Imagine this scenario: you are a nurse and a patient under your care needs an IV, but you are unable to locate an access vein into which you can insert a catheter. After a first, unsuccessful attempt to place the IV (a first stick), you are unsure about what to do next.
It happens. Frequently. And when it does, you summon the Vascular Access Team.
At the urging of Vice President of Nursing Tasha Frisinger, the eight-member team was formed on July 1 to answer the challenges of a hard stick, sometimes called a DIVA, which, uncouth as it may sound, is simply an acronym for Difficult Intravenous Access “That is an actual term that is in some of our training, they’re actually referred to as a DIVA,” laughs Keeta Crawford, RN, Vascular Access, Rapid City Hospital.
Equipped with a specialized ultrasound machine and additional training to help them locate difficult veins, the Vascular Access Team is ready to spring into action at a moment’s notice. Whomever is on shift could end up just about anywhere in the hospital, (with the exception of the ICU, the Emergency Department or Neonatal Care, which have their own vascular specialists and procedures) helping to manually locate a vein, using the ultrasound to find peripheral (arm) access or considering possible alternative, central access pathways, such as dialysis catheters, internal jugular or external jugular IVs.
However, veins are not necessarily one-size fits all. So the vascular access team is able to adjust to any number of challenges in trying to solve a hard stick.
“It could be that genetics play a part in it. It could be different diseases. So if a patient has chronic kidney disease, more likely their vascular access is going to be vastly different than a healthy individual that comes into the hospital, because their veins are going to be smaller,” explains Keeta. “The older you get, actually penetrating the vein to get a needle through might be difficult. So there’s a list of things that can happen with the patient that can make their veins more difficult to access than the next patient.”
If they are unable to find a vein by traditional, manual means, the Vascular Access Team relies on ultrasound imaging for help.
“Our machine allows us to actually visualize the vein, as opposed to when you’re just blindly placing an IV,” says Keeta. “Most of the time, you can find some type of access on a patient just with the ultrasound and not have any difficulty.”
Occasionally, the team is also deployed to assist with a patient who is frightened by needles. “You have some people that come in that are very afraid of the IV stick process more than anything else that’s going to happen to them in the hospital,” says Rayne Lester, RN, Manager Nurse. “If we can ease their mind a little bit and make it a little bit easier by using the ultrasound, why not?”
Keeta suggests the most vital of the vascular access team’s responsibilities may be best practices evangelism because, if an IV is applied incorrectly, a catheter could “blow through a vein” or an infection might occur and extend the patient’s hospital stay beyond what was expected. So, Keeta encourages nurses and physicians who would like more information about the vascular access team or who might need their help to reach out.
“Our goal is to help educate other nursing staff about the appropriate placement when it comes to anything vascular access. So if we go into the patient’s room and we are able to find a vein without our ultrasound, that is where the education piece would come.” In such instances, they might advise the nurse on how better to identify a suitable access point.
By contrast, “In those instances where you know we can’t see the vein – you can’t just go in there, visualize the vein, find anything that’s palpable, or you can’t feel with your hands and just place it – we will use our ultrasound,” Keeta concludes.
The overall objective is for better patient outcomes. So if you ever find yourself in the presence of a real DIVA, you now know just who to call.