The CVAA Link: Winter/Spring 2017

THE CVAA

Newsletter of the Canadian Vascular Access Association

WINTER/SPRING 2017

Top Five Favourite CVAA Moments

By Melissa McQueen As I enter my sixth year with CVAA, I’ve looked back and thought about the last five years with this association. The non-profit world was new to me when I joined CVAA back in 2012, but I have been amazed by the passion and dedication our members and volunteers have for the mission and goals of our association. It’s been a thrill to be a part of CVAA and help contribute to its growth and sustainability. Looking back, here are my top five favourite CVAA moments:

1

2014 Conference—witnessing the legitimacy of hypnosis For those of you who were there, you’ll likely remember the spectacle some of us put on, all under the influence of the Incredible Boris. Once a skeptic, I am now fully a convert—what other excuse could there be for the crazy dancing, catwalk strutting and general nonsense I performed in front of you? I’m still living those videos down.

2

Invigilating exams I love having members wanting to write the CVAA certification exam in the Hamilton area, as I can volunteer to invigilate for them. It’s such a great way to meet people in person and have a one-on-one chat about their work and CVAA. Working from home can be isolating at times, so any opportunity I get to meet you in person is a treat!

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

3

Attending chapter events The same goes for chapter events I get to attend—usually in the Hamilton area, but it would be amazing to attend them all (especially Bermuda!). The amazing volunteer work the chapters do for their events and members blows me away every time. The local events are so well attended and it’s exciting to make people aware of CVAA. Plus, one time, I got to dress up as a judge!

4

2015 Conference—the handsome piper I can’t think of a better way to lead our conference delegates to a reception than a very handsome Halifax Citadel Regimental piper. Fun extras at the conference are definitely a ‘work perk’.

5

Annual in-person Board meetings While it might not seem like the best way to spend a freezing weekend in January, I always look forward to the Board’s in-person meeting each year. It’s so productive to meet in person, as opposed to our regular teleconferences, and we get so much done—and manage to have some fun too!

Each year, the Board members impress me with their dedication and work ethic.

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AND A SOLUTION FOR HIGH IV FAILURE RATES. IV therapy is one of the most common, invasive procedures conducted today.

Yet complications cause up to 50% of all IVs to be replaced before therapy is completed.1 That can result in delayed treatment, unnecessary restarts, pain and discomfort for your patients and stress for you. Enter BD Vascular Access Management—a new, integrated solution for reducing peripheral IV complications. It’s an approach that can help you achieve improved outcomes for your patients by combining evidence-based clinical training and education with a comprehensive portfolio of products—all working together to raise the quality of vascular access care. Discover the difference one company can make. Discover the new BD.

Visit the BD booth at CVAA Conference 2017 or bd.com/CVAA-2017 to learn more about the Difference of One. 1 Helm RE, Klausner JD, Klemperer JD, Flint LM, Huang E. Accepted but unacceptable: peripheral IV catheter failure.

J Infus Nurs. 2015;38(3):189–203. © 2017 BD. BD and the BD Logo are trademarks of Becton, Dickinson and Company. BD-2003 MC7517 (0217)

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

CVAA Conference

Are you joining us in Ottawa for the 42nd Annual CVAA Conference— April 26–28, 2017?

We have another great event planned for you including: • Pre-conference Workshop (Peripheral IV & Ultrasound) • Dinner & Social Event • Skills Lab hands-on demonstrations • Plenary, Concurrent and Symposium presentations • Exhibitor Networking • Much more….

• “Sticky Drugs,” Under-Infusions and Occlusions: Addressing the Home Infusion Confusion (Part 1) • Medical Assistance in Dying: What every HCP Needs To Know (PANEL) • IV Teams and the Vascular Access Specialist: Pros and Cons (Yes, let’s talk about the “cons”) and When it is just not an Option.

• Midline Madness: Sorting Through the Evidence as We Added Midlines to our Vascular Access Practice

The Preliminary Program is available here and the EARLY BIRD registration is open until March 27.

Register today and save!

