The past 10 months have been a learning curve for all health professionals, and this has been especially true for those of us working in intravenous (IV) therapy and vascular access. Our specialist teams and services have come into their own during the pandemic, providing reliable vascular access for COVID-19 patients in all care settings, supporting critical care with device insertion and providing a vital service for patients with difficult IV access.
It has been a difficult journey for nurses as a whole—and those who work in critical care have been indispensable and in short supply. Nurses who have found themselves redeployed to clinical areas outside their comfort zone or who have returned to clinical practice have done an admirable job in facing the challenges, some of which have involved regaining confidence in the administration of IV therapy and in performing venepuncture and cannulation. Providing IV updates and refresher training has, I am sure, kept you all very busy. E-learning and virtual training has been a revelation and an invaluable tool—and I am sure that the use of these new approaches will continue to become more widespread.
One of the biggest challenges in IV therapy and vascular access during the pandemic has been to maintain high clinical standards in the administration of IV therapy, device insertion, and care and maintenance. From the first wave of the pandemic it was evident, from my own experiences as a service lead and feedback from members of the National Infusion and Vascular Access Society (NIVAS), that an increase in complications associated with IV therapy and vascular access was occurring at a higher rate than expected. Anecdotally, this seemed to be due partly to a stretched and exhausted workforce and extremely challenging clinical environments, not to mention the effort needed to function effectively in uncomfortable personnel protective equipment.
Education has been the most effective way to raise standards of care and support nurses to reduce complications. The use of virtual platforms, such as webinars and podcasts—as well as online conferences, has provided more nurses with the opportunity to attend and learn than they had before the pandemic. Physically attending a conference is costly and requires time off work, so is not an option for many nurses. In contrast, virtual platforms allow events to be held at different times of the day for short periods of time, enabling nurses to log on and join a session during their breaks or at home. The availability and accessibility of such online platforms have allowed the delivery of best practice content to more health professionals than ever before.
In my own practice, short midlines, placed with ultrasound in the upper basilic vein or the lower cephalic vein, have become the most commonly used devices with self-ventilating and non-invasive ventilating COVID-19 patients. The placement of these midlines, which can be used for blood sampling and infusion therapy soon after admission, has reduced the number of close interactions required between nurse and patient because they tend to be reliable and remain viable for a longer time than ordinary peripheral cannulas. My team has used the cannulation technique for peripheral cannulas to insert radial artery catheters, using ultrasound as standard, and this has been a really well received element of the service and an opportunity to update the practice around arterial cannulation.
I have been amazed and encouraged by the stories of our NIVAS members who have had to adapt to, and deliver, different ways of working during the pandemic. Many new approaches have enabled nurses to reduce patient contact: these have included extending time between outpatient port flushing from 1 to 2 months, teaching patients to access their devices so they can flush these at home, and using tissue adhesive to seal the exit site of peripherally inserted central catheters (PICCs), helping to prevent infections and bleeding and thereby reduce the need to change PICC dressings after 24 hours. Members have also accepted and supported the routine use of monoclonal antibodies for the treatment of COVID-19 in general wards, and supported vaccination efforts in organisations. One thing is evident: that the value of vascular access/IV teams has been recognised now more than ever.
So stay safe and be proud of yourselves for the difference that you are making every day in the lives of your colleagues and your patients.