., Matthews, G., Stewart, S., Dawson, C., Greiner, J., . . . Williamson, A. (2015). Sacred Cow Gone to Pasture: A Systematic Evaluation and Integration of Evidence-Based Practice. Worldviews Evid Based Nurs, 12(1), 3-11. doi:10.1111/wvn.12072 Haughom, J. (2015, Oct 27). 5 Reasons the Practice of Evidence-Based Medicine Is a Hot Topic. Retrieved from


OBJECTIVES: 1. Identify 3 situations when gloves should be worn in healthcare. 2. Understand the 2 types of gloves available and when to use them. 3. List 3 reasons why gloves are not a substitute for hand hygiene. a. Tears and defects b. Not changing and doing hand hygiene between moments increases risk of transmission c. We may not don and doff them correctly

GLOVES: ARE THEY A SUPERPOWER? Superpowers are great, right? Iron Man’s suit, Wonder Woman’s magic bracelets, Violet’s invisibility – they all protect their owners from harm and create a sense of safety. An additional bonus I personally love is when they wear or use them, these superheroes can utilize their superpower to protect others from harm in addition to themselves. But you don’t see Iron Man ALWAYS wearing his suit, do you? He only puts it on when he needs it to protect himself or rescue others from potential danger. Superheroes learn when to use their superpowers to affect the greater good. A potential superpower all healthcare workers (HCW) have access to is great hand hygiene. A piece of this power is appropriate glove use. However, there have been studies that show HCW may tend to treat gloves solely as if they were Iron Man’s suit or Wonder Woman’s bracelets, instead of the entire process of good hand hygiene. How many times have you seen a hospital employee wearing gloves in the hallway while carrying a meal tray to the nutrition room? Or while taking a routine blood pressure or temperature reading on a patient? What about in the elevator as they transport a patient to a procedure? Are gloves alone a superpower that fully protects the HCW and patients from the transmission of organisms? Or, are they something that, like all superpowers, need to be used wisely and only when necessary?

One of the potential risks to vascular access specialists (VAS) is exposure to blood and body fluids while performing vascular access catheter insertion and performing care and maintenance of those catheters and sites. Along with a cap, gown and mask, gloves are one of the foundational personal protective equipment (PPE) tools of the trade for VAS to protect them from such exposures. Correct and appropriate glove use are a basic premise of hand hygiene. But basic doesn’t always mean intuitive. According to a 2015 systematic review, gloves are one of the most misused and overused tools in the PPE toolbox. The review included 23 studies, which came to the conclusion that compliance (use of gloves for correct situations) with glove use among HCW is poor, leading to the often overuse and misuse of gloves. In those studies, the major break in compliance was the failure to change gloves between procedures on the same patient (Picheansanthian & Chotibang, 2015). Considering the Keynote Speaker at the 2019 AVA Scientific Meeting is Prof. Didier Pittet, MD, MS, CBE, the Director of the Infection Control Program at University of Geneva Hospitals who leads the World Health Organization (WHO) Collaborating Centre on Patient Safety, this is a great time to review the basics of our hand hygiene superpower. By making the best glove choices based on when and what type then layering in knowledge on where hand hygiene fits into the picture, you ensure as much possible protection for you and your patients during glove use – or the lack of use. Per the WHO, gloves, both sterile and non-sterile, should be worn for two main reasons: • To reduce the risk of contamination of HCW hands with blood or other body fluids if there is potential for that type of exposure. (i.e., insertion of a vascular access device) • To reduce the risk of germ dissemination to the environment and of transmission from the HCW CONTINUED ON NEXT PAGE AUGUST 2019 | 9

GLOVE USE IN VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE to the patient and vice versa, as well as from one patient to another (Glove Use Information Leaflet, 2019). Many times, gloves are necessary when caring for a patient with a highly transmissible disease or multi-drug resistant organism requiring contact precautions. When is it truly appropriate to wear gloves in a healthcare setting and what type of gloves are needed? WHO has created a handy “Glove Pyramid” to help make those decisions. As vascular access specialists, most of you are aware of the need to wear sterile gloves when you perform vascular access (Glove Use Information Leaflet, 2019). At the top of the glove pyramid, sterile gloves usually have more precise sizing and are made to a higher standard, as determined by the U.S. Food and Drug Administration (FDA) and American Society for Testing and Materials (ASTM). This give the wearer better sensitivity and precision while performing tasks. The middle layer of the pyramid addresses usage of examination or non-sterile gloves (NSG). NSGs should be used in situations where there is a potential for touching blood, body fluids, secretions, excretions and items that are visibly soiled with body fluids and should be removed immediately after followed by hand hygiene (Glove Use Information Leaflet, 2019). Gloves are not recommended for HCW use when there is no potential for exposure to blood, body fluids or a contaminated environment (i.e., contact precautions, outbreak or an epidemic situation). The

WHO pyramid lists many examples of when not to wear gloves and yet it is common to see HCW wearing gloves in these situations. There is some interesting research around why this happens. Loveday et al. performed an observational study to examine how HCWs use NSGs via an audit tool and conducted interviews with staff to determine glove use perceptions. Below are a few of the themes teased in these interviews: • Gloves provide a barrier between the HCW and the patient which they felt protected the HCW from potential threat of infection transmission • Glove use may save time by being a substitute for hand hygiene • Changing gloves might be a time waster • HCWs may assume that patients expect them to wear gloves when caring for them This same study also found that nurses used gloves inappropriately 55% of the time and in more than 40% of those moments, there was a risk of crosscontamination (Loveday et al., 2014). In summary, glove use for inappropriate moments of patient care could potentially increase the risk of HCW transmission of organisms to the environment, their patients and themselves (Wilson et al., 2015). Gloves were created to protect the HCW from exposure to blood and body fluids. However, in the effort to contain contagious infectious diseases (i.e., contact precautions), gloves have evolved into a barrier that can help reduce the risk of pathogenic organism transmission to the environment and patient. U n fo r t u n a t e l y, CONTINUED ON NEXT PAGE “Glove Use Information Leaflet.” 2009. PDF File.


GLOVE USE IN VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE glove use in contact precautions may confuse hand hygiene moments because the HCW is wearing gloves for the totality of patient care. This may be a factor in the HCW perception that glove use can be a substitute for hand hygiene (Jain et al., 2017). But remember superheroes: Gloves are not the superpower – great hand hygiene is the superpower. The Centers for Disease Control and Prevention (CDC) as well as WHO and other organizations have published guidelines on what appropriate hand hygiene in healthcare settings should look like. Healthcare facilities are given the leeway of choosing which guidelines to follow, but are asked to choose guidelines, create hand hygiene policies and education around their guidance and assure HCWs are complying. Glove use (or not use) is/should be a piece of hand hygiene compliance measurement.

Hygiene,” let’s look at a few hand hygiene moments that might get missed during glove use.

MOMENT 1 Performing hand hygiene before putting on gloves HCWs may be unaware of all of the organisms they might have picked up from the telephone, the computer keyboard, personal items (I know people whose cats take naps in their purse), the coffee cup or the supply cart that. If hand hygiene is not performed before glove use, pathogens could be potentially be transferred to the glove box and other gloves touched in that box courtesy of this lack of sanitization. A few

Focus on caring for a patient with a central venous catheter Based on the WHO “My 5 Moments for Hand


Immediately before any manipulation of the catheter and the associated intravenous medication administration system, such as: 2a. Catheter insertion (before putting on sterile gloves), catheter removal (before putting on clean, non-sterile gloves), dressing change, drawing blood, or before preparing associated equipment for these procedures 2b. Accessing (opening) the administration set and infusion system 2c. Preparing medications for infusion into the catheter

Immediately after any task that could involve body fluid exposure, such as: 3a. Inserting or removing the catheter 3b. Drawing blood from the catheter

“My 5 Moments for Hand Hygiene.” 2015. PDF File.

AUGUST 2019 | 11

GLOVE USE IN VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE • Any manipulation of a patient’s catheter • Any manipulation of the patient’s medication administration system • Catheter insertion (before putting on sterile gloves) • Catheter removal (before putting on clean gloves) • Dressing change (before putting on clean gloves and before putting on sterile gloves) • Drawing blood (before putting on clean gloves) • Accessing the medication administration set • Preparing medications for administration into the catheter (My 5 Moments for Hand Hygiene, 2019).

studies found NSG boxes to be contaminated with bacteria – the potential source being contaminated hands from HCWs as they pull gloves from the boxes (Jain et al., 2017). Consider the potential for organism transmission from the HCWs hands to their gloves as they put them on, thus potentially moving those organisms to the patient during care. When an indication for hand hygiene precedes a contact that also requires glove usage, hand hygiene should be performed before putting on gloves (Glove Use Information Leaflet, 2019).

MOMENT 2 Before a clean/aseptic procedure


Hand hygiene should be performed immediately before any clean or aseptic procedure. This means after you’ve gathered all of your supplies, gotten the patient situated and prepped and before you don sterile or clean gloves (whichever indicated for the procedure). If we focus on the VA moments, many of those will be before:

Quick, complete CRBSI coverage.

After body fluid exposure risk This would involve doing hand hygiene after any task that might involve body fluid exposure, such as: • Inserting or removing a catheter (immediately after removing indicated gloves) CONTINUED ON NEXT PAGE

With 360° coverage, our CHG-Impregnated foam discs kill CRBSI-causing bacteria within two hours1 and reduce fungus and yeast growth.2 7-day protection

Provides ongoing protection from bacterial growth around insertion site.1


Kills Staph Aureus at 99.99% (4-log reduction) in under 2 hours.1


Of CLABSIs are preventable with evidence-based practices.3, 4

Stop by Booth 416 at AVA to learn more about adding Aegis to your CRBSI-prevention protocol. References: 1. Data available upon request. 2. Data on file. 3. Association for Professionals in Infection Control and Epidemiology. Guide to Preventing Central Line-Associated Bloodstream Infections. Washington, DC; APIC Implementation Guides, December 2015. Available at: http:// Accessed December 21, 2016. 4. Zimlichman E, Henderson D, Tamir O, et al. Health Care-Associated Infections: A Meta-Analysis of Costs and Financial Impact on the U.S. Health Care System. JAMA Intern Med. 2013;173(22):2039-2046. Available at: fullarticle/1733452. Accessed November 18, 2016. ©2019 Medline Industries, Inc. All rights reserved. Medline is a trademark of Medline Industries, Inc. MKT19W118348 / 3


GLOVE USE IN VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE • Drawing blood from a catheter (immediately after removing indicated gloves) • Removing/changing a soiled dressing (immediately after removing indicated gloves) (My 5 Moments for Hand Hygiene, 2019). One of the indications for hand hygiene when caring for patients is when you move from a dirty task (i.e., removing a vascular access dressing, cleaning the environment or a patient’s skin) to a clean or aseptic task (i.e., placing a new vascular access dressing, placing a vascular access catheter, accessing the line). This is one of the biggest challenges of hand hygiene and glove use (Picheansanthian & Chotibang, 2015). When a hand hygiene moment arises while the HCW is wearing gloves, then gloves should be removed, and hand hygiene like the use of a hand sanitizer or hand washing must be performed (Glove Use Information Leaflet, 2019).

