Intravascular Quarterly | IQ | Nov 2022

Intravascular QUARTERLY

Global Disclaimer: The views and opinions expressed in the Intervascular Quarterly Newsletter are those of the authors and do not necessarily reflect the official policies or positions of the Association for Vascular Access (AVA) or any of its leaders, volunteers, employees, committees, networks or other groups associated with AVA. For information on this publication, please email ava@avainfo.org.

2022 TOWS SURVEY THREAT, OPPORTUNITY, WEAKNESS, STRENGTH

Each year the AVA board meets in January to review the strategic plan and prepare for a successful year.

For 2023 we would like to get input from a broader range of stakeholders and we need YOU to help us. We are hoping to obtain input from stakeholders from both inside the association and outside the association. The following is a simple survey. I’d like for you to think about AVA from your perspective and share your honest feedback about the threats, opportunities, weaknesses and strengths of the association. Threats and opportunities are external factors that impact the association and weakness and strengths are internal factors.

Please fill out the demographic information to help us analyze the resulting data and answer the four questions. We will compile and analyze the results of the survey and provide that valuable information to the board as we work to identify our strategic advantages, strategic challenges and strategic opportunities.

Thank you so much in advance for taking the time to complete the survey. Your thoughts are important to us and will help make us a stronger association.

Thank you, Tonya Heim, MHA, MSN, RN, NEA-BC 2o22 AVA Board President-Elect

AVA FOUNDATION SCHOLARSHIP WINNERS

Michelle L. Hawes, DNP, CRNI, VA-BC, ACRP-CP

AVA Foundation President-Elect, 2022

The Association for Vascular Access Foundation’s vision is to create a world with safe and reliable vascular access.

At the 2022 AVA Scientific Meeting in Minneapolis, MN, the Foundation awarded 20 scholarships, including conference registration and travel expenses. The awardees are now a part of the mentorship program to assist with quality improvement and research leading to dissemination .

Sharing quality evidence through posters, presentations, and publication begins with a clearly defined study. The Foundation believes that the vision of a world with safe and

reliable vascular access will not be possible without sharing evidence on which to base best practices.

Assistance in the process of research, poster, presentation, and publication can be obtained through the AVA Foundation Mentorship Program. To contact the AVA Foundation regarding mentorship assistance, please email AVAFoundation@ avainfo.org. Information about the Foundation and ways to donate can be found at avainfo.org/page/foundation

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2023

Call for Topics and Presentations

WHO IS AVA?

AVA, The Association for Vascular Access, is a notfor-profit multidisciplinary professional organization uniquely positioned as the leader in vascular access education and research. Its mission is to improve patient safety, comfort and outcomes, define the vascular access specialty, promote a favorable public policy environment, optimize professionals’ knowledge and skills, share best practices, and promote research in vascular access. AVA’s membership includes clinicians from many disciplines including nursing, medicine, radiology, respiratory therapy, pharmacy, as well as consumers, professionals from industry, education, research, and others with an interest or specialization in vascular access and related fields.

Meeting attendees come from many countries and include professionals from:

Interventional Radiology • Oncology • Surgery • Education and Training • Critical Care • Home Care • Home Infusion • Hematology • Radiology • Pediatrics and Neonatology • Nephrology and Dialysis • Anesthesiology • Infectious Disease • Infection Prevention • Vascular Access • Research and Development • Sales and Marketing • Engineering

AVA ANNUAL SCIENTIFIC MEETING

2023 marks AVA’s 36th Annual Scientific Meeting with at least 1,300 attendees, which include 60–70 industry partners. The meeting site is in Portland, Oregon. AVA demonstrates its leadership role in the art and science of vascular access. This four-day conference (October 14-17, 2023) provides attendees with opportunities to participate in educational sessions, hands-on training, facilitated discussion, and networking.

General Sessions focus on development of the vascular access specialty, clinical research, professional development, technological advances, and evidence-based practice.

Breakout Sessions will offer small group presentations emphasizing subjects of interest for the vascular access specialist and related disciplines; abstract and poster presentations allow participants to share original research, education projects and clinical innovations.

Platinum Showcases and Exhibits afford participants, corporate members, and exhibitors the opportunity to learn from each other, design and apply new technologies, science, and techniques in the most effective ways.

With separate registration fees, an additional day of Pre-Meeting Workshops (October 13, 2023) offers in-depth exploration of topics of critical importance to the vascular access community.