Here is a sample of some of the sessions: • Extreme IR – Central Venous Access • Social Media and Internet: Patient Friend or Foe? • Subcutaneous immunoglobulin therapy: A cost-effective and comfortable alternative to intravenous infusion • It’s a mAb world: Practice considerations in monoclonal antibody therapy

The Ottawa CVAA chapter has been working so hard and enthusiastically to welcome you to their fair city!

Follow along with their journey on Facebook here.

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Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

CVAA Guidelines Update The national guideline project is well underway and our dedicated Guideline Development Group (GDG) and Steering Committee (SC) have been working hard reviewing existing standards and drafting recommendations.

We will be meeting at the CVAA conference in April for our first consensus meeting. The members of our team are: SC: Daphne Broadhurst Carmen Cernusca Brenda Gray Karen Kelln Sheryl McDiarmid GDG: Sarah Burns Melanie Cates Nan Cleator Patricia Connick Adele deRosenroll Ankica Djurcic-Jovan Nancy Friesen Tracey Hagan-O’Connor Jocelyn Hill Tami Jemson Karen Laforet Kristie Naayer Kathleen Toth Elaine Tardif – 3M Sponsor Rep Connie Wootten – BD Sponsor Rep

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Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Continuing Education Questions 1. When assessing/treating a CVAD for an occlusion which of the following is true: a) As long as one lumen of a CVAD is functional, do not treat the second occluded lumen b) Thrombolytic agents can be used only when a complete occlusion has occurred in all lumens c) Thrombolytics can dwell for 30–120 minutes with a possibility of up to 72 hours in the case of a mural thrombus d) When using alteplase for a partial occlusion in a single lumen implanted VAD, it must be increased to a one-time dose of 4 mg 2. The flow rate of blood in the SVC is approximately: a) 10 L/min b) 2 L/min c) 20 L/min d) 1 L/min 3. Which of the following is true about intraluminal thrombi? a) Intraluminal thrombi account for 5–25% of catheter occlusions b) Intraluminal thrombi forms when fibrin from a vessel wall injury binds to fibrin covering the catheter surface c) Intraluminal thrombi may occlude the tip of the catheter and cause partial obstruction d) Intraluminal thrombi may progress into a venous thrombosis leading to compete vein occlusion

4. According to the 2016 INS Standards, which of the following is not listed as a designated aspect of patient teaching: a) Proper care of the access device b) Precautions for preventing infection and complications c) Signs and symptoms to report such as redness, swelling, fever d) Maintenance of scissors at the bedside at all times 5. Informed consent prior to inserting a PICC line can be obtained by the physician performing the invasive procedure or the nurse assisting them, as long as it is done on the day the procedure takes place. a) True b) False 6. A patient’s medical history may provide details of conditions that may affect the peripheral vasculature. Which of the following may increase the difficulty in locating veins by observation and palpation?

1. History of frequent venipuncture 2. IV drug users 3. Fluid volume deficit/excess 4. Age a) 1 and 3 b) 2 and 3 c) 3 only d) All of the above

Answers to Fall 2016 CVAA Link questions: 1. D; 2. B; 3. C; 4. D; 5. C; 6. E

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Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Canadian Vascular Access and Infusion Therapy Day January 25, 2017, was the first annual Canadian Vascular Access & Infusion Therapy Day. Here is how some of our chapters celebrated across the country: NEOCVAA chose to celebrate the first annual Canadian Vascular Access and Infusion Therapy Day by trying to be inclusive of all of our membership. To this end, the executive decided to send “kits”

GTA chapter

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to each site across the Northeast with promotional items such as posters and various materials to promote the day, CVAA, and NEOCVAA, encouraging everyone to establish their own celebration. Each site was encouraged to send in pictures of how they incorporated the kits into their workplace. continued…

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Sudbury promoted the day with a large information booth in the Health Sciences North cafeteria.

Displays about CVAA national, NEOCVAA, central lines, infusions, venous anatomy and Debbie Kirkwood’s famous “hand” cookies decorated with veins were a hit. NEOCVAA executive members manned the booth throughout the day promoting it all to staff.

The Chemotherapy Suite at the Northeast Cancer Centre promoted the day with a poster display educating staff and patients about the work that is done in the area and the professionals who perform that work. Sylvie Kozlowskyj set up a draw with an IV bag filled with cinnamon hearts—guess how many and win a prize! She is yet to let us in on the secret

NEO Chapter

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of how she got the hearts into the infusion bag!