MOMENTS 4 AND 5 After touching a patient and the patient’s surroundings Though HCWs may feel safe and protected with gloves (Jain et al., 2017), gloves do not provide complete protection against hand contamination. Gloves have the potential to have small defects or holes which can lead to hand contamination while wearing. Wearing gloves that are too small can also potentiate these defects and cause glove failure in the form of rips or tears (Ellis & Camardella, 2005). HCW also have the potential to contaminate hands during glove removal. In a 2015 study by Tomas, et al. of 435 glove and gown removal simulations, contamination of skin or clothing with fluorescent lotion occurred in 46% cases. Contamination occurred more frequently CONTINUED ON NEXT PAGE AUGUST 2019 | 13

GLOVE USE IN VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE with gloves (52.9%) than gowns (37.8%) (Tomas et al., 2015). Hand hygiene after glove removal remains the basic way to assure hand decontamination after glove removal (Glove Use Information Leaflet, 2019). Vascular access clinicians are superheroes in the healthcare world. They are responsible for assuring patients get the best possible vascular access in the safest possible way that prevents complications and infections. Like Iron Man and Wonder Woman, all superheroes have their own superpower, including vascular access clinicians. While gloves are an important tool of vascular access clinicians, the true superpower that protects is great hand hygiene which includes appropriate glove use coupled with cleaning hands at appropriate moments in patient care.

REFERENCES Ellis, K., & Camardella, E. (2005). Hand Hygiene and Glove Issues: Promoting Compliance and Education. Infection Control Today.


Glove Use Information Leaflet. (2019, June 19). Retrieved from World Health Organization: gpsc/5may/Glove_Use_Information_Leaflet.pdf Jain, S., Clezy, K, & McLaws, ML. (2017). Glove: Use for safety or overuse? American Journal of Infection Control, 14071410. Loveday, H., Lynam, S, Singleton, J, & Wilson, J. (2014). Clinical glove use: healthcare workers’ actions and perceptions. Journal of Hospital Infection, 110-116. My 5 Moments for Hand Hygiene: Focus on caring for a patient with a central venous catheter. (2019, July 25). Retrieved from World Health Organization: https://www.who. int/gpsc/5may/HH15_CentralCatheter_WEB_EN.pdf?ua=1 Picheansanthian, W., & Chotibang, J. (2015, May 15). Glove utilization in the prevention of cross transmission: a systematic review. Retrieved from https://www.ncbi.nlm.nih. gov/pubmed/26447080 Tomas, M., Kundrapu, S, Thota, P, Sunkesula, V, Cadnum, J, Mana, T, . . . Donskey, C. (2015). Contamination of Health Care Personnel During Removal of Personal Protective Equipment. Journal of the American Medical Association, 1904-1910. Wilson, J., Prieto, J, Singleton, J, O’Connor, V, Lynam, S, & Loveday, H. (2015). The misuse and overuse of non-sterile gloves: application of an audit tool to define the problem. Journal of Infection Prevention, 24-31.

You probably already know about the ISAVE That Line campaign AVA launched in 2006 to bring crucial principles of vascular access device management directly to the bedside. Putting patients first, ISAVE encourages and emphasizes a “back to basics” approach, essential to reducing the risk of infection and improving the management of all vascular access devices.

On the cliniciancentered version, ISAVE stands for:


Implement insertion care and maintenance bundles


Scrupulous hand hygiene


Always disinfect every needleless connector


Vein Preservation


Ensure Patency

Introducing our NEW addition to the ISAVE family that supports this program from the ground level: A patientfriendly version. Written and edited by patients and caregivers, this new resource is completely FREE as a downloadable PDF. Please share and distribute this resource in your facilities, with your colleagues, on your social media platforms, with your patients and with your family. We simply ask that you not amend it without prior permission from AVA.

On the patientcentered version, ISAVE stands for:


Inform us right away


See us check your IV often


Ask us to clean our hands


Value your veins

If you’d like laminated full-size sheet versions of this patient asset already printed, we have those available for sale in the AVA store in packs of 10 for $25.


Expect us to follow basic rules

Click here to purchase yours.

Remember, purchasing official ISAVE assets directly helps AVA advance its mission, which is Protect the Patient | Educate the Clinician | Save the Line. You can also support the AVA Foundation, which focuses on advancing Education, Research and Innovation in vascular access. Take the pledge, be involved and join AVA in our mission to keep our patients free of infection!

Find out more about this exciting addition at

A Guide For Patients and Families




S welling T emperature Change O ozing P ain



Is it working? Is there Swelling, Temperature change, Oozing, Pain? Is your IV dressing clean, dry and not peeling? Is your IV still needed?


Expect us to wash our hands or use hand sanitizer when going in and out of your room.


We have technology to help us place your IV. If you are not getting IV fluids or medicines, you might not need an IV. Protect your IV from accidently getting pulled out.


or find out more online.

We will talk with you about your IV needs. We will select the best IV for your care. We will choose the best site for your IV. We will ask for help if we cannot get your IV after 2 attempts. We will clean your skin before inserting your IV. We will scrub the end of your IV every time we use it.

The information presented in this PDF is free to download and share and made available by The Association for Vascular Access (AVA) strictly for educational purposes. This document is meant to provide general information and understanding of Vascular Access devices and procedures. It is not meant to provide specific medical advice. AVA, it's Board of Directors, staff and members are not liable for outcomes associated with your care. AVA encourages the use of this document for Vascular Access education, provided it is not modified. Please share it with clinicians, patients and their families and attribute this resource to AVA. You may also include the links to our additional resources (if applicable). AVA's informational resources educate these clinicians, patients and their families to ensure they receive safe Vascular Access care. Feel free to print, post and share this document within your healthcare institution, as well as on social media. If you have questions, please contact

Stay up on the latest at AUGUST 2019

| 15

IQ is proud to bring you a series of

Vessel Health and Preservation

articles by several of the authors featured in AVA’S Vessel Health and Preservation: The Right Approach for Vascular Access

Do you have your Enhanced Edition yet?


Since the inception of the Vessel Health and Preservation (VHP) concept in the mid-2000s, the first poster presentation on the VHP quadrant model in 2010 and the publication in 2012 (Moureau et al., 2012), the concept of preserving vessels through a model integrating evidence-based practices has been embraced by clinicians working with vascular access devices (VADs). In this age of evidence application, a systematic process of best practice application from initiation of patient admission and treatment to discharge and completion of IV therapy makes both patient safety and economic sense. Through

a team of individuals issues were studied, problems identified, and consensus was achieved into what has become VHP. The body of knowledge included in the VHP model has become extensive, requiring a clear understanding of the components, and a planned roll-out of education and process application. This complete information is now available in book form, published through Springer Nature, as well as an enhanced edition in the form of an e-book on Amazon Kindle, Apple iBooks and Barnes & Noble NOOK through The AVA Foundation and sponsored by the Australian Vascular Access Society (AVAS), the CONTINUED ON NEXT PAGE


VESSEL HEALTH AND PRESERVATION, CONTINUED FROM PREVIOUS PAGE Infection Prevention Society (IPS) and the National Infusion and Vascular Access Society (NIVAS).

WHAT IS VHP? VHP is a model (see figure below) founded upon a philosophy in which the patient’s vasculature and historical use for infusion therapy are considered and prioritized as a key healthcare objective. Beginning with a patient requirement for intravenous access the cycle moves from Assessment/Selection, to Insertion, Management and Evaluation, all with the application of evidence-based practices. This VHP process is established to result in the best outcomes for the patient. VHP is about the goals of preserving vessels, reducing insertion attempts, minimizing complications and promoting efficiencies that lead to cost savings. Each quadrant is focused on a specific group of evidence-based practices, linking a cyclic

process to the next quadrant moving from the first admission assessment, to the last completion of treatment, discharge and evaluation with education integrating all quadrants. The first quadrant of the VHP model is assessment and selection, assessment of the patient and vasculature, along with selection of the most appropriate insertion location, vein and device. Evidence contributes to criteria of assessment, for patient history, condition and co-morbidities, and device selection, for vein depth, size, position in relation to other structures, number of lumens needed, size and most appropriate device based on indications. These components contribute to the section of the right line for the right patient. The second quadrant deals with the right inserter, one who is most qualified for the device selected. CONTINUED ON NEXT PAGE


AUGUST 2019 | 17

VESSEL HEALTH AND PRESERVATION, CONTINUED FROM PREVIOUS PAGE Education and appropriate training for the insertion are the main evidence-based components of this part of the VHP cycle. Research has shown that specific training of individuals while establishing competency result in fewer complications. Veins are preserved when insertion attempts are limited by ensuring those performing insertions are trained with insertion techniques that follow recommendations from literature and principles of infection prevention. Infection prevention practices carry over into the VHP third quadrant of management. VAD care and maintenance includes careful assessment performed at least once daily when in acute care evaluating dressing and securement adherence, catheter function through flushing, device necessity and outcome monitoring. In the evaluation section, the final quadrant of VHP measures patient outcomes and satisfaction along with research and consideration of new products needed to improve outcomes. Data collection within activities of any of the quadrants contribute to identification of negative patient outcomes indicating staff needs that may dictate education priorities. These same conclusions for performance improvement may indicate production solution options. Each quadrant of VHP join to provide the components necessary to ensure the best outcomes.