The Call for Topics seeks submissions from:

1) Professionals who wish to submit a Topic for Presentation

2) Recommendations for speakers and/or topics to be included in the Scientific Meeting

• Participation and submission of topic suggestions is NOT limited to AVA members

• Topics should address the general or specific interests of AVA members and meeting participants keeping in mind that AVA is an organization of clinicians, healthcare specialties, and industry/ corporate professionals involved in vascular access and related fields

• Presentations must avoid any semblance of commercialism

• General Sessions are limited to 60 minutes in length

• Breakout Sessions may be scheduled from 30 to 60 minutes in length at the discretion of the selection committee

• Hands-On Workshops may be scheduled for a full day (8 hours) or for a half day (4 hours)

• A topic submitter may submit more than one topic, but please note that each speaker may be limited to presenting at only one invited session and one poster/oral abstract as the principal author

• AVA values diversity, inclusion, and professional mentoring among its membership and promotes these values in its topic and speaker selection processes

• AVA reserves the right to solicit additional and/or new speakers for any proposed topic

Get prepared for your Presentation Submission.

The information listed below is required to complete the submission process. Each submission is reviewed by program committee members who score the key elements based on how closely the given criteria are met.

Presentation Title:

Use key words that describe the specific topic and content of the abstract. Catch phrases can be used but need to include a reference to the topic. For example, “Making a Difference” may get attention but does not suggest what the abstract is about. By adding a specific reference to the abstract subject matter, the abstract title becomes clearer; i.e., “Making a Difference: Ace Inhibitors in Hypertensive Patients.”

Target Audience:

What population is this session designed to benefit most?

Level of experience of the target audience: Basic, Intermediate, Advanced What type of presentation is this? General Session Breakout Session* Hands-On Workshop

*Breakout Sessions may be scheduled from 30 to 60 minutes in length at the discretion of the selection committee.

Prerequisite: Include the minimum knowledge and/or skills required to most benefit from this session.

Purpose/Goals:

This statement should be the most important primary information you want to convey for the abstract. This should be one or two sentences. The title should not be repeated.

Has this presentation been given before? Where?

Learning Objectives /Outcomes:

Minimum of three objectives are required. Provide three to five outcomes that complete the statement: “By the end of this session the participant will be able to” Do not type this statement in the text box when entering each of your outcomes.

Content Description:

The content description should be concise yet comprehensive. Ask yourself as you are reading the session description, “As an attendee, do I know what this abstract is about and would I want to attend?” Ask a colleague to read it as well while considering the same question. (max. 1,000 characters including spaces)

Additional Text:

Any additional text that expands the content description to be used for the review process. This narrative is your opportunity to provide a convincing overview of the value of your proposed session. If the reviewers cannot clearly understand what this session is about, your odds of having your abstract selected are greatly reduced. Expansion of the content description must be written in a brief, well-organized, and focused manner. In one paragraph the potential speaker should have written a narrative that: 1. Identifies the key topics that will be addressed 2. Describes any special learning activities, such as case study analysis, audience participation, or interactive discussion.

Speaker Contact Information, CV/Resume, Presentation Experience, and Availability Over Meeting Dates.

Contracts are signed only with the primary presenter. Only the Primary Presenter may be eligible for any speaker incentives. All presenters must be aware that this application is being submitted.

Some applicants will be contacted by an AVA 2023 Annual Meeting Design Team Member for a phone interview between February and March of 2023 to discuss the presentation submission. Please try to return messages promptly. The interview is an integral part of the submission review process. Failure to participate, or be available for an interview may result in the elimination of the submission from the review process.

The program will be selected by April 2023 Applicants will receive notice by email.

AN INCONVENIENT TRUTH ABOUT CONVENIENCE KITS

Michelle L. Hawes, DNP, CRNI, VA-BC, ACRP-CP

I am going to start this with the truth about sutures. Sutures are excellent for wound closure but are not intended to secure external devices. Look at any instruction for use (IFU) document accompanying a non-absorbable suture, and you will find no reference to securing external devices of any kind. Here is a summary of six IFUs for standard non-absorbable sutures.

As indicated, all are labeled for general soft tissue approximation and/or ligation. Why does this matter? Because of the regulation from the Food and Drug Administration (FDA) Guidance Document, linked here

Here is a quick breakdown of the logic behind the Convenience Kit Interim Regulatory Guidance (May 1997, last update March 2018). This document was implemented so convenience kits could be assembled and not need separate approval from the FDA to be marketed. The guidance makes sense if all the components in the kit have already been approved. Why would bundling the approved devices together change their functionality?

In the guidance document, this is what is stated about the requirements for the components in the kit.

2. Components

Convenience kits subject to this guidance should only include components that are either: (1) legally marketed preamendments devices, (2) exempt from premarket notification, or (3) have been found to be substantially equivalent through the premarket notification process. The components should be purchased in finished form, i.e., they should be packaged, labeled, etc., consistent with their legal marketing authorization.

The inconvenient truth is that according to this guidance on convenience kits, there should be no confusion that the sutures provided are for wound closure and not to secure an external device. First, however, let us consider giving a grace period for the first few years that this interim regulation was implemented.