The Diagnostic Imaging Department at HSN also celebrated the day with posters and more of Debbie’s famous hand-shaped cookies.

We look forward to the second annual Canadian Vascular Access and Infusion Therapy Day.

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Nova Scotia Chapter

Calgary Chapter

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Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Meet the Board Each CVAA Link issue features short interviews with members of the CVAA Board. This issue, meet Daphne Broadhurst!

Why did you join the CVAA Board?

When I was approached by the Board, I was concerned about the time commitment.

However, it seemed to be such an incredible opportunity to join the new wave of change within the organization.

It proved to be opportune timing under the leadership of President Kim Newcombe, as the organization was strengthening its foundation.

It’s been an incredible experience in understanding the governance of such an organization. Members really need to consider adding this to their professional learning plan.

What are you the most excited about for 2017 with CVAA? Just wait Canada for the publication of our national guidelines on infusion therapy and vascular access! Our members have resoundingly issued a plea for national guidance in our specialty.

While we started off a bit rocky, with the loss of our project management firm, we have such an incredibly dedicated group of volunteer guideline development group members who are pouring their hearts, time and wealth of knowledge and experience into making this happen. I am confident this is going to become the authoritative reference tool for practitioners across the nation.

Go CVAA! What aspect of the upcoming conference are you most looking forward to?

I’m hoping to see many old acquaintances and meet keen new individuals who are going to come and celebrate the nation’s 150th anniversary with us and experience a CVAA conference in my beautiful hometown of Ottawa. I’m so excited that we can all once again (as we used to many years ago) come together, kicking it up at our evening banquet. We are going to have a blast dancing (and maybe a wee bit of drinking) and celebrating Happy Birthday, Canada!!

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Tell us something interesting about yourself (personal, not professional) I live for being up at my cottage, where I spend every spare moment of my time. In an effort to save funds when my husband and I built the cottage ourselves, I took out every book (no kidding) in the library on house building and drew up the building plans for permits and calculated and ordered every nail, board and window in our place. Ask me anything about joist and rafter spans and I’m your girl.

Amazingly, 13 years later, it’s still standing strong. There’s no better way to regenerate than floating on the water with my husband of 27 years in our kayak and reading, as the breeze blows us around.

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Alliances Did you know CVAA offers a Community Infusion Alliance (CIA) program with two pilot projects?

The CIA is a formal organizational unit of CVAA, created and maintained by CVAA members who hold common professional interests. Alliances provide a multidisciplinary forum for learning, resource-sharing, education development, nationwide networking and professional interchange among members.

• To collect, develop and dissem- Withdrawal Occlusion Pilot inate recommendations, tools Project and/or activities concerning • To develop process and enhome infusion ablers for problem solving CVAD occlusions, specifically The first CIA projects are: catheter patency — infusion and KVO & Medication Related withdrawal (aspirating blood) Occlusions in the Community and next steps when catheter is • To develop best practice not functioning properly to enrecommendations for KVO with sure optimal patient outcomes. the aim to prevent catheter occlusions related to infusion Watch the CVAA website here therapy to improve patient for forthcoming documents and outcomes. resources!

Each Alliance shall define the mission and purpose of its group, which will guide the development and function of the alliance in alignment with CVAA’s mission and vision statements. The guiding mission statement of the CIA is: To advocate for excellence in infusion therapy in the Canadian community setting through a collaborative multidisciplinary approach.

The overriding objectives of the CIA are: • To provide a high standard multidisciplinary team approach to home infusion while increasing member engagement • To provide an opportunity to work collaboratively on projects to assist in advancing CVAA’s mission of advancing excellence in infusion therapy in Canada • To advise the Board of Directors on matters pertaining to home infusion

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The Site~Rite® 8 Ultrasound System with integrated Sherlock 3CG™ Diamond Tip Confirmation System is designed to simplify the placement of vascular access devices • Vein measurement tools • PICC Tip Tracking • Tip confirmation Site~Rite® 8 Ultrasound System Indications For Use: The Site~Rite® 8 Ultrasound System is intended for diagnostic ultrasound imaging of the human body. Specific clinical applications include: • Pediatric • Peripheral Vessel • Cardiac (adult and pediatric)