HOW DOES VHP WORK? Application of the quadrants of VHP model require a staged implementation plan to best achieve optimal outcomes. A focus on unit by unit application allows customization of VHP cycle consistent with 18 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

the Plan Do Study Act process. Sample forms are available in the VHP book for patient assessment, vein assessment, device selection, daily assessment, patient and staff evaluation. Throughout the chapters in the VHP book you will be guided through the necessary educational components and evidencebased practices used for each part of the VHP model and quadrant. VHP is a change in culture reflecting a commitment to patient safety in a true evidence-based platform and model. The commitment to a VHP implementation plan will involve a series of steps that may span months or years to complete the transformation to a patient-based program of safety with vascular access initiation, management and treatment delivery. Quality is not represented as a single action, but a philosophy of combined actions that result in patient safety as a component of every clinical activity. Nancy Moureau: Owner and CEO of PICC Excellence, Inc., speaker and educational consultant for 3M, Access Scientific, AngioDynamics, Teleflex, BD Carefusion, Chiesi, Cook Medical, Entrotech, Fresenius Kabi and Nexus; researcher at Griffith University in Queensland, Australia; research grants have been received from 3M, Cook Medical and Entrotech. Nancy Trick: Employed by Becton Dickinson. Moureau, N.L., Trick, N., Nifong, T., Perry, C., Kelley, C., Carrico, R., Leavitt, M., Gordon, S.M., Wallace, J., Harvill, M. and Biggar, C., 2012. Vessel health and preservation (Part 1): a new evidence-based approach to vascular access selection and management. The Journal of Vascular Access, 13(3), pp.351356.

RIGHT TRAINING AND EDUCATION Evan Alexandrou, RN, BHealth, ICU Cert, MPH, PhD Nicholas Mifflin, RN, BN, ICU Cert Peter Carr, RN, PhD, MMedSc, BSc

Secure vascular access is the cornerstone of optimal health care delivery. It’s hard to imagine a clinical procedure being undertaken without access to the venous system. It is an essential element for many therapies, yet one that carries many often underestimated risks. The best outcomes from vascular access are a result of well-trained inserters using the best procedural techniques based on the latest evidence. Well trained inserters choose the right device based on key factors such as patient assessment, infusate characteristics and length of anticipated dwell. In turn, these elements influence anatomical placement of the device. Good training and education – that which incorporates theory, simulation and competencybased assessment – along with procedural volume reduces the risk of mechanical complications during a procedure in addition to latent complications like thrombosis and infection. The primary goal of Vessel Health and Preservation: The Right Approach for Vascular Access (VHP) is to reduce risks associated with the insertion and management of vascular access devices (VADs). We achieve this through appropriate education and training. Part of good education and training is to incorporate evidence-based insertion bundles. Such checklists must be embedded in clinician education and help with compliance of the latest recommendations to mitigate complications, particularly for junior staff. However, emphasizing that education and training on the insertion of any VAD goes beyond the insertion phase is critical, and consideration needs to be given on the care of the device after its insertion. The insertion phase is typically only a small proportion of the life of a VAD but is the most influential on its performance and survival. The VHP protocol requires healthcare personnel to provide correct care and maintenance procedures

and associated infection control practices routinely for patients with vascular devices. Using a bundle approach for the maintenance of VADs has proven to be effective in preventing infection. Any clinician education on insertion techniques for VADs should also address principles of care and maintenance to help reduce premature failure. The successful insertion of any VAD on the first attempt will undoubtedly preserve veins and reduce risk of venous depletion, something common in patients with chronic disease. Venous depletion can have a profound impact on patient well-being and experience. Multiple attempts at venous access can place the patient at great procedural risk, delay important treatment and place the patient in a position where they endure significant discomfort and anxiety. Most facilities around the world require clinicians to be competent (and in some cases, accredited) to perform vascular access. However, there is wide ranging variability of first time insertion success for both peripheral and central access. The use of guidance technology such as near-infrared and ultrasound has reduced procedural complications, and in some instances (such as central venous access), has become the gold standard. Use of such technology requires significant training of clinicians to ensure its appropriate use and does not artificially inflate the confidence of a novice inserter as procedural complications are just as likely when this technology is used inappropriately. The type of education and training provided to clinicians depends on organizational resources. A blended learning approach is considered the most advantageous. This model incorporates online webbased approach to support face to face lectures and simulated practice with medium to high fidelity task trainers to improve skill acquisition, increase learner confidence and reduce complications in clinical CONTINUED ON NEXT PAGE AUGUST 2019 | 19

RIGHT ASEPSIS WITH ANTT® FOR INFECTION PREVENTION Simon Clare, RN, BA, MRes | Research & Practice Development Director – The Association for Safe Aseptic Practice

Writing for your peers is a challenge; this is doubly true if the writing activity in question allows you to have an opportunity to work with some of the best people in the field. Co-writing Chapter 11 of Vessel Health and Preservation: The Right Approach for Vascular Access (VHP), titled “Right Asepsis with ANTT® for Infection Prevention,” was just such an opportunity, and one both Stephen Rowley, RN, RSCN, MSc, BSc (Hons) and I immensely enjoyed. This book’s usefulness will ultimately measure its worth, and I believe that the quality and utility of its contents is both a testament to the editor and authors, and to its design and format. Though I acknowledge bias, from my perspective, one of the standout features of this new textbook is the standardization of the clinical practice language and description of aseptic technique using ANTT®, the de facto international practice standard for aseptic technique. Language is the fundamental building block of education, training and ultimately understanding. In the absence of a single standard, the historical picture of aseptic technique is one of misunderstanding, misconception, ambiguity and

variability that had established a convoluted and confused picture typified by highly variable practice and questionable effectiveness. As a result, traditionally, textbooks often differed from chapter to chapter in how different authors describe aseptic practice, and as a result, they established various and varying standards of practice, each with different approaches often for the same or similar procedures. This new textbook pushes that approach firmly in the past and at a stroke establishes a new contemporary approach to clinical literature – this book is most certainly not business as usual! The book features so many interesting and important areas of intravenous therapy access and maintenance. Having a single approach to the language and description of aseptic technique using ANTT® adds an important and refreshing continuity throughout, with context and rationale weaving together both theory and practice. I believe we are at an important junction in healthcare, as we face the daunting international challenges of antimicrobial resistance (AMR), healthcareCONTINUED ON NEXT PAGE

RIGHT TRAINING AND EDUCATION, CONTINUED FROM PREVIOUS PAGE practice. The use of online training is considered advantageous in that it can be standardized and accessible almost anywhere, at any time. Incorporating video as a tool to demonstrate procedures and techniques has been a common inclusion within successful programs.

on the first attempt after careful consideration of the patients’ needs so that to minimize any complications whilst improving the patient experience.

Embedding education and training strategies that use VHP framework in our health care facilities provides every patient the opportunity to access a competent and qualified inserter for every insertion. This will safeguard the placement of the right device

Nicholas Mifflin: No disclosures


Evan Alexandrou: In the last three years has received investigator-initiated grants from BD/BARD and 3M and has provided education services to Smith’s Medical. Peter Carr: No disclosures Moureau, N. L. (2019). Vessel Health and Preservation: The Right Approach for Vascular Access. Springer.

RIGHT ASEPSIS, CONTINUED FROM PREVIOUS PAGE associated infections (HAI) linked to large-scale humanitarian disasters, coupled with threats to the uptake of vaccination and immunization. Speaking the same language for infection prevention and control has never been more important for healthcare professionals. Last year, a team from The Association for Safe Aseptic Practice (ASAP) worked with Médecins Sans Frontières (MSF) to develop ANTT® in challenging humanitarian aid settings in Syria, South Sudan and Sierra Leone drove the importance of this point home. The ANTT® project is nearly 15 years in development and has required hard and dedicated work by a team of healthcare professionals at ASAP. Its Board of Directors and an ever-increasing group of concerned people all over the world work towards the goal of establishing a single clinical standard for aseptic technique with ANTT®. The historical lack of a standard for aseptic technique is, of course, multifaceted. But at the heart of it is the lack of a

paradigm for aseptic technique among health care communities. As an organization, ASAP will continue to build on the spirit of collaboration exemplified by this textbook and encourage individuals and both small and largescale healthcare organizations to become aware of the theory practice gap associated with aseptic technique while beginning to seek to address the lack of research in this key area of practice. Someone once described aseptic technique to me as something of a lost art – something we realize is important but have accepted as something we learned when we trained and has evolved quite personally and ritualistically along with our daily clinical practice. This isn’t a good route of development for something as important as a critical clinical competency! In truth, without a standardized clinical practice framework aseptic technique is difficult to definitively CONTINUED ON NEXT PAGE

AUGUST 2019 | 21

ASEPTIC NON TOUCH TECHNIQUE (ANTT®) Stephen Rowley, RN, RSCN, MSC, BSc (Hons) | Clinical Director ANTT – The Association for Safe Aseptic Practice

We were delighted when Nancy Moureau asked us to provide a chapter on Aseptic Non Touch Technique (ANTT®) for Vessel Health and Preservation: The Right Approach for Vascular Access. We were even more pleased that Nancy wanted the book to avoid the historical pitfalls of referring to aseptic technique ambiguously with different interpretations and terminology for aseptic technique in different chapters. As a result, this is a comprehensive and contemporary textbook that refers to all matters of aseptic technique using the single standard of ANTT® throughout. This isn’t of course about semantics. It’s a passion and the mission of The Association for Safe Aseptic Practice, of which I’m proud to lead, to improve standards of aseptic technique and safety for patients globally. There are many facets to this but, ultimately, it’s recognizing the fundamental nature of aseptic technique as a critical clinical competency in all matters of intravenous access and ongoing maintenance. One can consider ANTT® as the patients last line of defense during any kind of invasive procedure, and the responsibility for effective technique sits squarely with the practitioner. That said, all practitioners need adequate education and training and this has often fallen well short in this area. Not least, because before ANTT®, there wasn’t a comprehensive practice framework and a

single international standard for aseptic technique. We were all talking differently about something that demanded a universal language and standard approach. The best practice guidance throughout this book, including ANTT®, is very timely given the growing concern with underlying and undetected peripheral venous catheter infections and mortality in particular. Work by Mermell and DeVries demonstrate and articulate this unseen problem poignantly. When then factoring in the advent of Clinical Indication and longer dwell times, the patient safety challenge is set out very clearly. There is much work to do and we are pleased to collaborating with forward thinking key opinion leaders like Nancy and specialist organisations like the Association for Vascular Access. For background, I originated the ANTT® Clinical Practice Framework in early 2000. In 2012, The National Institute for Clinical Excellence (NICE) defined ANTT® as, “A specific type of aseptic technique with a unique theory and practice framework.” NICE also highlighted ANTT®’s value as a foundation for guideline development and, more importantly, research. It became the de facto standard across the UK quite rapidly and is now used in over 30 countries. Testament to ANTT®, adoption CONTINUED ON NEXT PAGE

RIGHT ASEPSIS, CONTINUED FROM PREVIOUS PAGE define or describe, it is harder still to detail the rationale and evidence base. It is often easier to describe practice generically as aseptic technique – we believe this has only added to the confused picture of practice and aided in the continuance of the myth that aseptic technique is universally understood and practiced the same way everywhere. This textbook is an excellent example of the benefit of standardized language and practice for aseptic technique. It provides not only the prescription for aseptic technique but the description of it using 22 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

ANTT®. I believe this will only help translate the many IV practice issues described into real-world practice every day. The Association for Safe Aseptic Practice (ASAP) is notfor-profit Non-governmental Organisation, based in the UK working with more than 30 countries around the world to standardize the practice of aseptic technique using the single practice standard of Aseptic Non Touch Technique (ANTT).