In

1997, few engineered securement

devices (ESD) were available to replace the gap in securement that sutures had filled since the 1960s. Although, by the last update in 2018, the choices were greater, including a large amount of research on ESD safety and efficacy. Therefore, at this time, there is no reason for sutures to be placed in a central venous access device (CVAD) convenience kit intended to function as securement. Perhaps a sticker placed on current kits explaining there is no securement would get some additional focus on the issue.

In the guidance, CVAD kits are designated under cardiovascular devices. The specific information on these kits can be found in the product classification. Lifted directly from this document is the following definition:

“This product code has been established in accordance with the May 20, 1997, guidance entitled, convenience kits interim regulatory guidance, found at www.Fda.Gov/cdrh/ode/convkit.

Html. This type of convenience kit, as listed in the guidance above, is under enforcement discretion, and does not require a premarket notification (510(k)) to market if it meets all criteria in the guidance.”

Now that we know that sutures should not be in convenience kits, what can we do? Contact the FDA and ask why they are currently allowing sutures in CVAD convenience kits as a securement device when they have never been marketed or labeled for that function. The regulation falls under the Center for Devices and Radiological Health (CDRH) office and can be found at https://www. fda.gov/about-fda/contact-fda

Now that we are on the road to removing sutures as an option for securing any external device, what’s next? As vascular access specialists, it is our job to review the research on engineered securement devices to bring the best evidence to the discussion of replacing ineffective and unsafe suture-based securement.

In a recent systematic review of the safety and efficacy of current securement alternatives, the subcutaneous anchor securement system (SASS) significantly limited the incidence of migration and dislodgement associated with CVADs (Bell, et al., 2022).

More randomized control trials focused on the safety and efficacy issues of securement defined in the systematic review will continue to increase the weight of evidence to aid in the optimal securement choice post sutures.

In summary, 1. According to the FDA’s guidance documents, sutures must be removed from convienece kits if intended for anything other than wound closure.

2. Your help is needed to contact the FDA with your concerns about the convenience kit guidance allowing sutures to remain in kits intended for securement.

3. Assess the evidence in the systematic review and other peer-reviewed research when choosing an engineered securement device.

4. Consider conducting research on the safety and efficacy of engineered securement devices.

Reference: Bell, J., Hawes, M.L., Gibson, S.M., & Diloreto, E. Systematic Review of the Safety and Efficacy of CVAD Securement. Journal of the Association for Vascular Access. 2020;27(3):15-35. https://doi.org/10.2309/JAVA-D-22-0013

SEASON 5, EPISODE 9 A CHAT WITH MATT OSTROFF

Judy talks to Matt Ostroff about his upcoming book, presenting at AVASM22, and the 2022 ANCC Magnet Prize® awarded to St. Joseph’s University Medical Center.

SEASON 5, EPISODE 8 WHY CKD PATIENTS REQUIRE THE VASCULAR ACCESS COMMUNITY TO DO BETTER TO PRESERVE THEIR VASCULATURE

Judy talks to Dr. Mike Serle about the recent AVA Scientific meeting and discusses the CKD population.

SEASON 5, EPISODE 7

DIFFICULT DRESSINGS, POOR SITE SELECTION, AND OTHER UNIVERSAL PROBLEMS

In this episode, Judy talks to Jack LeDonne MD and Michelle DeVries. Jack shares the 4 universal challenges he sees in all facilities he visits. Michelle and Judy discuss dressing disruptions and difficult situations with adhesives.

SEASON 5, EPISODE 6

EVOLUTION OF VASCULAR ACCESS SPECIALIST TEAMS

In this episode Lauren Langlands, a nurse starting a vascular access team in a small hospital, is joined by Lee Steere and Warren McGlauflin, both experienced VAST directors, to talk about the possibilities and sticking points of how teams evolve within different organizations.

NATIONAL INSTITUTE OF NURSING RESEARCH

2022–2026 STRATEGIC PLAN

MISSION: Lead nursing research to solve pressing health challenges and inform practice and policy—optimizing health and advancing health equity into the future.

RESEARCH LENSES

Systems and Models of Care

Reduce and ultimately eliminate the systemic and structural inequities that place some at an unfair, unjust, and avoidable disadvantage in attaining their full health potential.

Identify effective approaches to improve health and quality of life by addressing the conditions in which people are born, live, learn, work, play, and age.

Address critical health challenges at a macro level that persistently affect groups of people with shared characteristics.

Prevent disease and promote health through the continuum of prevention—from primordial to tertiary.

Address clinical, organizational, and policy challenges through new systems and models of care.

