PROBLEM

Patients were not proactively assessed for the proper vascular access device. Selection was reactive with placements being performed by radiology at increased cost. Best practice supported the early selection of the proper device to facilitate completion of proposed IV therapy without interruption or complication. EVIDENCE The evidence suggested that proactive assessment, accomplished with a Vascular Access Team (VAT) resulted in the selection and placement of the appropriate device for the proposed therapy. Bedside placements were found to be more cost effective and associated with greater patient satisfaction. STRATEGY The evidence suggested that proactive assessment, accomplished with a Vascular Access Team (VAT) would accomplish the organization’s goals: (1) decrease PICC line placements in radiology by at least 50%; (2) increase patient satisfaction related to IV placement, and; (3) decrease infiltration and extravasation injuries by 75%. PRACTICE CHANGE A 3-person team was trained in ultrasound-guided placements used with a tip locating system. Standing order sets for the care of PICC lines were developed and policies were revised to reflect best practices. EVALUATION 1. Number of PICC lines placed by the VAT (Goal: 50 % of volume would be assumed by the VAT). 2. Increased patient satisfaction related to the question: “Skill of the person starting your IV.” 3. Decreased incidence of extravasation and infiltration injurie