The special enhanced edition of Vessel Health and Preservation: The Right Approach for Vascular Access is now available to purchase.

Get yours today for just $9.99! Hours of exclusive audio interviews with the authors discussing their areas of expertise are embedded into this version of the book, as well as animated videography capturing elements from actual vascular access procedures. AVA has also elevated the overall readability, and through Apple, Amazon and Barnes & Noble has added note-taking and flash card functionality for readers.

ASEPTIC NON TOUCH TECHNIQUE, CONTINUED FROM PREVIOUS PAGE is typically organic but is increasingly being mandated nationally by governments. As critical as ANTT® is to safe intravenous practice, it’s important to note that the ANTT® Practice Framework is designed for all invasive procedures and maintenance of indwelling medical devices – “from surgery to community care.” It’s been particularly interesting in the last few years to see the utilization of ANTT® in the most challenging of humanitarian settings and it’s been a privilege to do this with organizations like Médecins Sans Frontières (MSF). We are currently providing extra focus on ANTT® development in the USA and are keen to support practice and ANTT® implementation, whether that be in small teams or large organizations. As a nonprofit NGO, The-ASAP advise and provide a number of core ANTT® resources freely.

We are really looking forward to speaking at the 2019 AVA Scientific Meeting in Las Vegas in October and having opportunity to meet lots of delegates interested in ANTT®.

REFERENCES DeVries, M., Valentine, M. & Mancos, P. (2016) Protected clinical indication of peripheral intravenous lines: successful implementation. Journal of the Association for Vascular Access. 21(2): 89-92. DeVries M, Valentine M (2016) Bloodstream infections from peripheral lines: An underrated risk. American Nurse Today 11(1) Mermel, LA. (2017) Short-term Peripheral Venous CatheterRelated Bloodstream Infections: A Systematic Review. Clinical Infectious Diseases. 65(10):1757-1762.

AUGUST 2019 | 23

NEW AVA POSITION PAPERS Beth Gore, PhD | AVA Project and Relationship Manager

AVA released two new Position Papers this summer. Their topics include the use of visualization technology for the insertion of peripheral intravenous catheters and peripheral arterial catheters. You can easily find them on the Position Statement page on the AVA website, located under the Publications tab. Simply click the titles to read or download as a printable PDF. These are the first of several position papers under review. Be sure to check the page often to see the latest developments and follow AVA on social media for up-to-the-minute information as additional papers become available. In 2018, AVA spearheaded a “No Blind Stick” campaign with the intention of answering the following question from AVA Director of Clinical Education Judy Thompson, MSNEd, RN, VA-BC™:

These papers represent AVA’s first steps to address Thompson’s inquiry. When asked why AVA took and published a paper on this position, its author and AVA Position Paper Committee Chair Stephanie Pitts said, “This position paper demonstrates AVA’s daily pursuit of advocating for improved vascular access quality and experience for patients. CONTINUED ON NEXT PAGE



al Ultrasound Guided Peripher by Arterial Catheter Insertion Qualified Vascular Access Specialists or Other Applicable Healthcare Clinicians

MSc, RRT, VA-BC™ Amy Bardin-Spencer EdD(c), VA-BC™ c, BHSc, ICCert, RN, APRN, Timothy R. Spencer, DipAppS

“If we have the ability to ‘turn on the flashlight’ and see the path in front of us, does that not make our journey safer? We promote ‘No Blind Sticks’ because it’s better for patients. Remember when we would put in central lines without maximum sterile barriers (MSB)? There was initial (and some residual even today) push back, but we have come to accept that MSB is better and safer for the patients we serve. So are visualization technologies for vascular access device insertion.”

Written by Amy Bardin-Spencer EdD(c), MSc, RRT, VA-BC™ and Timothy R. Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC™ Adopted by the AVA Board of Directors August 2019 August 2019



POSITION PAPER The Use of Visual ization Technology for the Insertion of Periph era Intravenous Cathet l ers

Stephanie Pitts, MSN, RN, CPN, VA-BC™ Matt Ostroff, ARNPC, VA-BC™

July 2019

NEW AVA POSITION PAPERS, CONTINUED FROM PREVIOUS PAGE “Currently, the standard of practice is to start PIVs completely ‘blind’ or to use visualization technology after multiple failed attempts or on ‘difficult’ patients,” she continued. “Patients want to be stuck once. Healthcare providers want to be successful. The literature supports the use of visualization technology in improving first stick success.” Similarly, the publication that focuses on arterial catheter insertion provides a framework for vascular access specialists looking to add that skill to their repertoire. “This framework provides strategies for clinicians to impact insertion and care practices for patients

who require peripheral arterial catheterization,” Amy Bardin-Spencer, EdD(c), MSc, RRT, VA-BC™ said. “Position papers like this will aid in team advancement by supplying the necessary elements required for such practice change. Using this paper to implement these changes may allow the team to include peripheral arterial catheterization into its daily scope of care.” AVA intends to innovate, educate and lead in instruction beyond these position papers. Stay tuned for additional educational opportunities in the form of webinars, ISAVE That Podcast interviews with authors and other vascular access key opinion leaders and through available courses on AVA Academy.

A BEHIND-THE-SCENES LOOK INTO THE CREATION OF POSITION PAPERS: Before being adopted by the AVA Board of Directors, position papers go through a rigorous peer-review process. First, topics are decided upon by a clinical education team, led by AVA Director of Clinical Education, Judy Thompson. AVA Director-at-Large, Stephanie Pitts serves as Chair of the Position Papers Task Force. Together, the team selects topics and authors to craft the position papers based on the latest evidence. The authors write and submit their drafts to the AVA Staff. An editor does some basic copy edits and formatting. Then the paper is off to the Clinical Review Team (CRT). This committee is led by Jocelyn Hill, the current Secretary of the AVA Board of Directors. Reviewers are matched based on the content of the paper and their expertise. The CRT reviewers are given a survey tool, a copy of the paper and guidelines for review. Once they share their comments, an AVA staff member collates the edits and recommendations. At this point in the publication process, a paper receives one of three designations: accepted as is, accepted with minor edits or not accepted. If the paper is not accepted, the authors receive comments from reviewers in addition to guidance on how to amend the paper and a request to resubmit with the suggested edits.

When the paper is accepted by the CRT, edits for content continue. Various members of the Board, Committee and Staff read for clarity and content. A graphic designer creates the cover and AVA staff completes final edits to appropriately format and lay out the paper. The Board of Directors receives the final copy and officially adopts it as a position paper. AVA staff members load it to the AVA website as a downloadable PDF. Many of the position papers are expected to be sent for consideration of inclusion in the Journal of the Association for Vascular Access. Some will make an appearance in Intravascular Quarterly, sent to membership via email or even shared across AVA’s various social media platforms. You are likely to hear the authors of these papers make an appearance on a future episode of the ISAVE That Podcast. Some will become CE webinars or even turned into a course on the AVA Academy. If you have interest in submitting a topic you’d like to see as a position paper or would like to be an author of a paper, please submit your thoughts to Beth Gore at If you’d like to submit your credentials for inclusion as a reviewer on a future Clinical Review Team, drop Beth an email along with your areas of expertise. AUGUST 2019 | 25



The ability to expand the placement of vascular access devices beyond peripherally inserted central catheters (PICCs) requires multidisciplinary collaboration among physicians and nurses. The following case study reviews the collaboration of two vascular access specialists with three physicians (Critical Care: Dr. Giri, General Surgeon: Dr. Corrales, & Interventional Cardiologist: Dr. Aziz) to gain access for a critically ill patient in the intensive care unit (ICU). A 56-year-old male diagnosed with pneumonia was found unresponsive at a local nursing home, with the patient’s downtime unknown. Emergency medical services (EMS) transferred the patient to a community hospital in the Chicago area. On arrival, the patient was unresponsive and hypotensive. His past medical history was extensive, displaying diabetes, hypertension, a seizure disorder, necrotizing fasciitis, large sacral wound, diverting ostomy, memory loss, and cardiomyopathy with an ejection fraction of less than 40%. The patient suffered a large middle cerebral artery (MCA) stroke in December 2018 and at that time underwent trach and peg insertion for dysphagia. The patient also had a tunneled dialysis catheter in the right axillary/subclavian vein for endstage renal disease (ESRD). While in the emergency room, nurses made multiple attempts to establish peripheral access. Due to a lack of documentation, it was unclear if the nurses ever considered intraosseous access. Subsequently, nurses attempted to achieve access through bilateral femoral central venous catheter (CVC) insertion. These attempts were also unsuccessful, with little records available regarding them. A review of nursing documentation states, “Multiple CVC attempts to bilateral femoral veins were unsuccessful.” The patient was intubated in the emergency room, stabilized and 26 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

sent to the ICU for further treatment. Once the patient was in the ICU, the vascular access team received a call to place a CVC. A complete assessment of all potential sites followed, beginning with the upper extremities. The team made note of multiple collateral veins, excluding the arms as a potential insertion site due to renal disease. The neck revealed patent internal jugular (IJ) veins bilaterally. The team did observe a slight narrowing at the confluence of the IJ, brachiocephalic, and subclavian veins which was attributed to the chronic HD catheter. The team did not have access to a long enough catheter to access from the left IJ and excluded it as a potential insertion site due to limitations with the catheter length and the nature of the infusates. The patient’s renal disease also excluded the subclavian vein as an access site. Lastly, the team assessed the groin, where it noted more than five puncture sites under gauze dressings near the inguinal fold. Ultrasound assessment of the femoral vein and artery at the mid-thigh level revealed healthy, patent, compressible vessels. The assessment was discussed with the critical care physician. The team prepped the right IJ and achieved access on its first attempt. The vessel dilated without difficulty. However, the catheter only advanced 11 cm until the clinicians felt resistance. An external measurement taken prior to the procedure was 18 cm from the access point to the superior vena cava/cavoatrial junction, indicating to the team the catheter was likely stuck in the area that appeared stenosed on ultrasound. The team paused for a second to evaluate available options before continuing the procedure. The team sought advice from the general surgeon, CONTINUED ON NEXT PAGE

