An Answer from the Frontier: Securement, A Case Review by Amanda Saylor, MSN, RN, CRNI
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Our vascular access team (VAT) had a well-known issue at our facility. As had happened many times before, a patient received multiple peripherally inserted central catheters (PICCs) and midline catheters only to have them migrate out over days to weeks. Whether this happens to a patient with a one-time order for six weeks of intravenous antibiotics or to patients with more chronic health issues, a migration or dislodgement of a vascular access device out of its intended tip location is an adverse patient event.1 The patient in this case review had received four PICCs and multiple midline catheters. Every PICC had migrated out of position or dislodged entirely during her infusion therapy. As the goal of any VAT is to place the right line that will safely complete the course of therapy, our team had failed every time with this patient. The failure was not in not understanding current evidence for vein selection,
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catheter-to-vein ratio, or even care of the PICC to avoid the risks of infection. The VAT had well-developed policies and protocols and members with national certifications in infusion therapy and vascular access.2,3 The potential for migration and dislodgement occurred because securement became an afterthought of this well-placed device.