Q&A: What's VAT?

Mary Greeley recently formed a Vascular Access Team (VAT), to ensure we had staff highly skilled at accessing veins, particularly for patients who have difficult veins. Here Kristen Stump, a radiology nurse with extensive VAT experience, explains the purpose of the team and what it means for patients. (Katrina Remes, a radiology nurse who is part of the VAT, also contributed.)

What is a vascular access team?

A vascular access team is a group of individuals with education and training specific to vascular access devices. This includes training on the insertion, care, and maintenance of these devices. 

What are the benefits?

Having a vascular access team gives the patients access to someone who has had additional instruction and hands-on training. Vascular access team members approach the patients’ needs for IV access from multiple angles, including chart reviews of patient medical histories, labs, physician notes, plans of care, and previous documentation of IV access and attempts. IV access is the most performed invasive procedure and patients generally have quite a bit of anxiety about getting an IV. Our goal is to provide the right type of vascular access device in the best location the first time.

What is your role with the team?

Kristen: I am currently the vascular access team lead nurse. I help coordinate staff education and training regarding insertion and maintenance of ultrasound-guided IVs, midlines, PICC lines, and port access as well as central lines care and maintenance. I have been a registered nurse for 12 years and have worked in EMS, emergency department, critical care, and the inpatient float team. I always took an interest in difficult IV insertion and vascular access. I became board certified in vascular access about a year and a half ago to further my education in this area. 

Katrina: I have been a vascular access nurse in the Radiology Department at Mary Greeley for 7 years. In addition to inserting various vascular access devices, I educate and train staff on the insertion and maintenance of ultrasound-guided IVs, midlines, and PICC lines. I also train staff on care and maintenance for central lines and ports. Furthermore, I create and update policies and procedures related to vascular access and serve on multidisciplinary committees to ensure that our patients are receiving the most up-to-date evidence-based care. I became board certified in vascular access in 2019. 

Are you training other staff? How extensive does that training go? 

We are training other staff in the hospital on ultrasound guided IV placement. Ultrasound-guided IV training consists of a 4-hour instructional class, after which individuals need to have a minimum number of successful insertions with a preceptor before they are allowed to perform the skill on their own. PICC line and midline insertions continue to be led only by radiology nurses because the procedures can be quite complex. 

We have staff trained in ultrasound-guided IVs in different areas of the hospital. Trained staff can float when needed to assist other units with IV insertions on patients with difficult vascular access. 

What did we do before having avascular access team? 

Difficult IV insertions were mostly managed by the nurses from the radiology department and by critical care and emergency department nurses. This was due to these nurses inserting more IVs on a regular basis and inserting them on patients with more complicated illnesses. The radiology nurses also inserted midlines and PICC lines. But in recent years, we have seen an increase in emergency department and ICU patient volumes, especially during the COVID-19 pandemic, which led to the nurses having a harder time leaving their units.

Why do some people have veins with access issues? 

Certain disease processes damage vessels
over time and this makes it more difficult to find a vein that will accommodate a vascular access device. This can be due to either the disease itself or the treatments that are used to manage it. Some diseases that can damage vessels include diabetes, chronic kidney disease, cancer, and autoimmune diseases. Genetic factors also play a role as does age—the very young and the very old are at higher risk for access issues.

Can you walk me through the general process you follow when accessing challenging veins. 

We receive a phone call from a nurse or provider stating that a patient needs vascular access or we receive an order from a provider for a midline or PICC line. As a vascular access team RN, we review the patient’s chart. This includes looking at the patient’s history, current diagnosis, laboratory values, length of treatment, and type of treatment. Then an ultrasound assessment of the patient’s arm is performed. The results of that assessment and chart review determines what vascular access device is the most appropriate and what member of the team is trained to insert it.