CASE STUDY, CONTINUED FROM PREVIOUS PAGE who put on a cap and mask and came to the bedside to receive an overview of the situation. After offering suggestions and helping work through the problems that were being experienced, the surgeon ultimately recommended a traditional femoral CVC be placed.  As the general surgeon left the room, the interventional cardiologist was rounding on the patient. The vascular access specialists again explained the complexity of the patient’s vasculature,

history, and current situation. The interventional cardiologist offered some suggestions, one being traditional CVC placement with a stiffer wire through the same access point. The team and physician agreed to this one last approach before aborting the procedure. The interventional radiologist scrubbed in and attempted a traditional Seldinger insertion. After the procedure was unsuccessful, they also recommended a traditional femoral CVC for access. The interventional radiologist agreed to follow the patient and offer treatment options such as ballooning the superior vena cava once the patient was stable. He was intrigued with the teams intravascular doppler, the use of the Jugular/Axillary Central Catheter (JACC) a 6fr CVC, and the modified Seldinger technique for CVC placement. The team informed the critical care physician of its decision to abort the IJ attempt due to the inability to advance the catheter as well as the recommendations

of the other physicians. They agreed that the patient needed access but did not agree that a traditional femoral site was the best access. He preferred midthigh access because it would be easier for the nurses to provide the care and maintenance for the catheter compared to the traditional femoral site. The team prepped the mid-thigh for access, identifying the vein as 5cm deep/4mm with the artery to the left of the femoral vein. The vessel was accessed in one attempt. The wire and catheter threaded without difficulty. Intravascular doppler was used to rule out arterial puncture. Blood return from both lumens was brisk and the PICC flushed easily. Currently the hospital policy includes a followup KUB scan to confirm tip placement in the inferior vena cava for mid-thigh femoral (MTF) PICCs. The KUB confirmed the tip location of the MTF PICC at L1 and the catheter was released for use. The lead critical care physician was thankful for the access the team provided for his patient. The growth and development of our vascular access team has been built on many cases like this, truly emphasizing multidisciplinary collaboration to achieve optimal outcomes for patients while highlighting the respect of the team among providers. It would not have been possible to expand to CVC placement or MTF PICC placement without this type of collaboration, respect, support, and mentorship.  The authors see the ability to access the veins of the neck, chest and groin as a privilege and fully understand that it is not an option for all vascular access specialists. Through examples such as this case study and other recently published case studies, the vascular access specialty continues to establish MTF PICC placement as an alternative access site for adult patients, much like pediatrics. We must continue to publish case studies and conduct further research on the efficacy of this alternative access site when our traditional sites have been exhausted. More importantly as a specialty we must continue to define and establish the expansion of the specialty through multidisciplinary collaboration. Teamwork is the cornerstone for good outcomes. AUGUST 2019 | 27

AVA Academy is always open!


The Association for Vascular Access (AVA), in collaboration with The Clinician Exchange (TCX), launched a new, best-in-class learning management system tailored to aspiring and established vascular access clinicians. Providing cutting edge training, critically-acclaimed presentations from scientific meetings, journal review courses and much more, AVA Academy is a groundbreaking initiative that advances the heart of AVA’s mission – Protect the Patient | Educate the Clinician | Save the Line. Academy curriculum is now available to the public, and to active AVA members at a discount.

Looking to further your education but struggling to find the time amidst a busy work schedule? AVA Academy is always open! It's our mission to create greater public awareness of vascular access and to empower our members with significantly more educational resources, networking opportunities, and advocacy tools in support of and dedication to the patients that we are entrusted to serve.

AVA Academy is now open to all curious minds Choose and enroll in your classes today!

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• If you're not an AVA member, consider Joining AVA or you may create a Guest Account at no charge

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attendees are invited to

The AVA Foundation Lunch & Learn

V E S S E L H E A LT H A N D P R E S E R VAT I O N Monday October 7, 2019 12:15pm-2:00pm


Octavius 24-25 (entrance at 4, 12 and 20) FE ATURI NG PRESENTERS: Peter Carr, RN, PhD, MMedSc, BSc Michelle DeVries, BS, MPH, CIC, VA-BC™ Tricia Kleidon, RN, BSc(Nursing), GradCert.(Pediatrics), MNursSci(NursePrac) Nancy Moureau, RN, PhD, CPUI, CRNI®, VA-BC™ Nancy Trick, RN, CRNI®, VA-BC™ Amanda Ullman, RN, GradDipPaedICUNursing, MN(Research), PhD

This event made possible through AVA Foundation donors such as:

AUGUST 2019 | 29

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HAVE YOU BEEN LISTENING? ISAVE That Podcast Season 2 Episode 9 - 07/19/19 Episode 9 takes a deep dive into the land of tissue adhesive. It features a discussion with self-proclaimed “glue addict” Rebecca Stevens, RN, BSN, VA-BC™. Peter Carr, PhD, MMedSc, BSc, H Dip A&E Nurs, Dip HE Nurse then joins the show to chat with us about his contributions to Vessel Health and Preservation: The Right Approach for Vascular Access. Episode sponsored by Adhezion Biomedical.

Episode 8 - 07/02/19 It is Vessel Health and Preservation time! On Episode 8 of Season 2 of the ISAVE That Podcast, hosts Judy Thompson, Ramzy Nasrallah and Eric Seger discuss the enhanced e-edition of Vessel Health and Preservation: The Right Approach for Vascular Access. Episode sponsored by 3M.



As a nurse for more than 40 years, I have seen huge changes in practice. One of the biggest advancements has been within the field of vascular access. For 20 of those 40-plus years, I supervised a vascular access team placing appropriate lines for our institution’s acute care patient population and prepared them for discharge to a sundry of locations, from home care to subacute facilities. In my career, I witnessed the inconsistencies in line care of patients after discharge. Our team even developed a discharge sheet for all patients leaving our facility. But still, gaps remained. I remember when our facility transferred a patient with a peripherally inserted central catheter (PICC) from an acute care setting to a sub-acute facility. Three times a week, she trekked to an outside center for dialysis. Both the acute care and sub-acute units thought the PICC was the other group’s responsibility, and therefore failed to take ownership. As a result, and in the span of a month, the device was never flushed, and the dressing remained the same. This is despite the patient frequently asking who was going to care for her PICC. It fell on deaf ears. It is time to coalesce the continuum of vascular access care and bridge the gap from acute care to post-acute care best practices. How do we do that? Where do we start?

Some food for thought: • Who is responsible for obtaining and giving the vascular access information from acute to postacute? • How is the information disseminated to the postacute care facility? • Is the person obtaining and giving the vascular access information medically trained? • Who is responsible for care and maintenance of vascular access lines in the post-acute care setting? • How much training have the receiving facility employees received on vascular access? Where was it provided? Did it happen in nursing school? At the time of employment? Or as an in-service? These, among others, are important and pending questions. The newly formed Continuum of Care Special Interest Group (ConSIG) wants your help and ideas. How do we, as an association, help address these important issues? Would you like to be a part of the solution? Will you be at the AVA Scientific Meeting October 4-7 in Las Vegas? If so, please stop by the AVA booth and meet with the ConSIG leaders and share your thoughts and ideas. If you’re not able to attend the conference, drop us an email at We’d be happy to hear from you! And don’t forget to pay a visit to the ConSIG page on the AVA website to learn more.

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STAFF SPOTLIGHT TONYA HUTCHISON: CHIEF OPERATIONS OFFICER My Name: Tonya Hutchison My Position at AVA: Chief Operations Officer My Support System: I am lucky to be surrounded by amazing family and friends that seem to always be there when I need them. My husband and I have been married for 10 years and together we have a blended family of 6 kids and 3 grandkids. We are lucky to live near fantastic grandparents that provide the support needed to raise them in this crazy world! Friends are also very important to me and provide a different kind of support. I have played in the same Bunco group now for 17 years and always make time for our annual Girls Weekend Getaway. My Favorite Movie: Big. Tom Hanks played Josh Baskin in that movie – love it so much that I named my first born Josh. I adore Tom Hanks, so really any movie he is in is on my favorite list. My Favorite Quote: “Find people who will make you better.” – Michelle Obama My Escape: Going to the movies. I love relaxing in a cushy, reclining seat with a blanket and a big bucket of buttery popcorn and escaping into a good movie. My Favorite City: New York City; I have only been one time, but it was one of the most memorable and fun weeks I have ever had. Definitely a city full of life! I would love to go back. My Roots: We moved a lot when I was young. I was born in California, but grew up in several different cities in Texas. Spent a few years in Utah during middle school years but then headed back to Texas. Relocated back to Utah in 2000 and I love it here! What do you enjoy about working for AVA: There are many things I enjoy about working for AVA. I enjoy collaborating with the great core staff. We are a small, yet mighty group and I consider them my family. I also enjoy working with the passionate volunteers in their roles as the Board of Directors and committee and task force members. However, what reenergizes me each year is going to the annual meeting and watching how this enthusiastic group strives to learn and share so that they can give their patients the best care possible. 32 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

AVA STAFF SPOTLIGHT, CONTINUED FROM PREVIOUS PAGE What do you do at AVA: I am here to ensure the operations of AVA run smoothly with the dedicated core staff, to support the Board of Directors and membership and to manage the annual Scientific Meeting. The strategic plan is the blueprint for this work and my role as COO is to operationalize that plan with the incredible team I work with on a daily basis. What are your goals at AVA: I want to continue to collaborate with the core staff, Board of Directors and volunteers to create an association that provides a place where new ideas, education and research can be shared to make vascular access safe for us all.









