• Small Organ (breast, thyroid, parathyroid, testicles) • Musculo-skeletal (conventional and superficial)

Imaging Applications Exam Type (Adult and Pediatric) Vascular Bard Canada Inc. 2715 Bristol Circle, Unit 1 Oakville, Ontario, L6H 6X5 Tel: 1-289-291-8000 Customer Service: Western Canada: 1.800.268.2862 Eastern Canada: 1.800.387.7851 Ontario: 1.800.387.9473 Fax: 1.800.632.2109

Assessment of vessels in the extremities and neck (e.g., jugular, carotid) leading to or coming from the heart, superficial veins in the arms and legs (e.g., basilic, cephalic, brachial, femoral, radial, saphenous), and vessel mapping.

Assessment of superficial thoracic vessels (e.g., axillary, innominate, subclavian) Imaging Applications Exam Type (Adult and Pediatric) Vascular Access

Guidance for PICC, CVC, dialysis catheter, port, PIV, midline, arterial line placement, access to fistula and grafts, and general vein and artery access

Interventional

Guidance for biopsy and drainage

Superficial

Assessment of breast, thyroid, parathyroid, testicle, lymph nodes, hernias, musculoskeletal procedures (e.g., joints, ligaments, tendons), soft tissue structures, and surrounding anatomical structures

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Sherlock 3cG™ Tip Confirmation System (TCS) Indications For Use: The Sherlock 3CG™ Tip Confirmation System (TCS) is indicated for guidance and positioning of Peripherally Inserted Central Catheters (PICCs). The Sherlock 3CG™ TCS provides real-time PICC tip location information by using passive magnet tracking and the patient’s cardiac electrical activity (ECG). When relying on the patient’s ECG signal, the Sherlock 3CG™ TCS is indicated for use as an alternative method to chest X-ray and fluoroscopy for PICC tip placement confirmation in adult patients.

Limiting but not contraindicated situations for this technique are in patients where alterations of cardiac rhythm change the presentation of the P-wave as in atrial fibrillation, atrial flutter, severe tachycardia, and pacemaker driven rhythm. In such patients, who are easily identifiable prior to catheter insertion, the use of an additional method is required to confirm PICC tip location.

Please consult product labels and inserts for any indications, contraindications, hazards, warnings, precautions and directions for use.

Bard, Advancing Lives And The Delivery Of Health Care, Sherlock 3CG and Site~Rite are trademarks and/or registered trademarks of C. R. Bard, Inc. © 2016 C. R. Bard, Inc. All rights reserved. BAS/SRT8/0916/0027

Canadian Vascular Access Association Association Canadienne d’Accès Vasculaire

Sosido Q&A Review Join CVAA’s January discussions: Home infusion CADD Solis | IO needles | PIVs above axilla | 3 poke rule | Subcutaneous sites All CVAA National members have access to the full discussions here: • Asked on Jan 30: Subcutaneous sites (6 replies to date) • Asked on Jan 23: Injecting into IV bag ports - 3 poke rules? (1 reply to date) • Asked on Jan 18: PIV’s started above the axilla? (2 replies to date) • Asked on Jan 9: Does anyone have a practice protocol for the use of Interosseous (IO) needles in their institution that they are willing to share? We are starting to see an increased use in our ED department (both adults and paeds) (5 replies to date) • Asked on Jan 5: Home infusion CADD Solis VIP site and line cares. (4 replies to date) View all discussions.

Not a CVAA National member (or haven’t renewed yet)? Join CVAA to participate.

CVAA Membership Survey Thank you for participating in the 2016 CVAA Membership Survey. The survey response rate was 26% (159 respondents), which was up from 2014’s rate of 19% (117 respondents).

The CVAA Board of Directors uses the feedback from the survey as we develop and prioritize our strategic objectives and direction for the association.

The survey provided great insight into what our members want. You can check out the full survey results here, but here are a few highlights: • More than 80% of you still value the hard copy paper journal and the articles we provide • Guidelines, publications and events ranked highest on CVAA’s benefits list • 70% of respondents are CVAA(c) Certified.

Thank you for your feedback!

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