Health Equity Social Determinants of Health

Population and Community Health

Prevention and Health Promotion

NETWORK NEWS

FLAVAN

Our members have been busy attending our meetings offered over the past several months. We gathered in Jacksonville in July 2022 where Tim Spencer, DipAppSc, BHSc, ICCert, RN, APRN, VA-BC presented on the reduction of malpostions, thrombosis, and infection sponsored by Teleflex. We introduced a hybrid meeting with a few members watching virtually as well.

Meagan Capen, CPNP-AC, MSN, VA-BC™ |

FLAVAN

President David Markle, RN, VA-BC™ | FLAVAN Secretary/Treasurer

Diana Melton, MSHA, RN, CRNI, VA-BC™ | FLAVAN Presidential Advisor

August 2022 our members assembled again in Jacksonville where Michelle DeVries MPH, CIC, VA-BC discussed PIVs, the infection risk, evidence, and patient satisfaction sponsored by BD, we also offered a hybrid option for our members to attend.

Collaborating with GulfVAN in August 2022 we were invited to join their virtual presentation by Tammy Johnson, RN, BS, CPM who shared advances in blood culture practice with diagnostic and antimicrobial stewardship sponsored by Magnolia Medical. A special thank you to GulfVAN.

In September we hosted Vance Clement, BSIE, MBA, Lineus Medical CEO in Orlando who presented the D.I.P.P.E.R study sponsored by Lineus Medical.

FLAVAN is excited to announce that our 2023 Educational Summit will be held April 29th at the Hilton Garden Inn Cocoa Beach Oceanfront. Registration opens early December 2022. Please email flavan1018@gmail. com if interested in attending or for vendor information.

FLAVAN has two open board of directors positions and are preparing for our upcoming elections. We can’t wait to introduce our newest board members in early 2023.

For more FLAVAN news and upcoming events please visit our website by clicking the link FLAVAN and don’t forget to like and follow us on Facebook!

PRESIDENT-ELECT Tonja Stevens, RN, VA-BC™

PRESIDENT-ELECT Tonya Heim, MHA, MSN, RN, NEA-BC

PRESIDENTIAL ADVISOR Jocelyn Grecia Hill, MN, RN, CVAA(c), VA-BC™

CHIEF OPERATIONS OFFICER

Tonya Hutchinson, CAE thutchison@avainfo.org

MARKETING MANAGER & ANALYTICS DIRECTOR Kayce A. Maisel kmaisel@avainfo.org

www.avainfo.org/networks

2022 BOARD OF DIRECTORS

SECRETARY Chellie (Michelle) DeVries, MPH, CIC, VA-BC™

DIRECTOR-AT-LARGE Staci Harrison, DNP, RN

DIRECTOR-AT-LARGE Swapna Kakani, MPH

DIRECTOR-AT-LARGE Karen Laforet, RN, MCIScAHCP, CCHN, CVAA, VABC™

DIRECTOR-AT-LARGE Nael Mhaissen, MD

DIRECTOR-AT-LARGE Chaitenya Razdan, MBA

AVA STAFF

CLINICAL EDUCATION SPECIALIST Blake Hotchkiss, BSN, RN, CCRN, CRNI, VA-BC™ bhotchkiss@avainfo.org

DIRECTOR OF CLINICAL EDUCATION

Judy Thompson, MSNEd., RN, VA-BC™ jthompson@avainfo.org

ADMINISTRATIVE ASSISTANT Jennifer Finlayson jfinlayson@avainfo.org

The 2021 AVA Resource Guide for Vascular Access: AVA's Recommended Study Guide for Vascular Access Board Certi cation provides an overview of basic vascular access knowledge and covers essential elements that clinicians implement on a daily basis. Throughout the Resource Guide, readers have access to high de nition images, videos, illustrations and engaging animations that give them a greater understanding of the concepts. The guide may be used to prepare for the vascular access board certi cation examination (VA-BC™), as well as serve as a resource throughout professional practice.

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:

Introducing I S A V E Inform us right away See us check your IV often Ask us to clean our hands Value your veins Expect us to follow basic rules

new resource is completely FREE as a downloadable PDF. Please share and distribute S T O P

On the patientcentered version, ISAVE stands for:

program from the ground level: A patient-friendly version Written and edited by patients A Guide For Patients and Families I NFORM US RIGHT AWAY IF YOUR IV SITE HAS ANY OF THE FOLLOWING: EE US CHECK YOUR IV OFTEN SK US TO CLEAN OUR HANDS ALUE YOUR VEINS

Find out more online.

in welling emperature Change ozing 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. 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.

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. XPECT US TO FOLLOW BASIC RULES:

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.

addition I S A V E 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! 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 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 ava@avainfo.org. www.avainfo.org

S A V E Stay up on the latest at www.avainfo.org/isavethatline

CALL FOR MANUSCRIPTS

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.

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.

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 ava@avainfo.org

SUBMISSION DATES ARE:

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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 info@avainfo.org and ask to be removed from the list. All removal requests are addressed promptly.