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The world of vascular access is constantly changing, making adjustments and evolving. This perhaps happens too slowly in the minds of some, but our specialty is certainly not stagnant. How can one “keep up” with it all? How “accessed” are you? The evidence, reports and information are everywhere. Not so long ago, it was only by wordof-mouth, face-to-face meetings or conferences and *gasp* hard copy journals that came in a mailbox to my door (many of which I still have as a proud #journalhoarder) that we received the latest details on new innovations and technologies. Now, we are inundated with information virtually at every blink of the eye. Social media is everywhere – we can engage in electronic communication through various and multiple platforms/applications like Facebook, YouTube, Twitter and Instagram. There are some platforms I am sure I missed because I, for one, am quite “social media naive” (by choice). We can now quickly and effectively reach out to friends, family, colleagues and even complete strangers. But how can we use, or SHOULD we use social media in healthcare? Can it improve patient outcomes? For the vascular access specialist, does it help or hinder clinical practice? There are pros and cons, risks and benefits that should be in the discussion and the background somewhere as we deal with all this access. Ultimately, the pros are the cons and vice versa. The pros include the constant access, having the most up-to-date information at your fingertips. The videos, 34 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

articles, and constant event marketing – the reach is huge and vast, crossing borders and time zones instantaneously. The cons to consider: What are you being taken away from due to this constant access, hooked on your phone or tablet all the time? How can you be sure the most recent post or article on that Twitter feed is in fact true, validated, peer-reviewed, and applicable to your clinical practice? What happens when there is so much to read and catch up on that you miss some of the “important stuff”? Imagine how patients feel. Are they caught in the middle of all this? Who would you rather have as a healthcare practitioner when you get admitted to the hospital? The clinician constantly and fully “accessed” or the one who has not read the latest e-journal on new and innovative vascular access techniques? So many questions, yet not many definitive answers. There is a common saying in healthcare: If it is not documented, it is not done. Considering all that is posted on the Internet through the countless social media avenues, I argue now that this saying needs to CONTINUED ON NEXT PAGE

ACCESS IS EVERYTHING, CONTINUED FROM PREVIOUS PAGE be taken with a grain of salt because I am not sure that just because it was on the Internet, it is true. Many things posted on the Internet are not really validated and will be there, searchable, forever. When we reply or post within the character-limit, can you really actually get your point across and be fully understood? There is huge risk for miscommunication and being taken the wrong way. We may lose altogether the art of meaningful conversation without the face-toface or voice-to-voice contact for the tone and facial expressions that are so important. Individual clinicians should consciously decide if, why and how to use the various social media platforms. It is completely up to this person to determine how much or how little they use social media. First and foremost, we need to keep our personal and professional lives separate. Social media can blur such boundaries. When communicating through social media, we must remember the ethical and professional standards that always apply and are paramount to success. Things like patient confidentiality, knowing your employer’s

policies on social media, being transparent by always disclosing who you are and being respectful are critical. Considering all of the above, how do we proceed? The ideal is that everyone has access to information, education and resources. Even though there are many people fully accessed and active on social media, there are still people that are not. Our collective objective should be to continue to raise the level of discourse about our specialty using various platforms and applications, which still includes (at the time of this writing) the basic, conventional methods of communication like a #facetofacechat or #pickupthephone and dissemination of information. Plus, the easiest one is to attend #AVASM19. Jocelyn Hill is a nurse from Vancouver, BC who struggles daily to keep up with social media applications because of her #FOMO and loves actual conversations in person, face-to-face. It is really not worth it to follow her on Twitter or send her a friend request on Facebook; she is mostly a lurker who barely posts.

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LOBBYING FOR THE VASCULAR ACCESS SPECIALTY Constance Girgenti, BSN, RN, VA-BC™ Sheri Pieroni, BSN, RN, VA-BC™ Laura Krick, MBA, CPM Tim Spencer, DipAppSc, BHSc, ICCert, RN, VA-BC™

Attending the American Nursing Association’s (ANA) Hill Day on June 20, 2019, in Washington, D.C., offered a great opportunity to learn about what it is like to be a nurse lobbyist on “The Hill.” Many of ANA’s statewide members, passionate about improving access to quality patient care, as well as making sure that there is a fair, safe and equal opportunity in healthcare for all, attended to voice their concerns and plans to improve healthcare within the U.S. Among the more 400 attendees were vascular access specialists (VAS) Sheri Pieroni BSN, RN, VABC™ and Constance Girgenti BSN, RN, VA-BC™, all encouraged at the great opportunity and learning experience attending and understanding the lobbying process offered. After signing up for 2019 ANA Hill Day, both thought it would be more impactful to also attend with a message specific to the vascular access specialty.

The clinicians entered the day curious about where a healthcare issue like safe vascular access fell among the priorities of government legislators. A parallel decision was made to start an online petition using, to generate support 36 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

and awareness to the need for dedicated VASs. The proposal was to have a VAS in every hospital across America – a large ask in its own right. Through professional and social media networking, the pair caught the attention of Laura Krick, Vice President, Clinical and Market Development for Interrad Medical, Inc., a strong patient advocate and survivor of pediatric cancer and other health challenges as an adult, as well as Tim Spencer, DipAppSc, BHSc, ICCert, RN, VA-BC™, a vascular access key opinion leader and the recipient of the 2019 Herbst Award, The VAS and vascular access team (VAT) needs a renewed and specific definition from the “IV team” or “infusion team” of the 1980s. It evolved to include a multidisciplinary group of healthcare providers that place more than the peripheral IV (PIV) and peripherally inserted central catheters (PICC). Clinicians researching and evolving the evidence, accountability and practice of vascular access provide the best possible long and short-term outcomes for today’s unique and complex patients. Today’s VATs are no longer defined by the device they place, the purpose for that device (infusion) or the environment, but are encompassing all aspects of intravascular access device-related decisions and care processes in order to place the right device to ensure safe vascular access practices and impact for better patient and device-related outcomes. Teams slowly disbanded over the years due to crippling healthcare budget cuts or in some cases facility administration believing that any nurse can place a PIV, regardless of the technique or number of attempts to do so. Putting this high-risk, high-volume procedure solely in the hands of the bedside nurses without effective training or effective outcomes and performance measures has proven to not be in the CONTINUED ON NEXT PAGE

LOBBYING FOR VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE best interest of the patient (Hunter et al, 2018). Device failures are reported to be as high as 65% (OMG, Alexandrou et al, 2017). The literature has not supported any cost savings associated with disbanding VATs. Instead, it shows there is a variation in the skill level of the generalist nurse and little accountability to the metrics of the most common invasive procedure conducted in hospitals today. Compared to a VAS, the knowledge, specialization and education gap widens as ever-increasing demands placed on clinicians continue to challenge clinical workloads. This lack of knowledge, time and accountability leads to multiple insertion attempts, patient discomfort, pain, increased dissatisfaction with healthcare services, frequent inappropriate device placement and on occasion, irreversible damage to the patient’s veins, limbs and prognosis.

These challenges also lead to venous depletion and complicate future venous access options, driving overall healthcare costs to higher levels. VASs have shown unequivocal effectiveness in reducing the incidence of CRBSI, device-related complications, and improve cost and efficiencies within healthcare facilities, when properly supported and empowered to drive the changes their organizations need and desire for their patients.

VASs have the potential to have a monumental impact on patient care, much like other dedicated clinical specialists in infection prevention (CIC), critical care (CCRN), anesthesia (CRNA), pediatrics and neonatology, acute care nurse practitioners (ACNP), oncology nurses (OCN), as well as wound and ostomy nurses with the proper definitions around accountability, training, and purpose. There are many clinical specialties contributing to the greater quality of patient care in the United States and around the world, who before our specialty lobbied the U.S. government for directives and mandates to drive the support and measures of success for their impact on patient and financial outcomes. This call to action discussed the reasoning behind the need to have one (1) VAS to every 100 patients for a minimum of 20 hours a day, 7 days a week. This opens the discussion for further evaluation and definition around VASs to ensure adequate patient safety, measures of effectiveness and service provision. The initial framework started the conversation and brought much awareness about the lack of knowledge and understanding general nurses and especially government representatives have on the impact of vascular access, patient care, and healthcare costs. It is an especially important time for nurses and nurse advocates to take their experience and insights to Capitol Hill. More than 300 meetings occurred between Representatives, Senators and the attending nurses. The nurses that attended ANA Hill Day 2019 demonstrated their support to the #EndNurseAbuse pledge and surpassed 20,000 signatures, a result of a grassroots effort to pass key legislation that will impact workplace violence against nurses. Nurses helped lawmakers understand the urgency behind the many pieces of legislation impacting nurses and their patients and in doing so, gained greater momentum in Congress. The Workplace Violence Prevention for Health Care and Social Service Workers Act (H.R. 1309), the Home Health Care Planning Improvement Act of 2019 (H.R. 2150), the Title VIII Nursing Workforce CONTINUED ON NEXT PAGE AUGUST 2019 | 37

LOBBYING FOR VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE Reauthorization Act of 2019 (H.R. 728), and lastly, “Safe Staffing Levels For Nurses and Patients” all found their way to the conversation during Hill Day. Safe staffing is not a bill yet – this legislation will address safe staffing levels and the request is that attention shift to the available technology, resources and unit workflow such as number of admissions, discharges, and transfers. This is a terrific place to introduce specific language about the vascular access specialty and requirements to improve patient outcomes and reduce overall costs of care. VASs attending ANA Hill Day used several case studies on how they and their colleagues impact patient safe staffing. Bedside nurses will often call the charge nurses on other floors or the most experienced nurses away from their patient(s) assignment to come assist with troubleshooting or establishing access. This practice impacts the patients left behind, as well as the nurse covering the patients for the nurse that has left the floor.  Examples of hospitals without a VAT:   1. Utilization of the Intensive Care or Emergency Room nurse to start an IV leaves 2 critically ill patients with minute-to-minute changes in health condition, in the care of another ICU nurse. This leaves 4 critical patients to 1 nurse, when it should be 2 patients to 1 nurse. This practice directly impacts safe staffing, putting the critically ill patient and nurse at potential risk. 2. A generalist nurse is pulled away from an assignment to start, troubleshoot or establish access, leaving her 5-6 patients in the care of another nurse. This practice leaves a total of 10-12 patients in the care of one nurse. Both of these are unacceptable situations from safe 38 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

staffing perspectives. Girgenti, Pieroni and Krick spoke with Gabie Camozzi, Legislative Aide for Sen. Richard Durbin, D-Ill., and Daniel Tsang, Legislative Correspondent for Sen. Tammy Duckworth, D-Ill. It wasn’t until meeting Rep. Bill Foster, D-Ill. and his Legislator Director, Samantha Warren, that they truly felt the magnitude and potential impact of lobbying. Foster could not fathom the impact of device failure rate of PIVs or the number of times patients are stuck with needles. Discussions with Rep. Janice Schakowsky, D-Ill. and Health Policy Advisor Osaremen Okolo continued to bring the issue to light, with the latter a strong supporter of current lobbied bills. This led to conversations about VASs roles and safe staffing, and an invitation for the Okolo to spend a day in a healthcare facility, if time permitted, to gain a greater understanding of the impact our specialty. Some data and statistics shared with these lawmakers concerning the government’s investment in healthcare: • The state of Illinois had more than 1.3 million hospital admissions • These admissions cost the government over $147 billion; more than 65% covered by Medicare and Medicaid payments • Of those admissions across 233 state hospitals, 98% required a vascular access device Tim Spencer met with local Arizona ANA members Amanda Foster, Heidi Sanborn, and Cheryl Schmidt, who all hailed from the Central Phoenix/Tempe area. They met with those legislators representing Arizona – Chad Michaels, spokesman for Rep. David CONTINUED ON NEXT PAGE

