I have spent a few years now talking about the concept of reliable vascular access. Also, I often recommend that we cannot initiate change in practice or invest in innovation unless we count. The aim of counting is to indicate how close we are to the goal of reliable vascular access. We should count what we feel is required… the list may include phlebitis, dislodgement, extravasation, occlusion… the list is virtually endless. However, before we decide what to count we need to clarify what is meant by ‘reliable vascular access and infusion therapy’.
I believe that to achieve reliable vascular access and infusion therapy we should consider outcomes at three particular stages of the patients journey. These are:
- Timely vascular access
- Insertion problem avoidance
- Reliable and expected outcome
If we first consider timely vascular access we may consider issues such as delays in treatment, access to community based services and first attempt insertions. Insertion problem avoidance includes the incidence of issues such as misplaced catheter tip and pneumothorax. Finally, counting outcomes related to reliability and expected outcomes on one end of the scale will provide data on issues such as morbidity, mortality, CLABSI etc. However, at the other end of the spectrum we can gather data on a vast array of significant topics such as… in-use interventions (e.g. resolving occlusions), length of stay and the number of devices that reached the anticipated dwell duration.
These considerations are not meant as a definitive direction. However, I hope that they help to point practitioners in a direction that ensures we ‘count’ outcomes based on the whole patient journey.