LOBBYING FOR VASCULAR ACCESS, CONTINUED FROM PREVIOUS PAGE Schweikert, Sylvia Lee, representative for Sen. Kyrsten Sinema, Jeffrey Finegan, spokesman for Rep. Martha McSally, and Rep. Debbie Lesko, R-Az. herself. There was good discussion on the targeted subjects, which included Safe Staffing Levels, the Nursing Workforce Reauthorization Act, the Workplace Violence Act, and the Home Health Planning Improvement Act. Tied in alongside with other topics, the VAS request got some airtime, despite limited opportunity for a deeper discussion. However, the need was raised, the ideology submitted, and the request admired. Attending ANA Hill Day 2019 also built relationships with ANA Executive Director Susan Y. Swart, Amanda Buechel, an ANA Director at Large, as well as the presidents of the Illinois and Arizona Nurses Associations. Both Sheri, Connie & Tim were asked to participate in a future webinar for the ANA members and were informed that ANA wanted to spotlight them for this initiative. The challenge while on The Hill was to provide a national description of the VASs role to our senators, representatives, legislative directors and legislative aides. Because of the different VAT models, it was kept in a relatively generic perspective, but descriptive, nonetheless.

Upon returning from D.C., the trio submitted a summary of the conversations to the AVA Board of Directors, requesting it to consider its public policy committee to help move these important initiatives forward and build relationships with key organizations. The goal is to start early and strong before ANA Hill Day 2020. All are welcome to attend ANA Hill Day 2020 and be the voice of our colleagues and our patients. A strong goal to achieve would be to have 15-19 states represented with at least 2 AVA members from each state, to bring forth as many VASs as possible on The Hill. Thank you to all that have supported this initiative – the words of encouragement are priceless. Please consider joining this us next year!

REFERENCES Alexandrou E., et al. Use of short peripheral intravenous catheter: characteristics, Management, and outcomes worldwide. Journal of Hospital Medicine. Published online May 2018. Hunter MR., et al. Addressing the silence: a need for peripheral intravenous education in North America. Journal of the Association for Vascular Access. 2019;23(3):157-165.

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AVA currently has 52 active networks The Association for Vascular Access is committed to providing an opportunity for members to broaden their knowledge of vascular access and related fields through networking opportunities and education. AVA Networks offer vascular access professionals the opportunity to network with other professionals in their area of expertise. Network meetings offer educational sharing opportunities, continuing education credits, dinner meetings and quality dynamic speakers.

Do You Know Where Your Nearest Network Is? w w w. ava i n f o . or g / n e t w or k s

Connecting Talent with Opportunity Search and apply for job opportunities in the vascular access field. On LinkedIn? Save time and import your profile directly to the AVA Career Center. Post an ad for an available vascular access position -find the best talent! 40 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

Start your search at:


to our Newest

Benjamin Bryant -- White House, TX Paula Moyano -- Santiago, Chile Daphne Hardison -- Nashville, TN Robyn Dittoe -- Marydel, DE Joanne Campbell -- Keswick, Canada Katrina Remes -- Ames, IA Patricia Muser -- Pierre, SD Michelle Lindwall -- Laguna Niguel, CA Patti McKnight -- Guntown, MS Elena Woo -- Honolulu, HI Lynn Isaacson -- Mountain Iron, MN Gabrielle Brown -- Kansas City, MO Aaron Edwards -- Kechi, KS Jason Robben -- Haven, KS Carolyn Fasoli -- Medford, MA Silvia Figueroa -- Guatemala, Guatemala Meghan Kauffman -- Rochester, NY Keli Fischback -- Montreal, Canada Colleen Cantwell -- West St. Paul, MN Carol Myers -- Ocoee, FL Lyndsay Smith -- San diego, CA Amber DeLee -- Angie, LA Carol Schmidt -- Havertown, PA James Heinert -- Racine, WI Dominique Bocchicchio -- Gilroy, CA Kevin Owens -- Decatur, GA Wendy Mccrary -- Memphis, TN Steve Bryant -- Mt. Pleasant, SC Stacey Merritt -- Tacoma, WA Jennifer Dolalie -- Fargo, ND Michael Jicha -- Marietta, GA Heather Graham -- New Albany, IN Rebecca Miskovic -- Langley, BC Erin Cillessen -- Alto, NM Sophie Jones -- Colorado Springs, CO Janet Abram -- Vancouver, WA Margaret Warichak -- Jefferson, WI Cyndi Evans -- Santa Rosa, CA Michael Placido -- Quincy, MA Samuel Lee -- Parkville, MO Erin Hieb -- Denver, CO Raymond Levitt -- Lindenhurst, NY Mark McLaughlin -- Nampa, ID Robin Schluter -- Tuttle, OK Hyunlim Kim -- Seoul, South Korea Jong Oh -- Pittsford, NY Rosiane Ferreira -- Sao Paulo, Brazil Chad Gilmore -- Gallatin, TN Garrett Wong -- Olive Branch, MS Melinda Tress -- Southfield, MI Ana Claudia Limoeiro -- Sao Paulo, Brazil Bianca Almeida -- Campinas, Brazil Tracy Jenkins -- Bowling Green, KY Jennee Canavesio -- Oklahoma City, OK Connie Sell -- Cape Coral, FL Deborah Mitchell -- Spokane, WA Nordis Forcades Crespo -- Miami Gardens, FL Carlos Damasceno -- Guarulhos, Sao Paulo Marie Woods -- Denver, CO

Jessica Whitehead -- Cullman, AL Jessica Schults -- South Brisbane, Australia Doug Papciak -- Lilburn, GA Lisa Sutherland -- Houston, TX Lyndsey McReynolds -- Spring, TX David McMeins -- Seattle, WA Kathleen Pratt -- Henrietta, NY Mark Bennett -- Arlington, TN Bettina Fyffe -- Rancho Santa Margarita, CA Merrydaile Punzalan -- Austin, TX Leah Nichols -- Spokane, WA Deitra Shipman -- Washington, DC Michele Brodie -- Vancouver, BC, Canada Melanie Falk -- Meriden, KS Pablo Figueroa -- Santiago, Las Condes, Chile Janet Schwartz -- Andover, MA Kenda Danowsky -- New Columbia, PA Amanda Cooper -- Valley Springs, CA Kimberly Botschon -- Longview, TX Holly Campbell -- Cottonwood Heights, UT Linda Ingalls -- Kamloops, BC, Canada Jeremy Gainer -- Wylie, TX Nicholas Palma -- Feasterville Trevose, PA Amy Gregory -- Jacksonville, FL Shelby Reimann -- Loveland, CO Matthew Morris -- Baltimore, MD John Egly-Russell -- Milwaukie, OR Elizabeth Friesen -- Anchorage, AK Dawn Fitzgerald -- Highland, NY Terri Adams -- Hamilton, TX Maureen Preciado -- San Antonio, TX Julie Sandersen -- Fort Collins, CO Mark Faucett -- Buderim, QLD, Australia Cynthia Fischer -- Austin, TX Lydia Cranford -- Sherman, TX Lisa Blasingame -- Rockwall, TX Tyler Hendley -- Aberdeen, MD Brittany Kelley -- Keller, TX Meesun Cho -- Federal Way, WA Tracey Ginnings -- Fort Worth, TX Priscila de Vera -- San Diego, CA Shawn Fisher -- Edgewood, WA S Eaddy -- Bayonne, NJ Jennifer Kersey -- Macon, GA Andrea Trotter -- Eugene, OR Hollie Markun -- Beaver Falls, PA Celeste Albert -- New Gloucester, ME Rebekah Caudle -- Elkin, NC Ellen Adrian -- West LInn, OR Joseph Hardy -- Milwaukee, WI Susan Carter -- Republic, MO Joanne Dalusung -- Houston, TX Thomas Morse -- Wichita, KS Nick Flaucher -- Olathe, KS CINDY GILMER -- Cottleville, MO Charles Swan -- Jacksonville, FL Joseph Elms -- Traverse City, MI Valerie Connelly -- Wichita, KS Tara Gibson-Burns -- North Canton, OH

Members (Joined May 1, 2019 - July 31, 2019)

Julie Hayman -- Alpharetta, GA Darian Yera -- Hialeah, FL Jessaca Condas -- West Jordan, UT Lindsey King -- Sacramento, CA Elizabeth Holowasko -- Saginaw, MI Zachary Lassiter -- Jacksonville, FL Shahanshah Manzoor -- Fremont, CA Kirby Jacobs -- Newark, CA Heather Maude -- Mableton, GA Amber Leach -- Sabattus, ME Kendra Bendak -- Plainfield, IL Karen Ratz -- Hiawath, IA Joesie Manucay -- Tacoma, WA Lydia Harris -- Forest Grove, OR Raul DeAnda -- Fair Oaks, CA Teresa Butman -- Cottonwood, AZ Becky Tung -- Campbell Ct, CA Claire Neil -- Santa Clara, CA Sandra Scott -- Sewell, NJ Steve Wiggins -- Richmond HIll, GA Dawn Berndt -- Fitchburg, WI Gina Fera -- Philadelphia, PA Tamitza Chavarria -- Las Vegas, NV Trisha Reiling -- Big Lake, MN Tammy Danielson -- Poway, CA Amber Brashear -- Roseville, CA Harsh Chheda -- Cheshire, CT Brent McHone -- Pleasanton, CA Lissy Sunny -- Mountprospect, IL Brad DeWulf -- Mableton, GA Susan Brown -- Moultrie, GA Patty Bartock -- Carlsbad, NM Krisdee Nelson -- Kaysville, UT Derek Swan -- Brunswick, ME Karen Fogg -- Williams, OR Shannon Cloutier -- Hebron, ME Theresa Dagel -- Overland Park, KS YunHee Lee -- Oakland, CA Mubin Yousuf -- Brunswick West, Melbourne Gabriela Camara -- Napa, CA Patty Pascual -- Los Angelels, CA Kara Rolland -- Bozeman, MT Valerie Martin -- Santa Rosa, CA Richard Spell -- Bolivar, TN Marjorie Metellus -- Rancho Cucamonga, CA Julie Montalbano -- New York, NY Nicole Guenther -- St. Charles, MO Lenore Ahfook -- Chula Vista, CA Manuel Fernandez -- Jamaica Plain, MA Katy Hunter -- Longmont, CO Janet Hand -- Tinley Park, IL Dexter Esteban -- Pearland, TX Liz Campbell -- Waltham, MA William Cardona -- San Diego, CA Keely Wright -- San Ramon, CA Ciera Lisser -- Bronx, NY Omana Mathew -- Missouri City, TX Lee Spann -- North Royalton, OH Brandy Bennett -- Richmond Hill, GA

Rachel Battey -- Caledonia, MI Patricia Hunt -- Deland, FL Krista Kyle -- Mansfield, MA Jennie Chen -- Houston, TX Jami Lung -- Boca Raton, FL Pamela Innis -- Quincy, IN Judi Caruso -- South Windsor, CT Cecilia Rogers -- New York City, NY Jenny Mills -- Oregon City, OR Cindy Augustine -- New Ellenton, SC Mattea Labs -- Cedar Rapids, IA Nicole Marsh -- Brisbane, Queensland Alexey Salamini -- San Francisco, CA Camille Stowell -- Syracuse, UT Holly Avery -- Houston, TX Andrea Arendas -- National City, CA Stephanie Boarman -- Brownsburg, IN Heidi Rogers -- Wake Forest, NC Lynne Rowan -- Kerrville, TX Kennisha Mask -- Pearland, TX Sonia Rodriguez -- Lakewood, CA Karen Young -- San Diego, CA Marylou Ringpis -- Porter Ranch, CA Mary Rose Santos -- Los Angeles, CA Sharon Key -- Murrayville, GA Jill Bright -- Hollister, CA Robert Pathrose -- Paramus, NJ Brittany Darder -- Willow Spring, NC Heidi Hatano -- San Jose, CA Emily Larsen -- Tarragindi, Queensland Rachel Rivera -- Albuquerque, NM Philip McWherter -- Riverview, FL Paul Barnes -- Mebane, NC Megan Beamer -- Lowgap, NC Rachael Edman -- Pennock, MN Christina Sanchez -- Albuquerque, NM Steve Jordan -- Monroe, LA Stacy DiCicco -- Las Vegas, NV Jenn Turner -- Millbury, MA Elizabeth Stewart -- Bradenton, FL Jennifer Reddick -- Rock Hill, SC Marsha Hopkins -- Weatherby Lake, MO Ester Marsh -- Philadelphia, PA Crystal Lehmann -- Fullerton, CA Michael Serle -- Whispering Pines, NC Kathleen Eastburn -- Phila, PA Alicia Clary Hayden -- Oakland, CA Alyson Lyons -- Rancho Palos Verdes, CA Jennifer Hoiem -- Rochester, MN Julie Ferguson -- Braselton, GA Peggy Yip -- Auckland, New Zealand Jennifer Hamilton -- Hebron, KY David Dorris -- Jonesboro, AR Crystal Conwell -- Carrollton, TX Samantha Keogh -- Brisbane, Queensland Lisa Rabow -- Atlanta, GA Kyle Bundas -- Burleson, TX

AUGUST 2019 | 41


11th Annual Vascular Access Summit August 17, 8:00 a.m. – 4:30 p.m. at the Renaissance Resort World Golf Village in St. Augustine, FL 5 CE Credits Available -- Registration includes continental breakfast and buffet lunch Presentations by: Melody Bullock, CRNI®, IgCN, BSN, BS, MS Kris Hunter, BSN, RN, CRNI®, VA-BC™ Matt Ostroff, MSN, AGANCP, VA-BC™ CRNI®, CPUI Amy Gregory, RN, MSHL Jack Ingold, RN $120 for pre-registration, $125 at the door



Boot Camp August 24, 8 a.m. – 1:30 p.m. 4 CE Credits Available Participants to rotate through the following sessions: • Implanted Port Accessing/De-accessing • Peripheral IV/Midline Catheters • CVC/PICC Dressing changes, care and maintenance • De-clot devices, troubleshooting devices, device identification • Registration includes breakfast and a snack during intermission Free to COVAN members, $10 for non-members



Quarterly Meeting Dinner and Educational Presentation August 20, 6:30 – 9 p.m. at Season’s 52 in Houston, TX Presentation by: Jill Nolte, BSN, BSN, CRNI®, VA-BC™ titled, “Vascular Access – A Surgical Wound” Registration includes dinner and refreshments Free to HOUVAN members, $15 for non-members



1st Annual Symposium IV Challenges, Failures and Documentation August 23, 8 a.m. – 4 p.m. at the Alaska Native Medical Center in Anchorage, AK 5 CE Credits Available Presentations by: Nadine Nakazawa, RN Russ Nassof, JD Tim Spencer, DipAppSci, BHSc, ICCert, RN, APN, VA-BC™ $45 for PolarVAN members, $65 for non-members (fee includes reduced PolarVAN membership through Feb. 2020)



2019 Full Day Scientific Meeting and Vendor Fair August 29, 8 a.m. – 4 p.m. 6 CEs available Participants to hear the following presentations: • Emergency Vascular Access: An Evidence-Based Approach • Clinically Indicated Peripheral Vascular Access Care and Maintenance • Impact of CLABSI and no-CLABSI – Chronic and Acute Patients’ Perspective • Novel Dressing Approaches for Disruptions in Skin Integrity Near PICC line Insertion Sites: Integrating Wound Care into Vascular Access • Catheter Technology – Evidence-Based Risk Reduction Strategy • Vascular Access Grand Rounds – Case Reviews $25 for students, $60 for INDIVAN members, $85 for non-members, $75 to attend the meeting and become an INDIVAN member for the remainder of 2019



Network Meeting September 5, 6 p.m. SAVE THE DATE! Details to come.


Network Meeting September 12, 6 p.m. SAVE THE DATE! Details to come.


Network Meeting September 19, 6:30 – 8 p.m. Presentation by: Dr. Pitou Devgon, titled Reviewing Approaches to Blood Collections Email to register


Network Meeting September 25 SAVE THE DATE! Details to come


AVACNY was proud to have Greg LoPresti, the Senior Vice President and CEO of Upstate HomeCare, share a presentation titled, “Success of Nurses Pivotal Role in Transitional Care” in relation to population health and successful disease state management at AVACNY’s June network dinner meeting. This meeting, sponsored by Upstate Home Care, took place at Swifty’s Restaurant in Utica, NY. LoPresti’s presentation sparked a lot of interest with our members, who actively participated in the discussion on home transition, disease state management and insurance barriers. Many disciplines shared their own experiences dealing with different payers and how they affect patient outcomes andhave the potential to delay discharge and therapies in alternative care and home infusion therapy settings. Our audience included many members from area hospitals involved in discharge planning, long term care management,

pharmacy infusion services, and vascular access. Plans are under way for the annual AVACNY Infusion Therapy & Vascular Access Teaching Day Symposium in November. We are looking forward to another excellent educational event in Syracuse. For more information about what is going on with AVACNY, visit us online at

AUGUST 2019 | 43

Watch for the latest from JAVA

Check out our upcoming Fall edition of:

Our Fall Edition of JAVA will be published before #AVASM19 Behind on your CEs? AVA members have access to the CE article in each issue of JAVA! Simply read and complete the short quiz to receive 1.0 contact hour. Click here.

Learn more about JAVA here. The Journal of the Association for Vascular Access (JAVA) publishes original peer-reviewed feature articles related to the care and management of patients with vascular access devices. AVA members are the ‘trend-setters’ in the vascular access arena and are keeping up with the most current advancements in the industry.





We invite you to submit original manuscripts in the field of Vascular Access. We are interested in receiving manuscripts on clinical practice, education and research related to vascular access including articles on vascular access manufacturing and technology, and vascular access care and maintenance issues in hospitals, home settings, hospice, and alternative care facilities. We also invite submissions to our Patient/Consumer Perspective column where we ask you to share personal stories or “lessons learned� about caring for, living with or having a vascular access device. In about 1000 words and in conversational style, present your story. You can submit on behalf of someone or encourage them to write it themselves.


Information for Authors at Or contact the JAVA Editor at AUGUST 2019 | 45

Advertise to the Market You’ve Been Looking For . . .

Advertising space available on The Second Edition of the ‘Chart of Pediatric CVC Maintenance Bundles’ IS AVAILABLE AT AVAINFO.ORG/STORE

GET YOURS TODAY! Printed full color with gloss UV coating 13” x 19” size Package of 5 Members: $40 Non-members: $50 Shipping included 46 | IQ | INTRAVASCULAR QUARTERLY NEWSLETTER

DO YOU LIKE WHAT YOU READ HERE? Would you like to be part of this publication? Do you have something interesting, informative or new going on in your place of practice? Have you cared for a special or interesting patient? Do you or your colleagues have new or innovative ways of doing things? Have you been to or presented to any meetings or conferences?

WE INVITE YOU TO SUBMIT FOR PUBLICATION Writing a submission does not mean that you have to write the next great American novel. It is more about presenting pertinent information in a brief, fun and creative way. Please submit to

SUBMISSION DATES ARE: FEBRUARY 1 deadline for submissions for February issue MAY 1 deadline for submissions for May issue AUGUST 1 deadline for submissions for August issue NOVEMBER 1 deadline for submissions for November issue

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Association For Vascular Access

Association For Vascular Access

F O R C O M M E N T S OR S U G G E S T I O N S , P L E A S E S U B M I T T O AVA @ AVA I N F O . OR G Disclaimer: AVA (Association for Vascular Access) is a professional organization of vascular access professionals dedicated to improving vascular access practice and patient outcomes through education and other means. AVA publishes this periodic electronic newsletter for our membership and other interested parties for information purposes only. AVA distributes this electronic newsletter with the understanding that AVA is not engaged in rendering medical or professional service through the distribution of the IQ publication. AVA is not giving advice and does not subscribe to guarantee the accuracy or efficacy of the information provided. Privacy Policy and Unsubscribe Information -AVA maintains strict rules of confidence with regards to your email address and all other personal contact information. We will not, under any circumstances, sell, transfer, or provide your email address to any third party for any reason. Email lists are compiled on an opt-in basis by AVA for the sole purpose of distributing the IQ newsletter. AVA does not condone or participate in the distribution of unsolicited email. If you feel that you have received an email transmission from AVA in error, please contact AVA at and ask to be removed from the list. All removal requests are addressed promptly.

AUGUST 2019 | 47

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Intravascular Quarterly - August 2019  

Intravascular Quarterly - August 2019  

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